"The focus of pharmaceutical companies is on their shareholders and on making money. But public health is not about profit; it is not about money; it is about rights-based access - for everyone, regardless of their means. So there is a conflict of interest in that relationship. We need people at the negotiating table who want to fix this. So, community involvement from the very beginning is very important. It is about having all hands on deck, I think everyone who is involved- from every community person, organisations, governments, policy makers, funders, pharmaceutical companies, we have to hold them accountable," rightly said Jim.
Take the example of Lencapavir. "It does not need to be priced over US$ 40,000 per person per year to be profitable. We are not asking pharmaceutical companies to do this for free, but do they deserve rewards that are exponentially beyond profit and just so high that it can bankrupt health systems? Or make health systems say that it is beyond their financial capacity to pay that kind of money? We cannot bankrupt our health system for one innovation when we have multiple health needs for the community. We cannot subsidise products that are so grossly expensive. We do not know how much the price of lencapavir will be decreased through voluntary licensing by the generic manufacturers who are also for-profit companies. So there is a lot to do to make sure that when it moves forward and it gets produced, it is priced in a way that is affordable for the people," he said.
PrEP approved in 2012 but many high burden nations yet to roll it out in public programmes
There are countries like India where even the oral daily PrEP is not in the government programme even 12 years after it was approved in 2012, forget about the long-acting new PrEP products. It is ironical that HIV treatment is free in India, but HIV prevention options like PrEP are not. "So, in a way you are putting people at risk of getting infected with the virus and then offer them lifelong treatment, but not giving them prevention medication for free. What sort of economy is this? If you have HIV, you get those very drugs (that could have been given to prevent HIV infection in the 1st place)," he said.
Even in richer nations like USA problems and disparities plague the development response. "There are many HIV programmes for people living with HIV around housing, food security and transportation vouchers. And I am happy for that. I am a person living with HIV, and I am happy to see other programmes that help people who need support. But then there are many people who are HIV negative, and who still are struggling- they do not have good housing, do not have a decent job, and are struggling to find their next meal. If we can get someone safely housed, make sure they have a full meal, it would help a lot in HIV prevention too all on its own," rightly remarks Jim Pickett.
"People who have HIV prevention as their concern have many other concerns as well, and many times those other concerns are more pressing problems for them- like where am I going to sleep tonight? Am I going to get a meal today? When will I get a job? How am I going to continue my education? These are their priorities, which make them more vulnerable to HIV infection," he added.
Reducing vulnerability of people to HIV requires society-wide structural interventions and political commitment backed with resources. "We are one whole person, and not separated in compartments," says Jim.
He is right. All health and development enshrined in promises our governments have made are also contributing towards HIV prevention, support and care. We, the people need to connect the dots and call for integrated development responses that are socially just.
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