Why Doesn’t Everyone Have Access to PrEP?

Dariana Portes @darianaportes (1)

The killer’s name is Gilead. I hadn’t heard of it before and I thought the name sounded oddly, almost eerily familiar. 

With some light googling I managed to find out that Gilead is an American biopharmaceutical company that makes antiviral drugs. It’s also the name of that heinous country from Margaret Atwood’s book-turned-TV series, The Handmaid’s Tale — which seemed like an odd coincidence, until I kept researching

Truvada is one of the drugs made by Gilead Sciences. On the commercial market, it’s sold and advertised as PrEP. It’s an FDA approved medication which, when taken continually and properly, reduces the risk of contracting HIV by 92 percent. Super effective, cheap to make — less than $60 a year according to the New York Times — and super easy to administer. So why isn’t everyone taking PrEP? 

Namely, because it’s absurdly expensive. 

The price of PrEP has risen over the years, with Gilead turning a profit of $14,000 per patient. No one else has previously been able to manufacture the drug because Gilead wouldn’t release Truvada from its patent. Since they’re the sole proprietor, they get to name their price, so they inflated it by 25,000 percent. Finally, after significant public outcry and protest, the pharmaceutical giant agreed to allow a generic version of PrEP to be made — but only by one company and in 2020

While it’s estimated that there are over a million people in the U.S. who would potentially benefit from the medication, only about 225,000 are currently on PrEP. Guess who most of those people aren’t: the Black (38%) and Latino (29%) men who have sex with men and made up 67% of HIV diagnoses in 2016  the majority of whom live in the South.

Meanwhile, Gilead Sciences is sitting comfortably at #199 on this year’s “Forbes Global 2000” list, with a market capital of $80.3 billion

Gilead actively depriving high-risk communities of access to PrEP is also avoidable, seeing as the trial research which established PrEP was substantially funded by the Federal Government. We live in America, so the government has “March-In” rights, which means they can come in and take stuff back if companies don’t comply with government and public interests. If they really wanted to, the government could take the Truvada patent from Gilead and give it to a generic pharmaceutical company to make at affordable prices. That clearly isn’t happening. 

Despite Gilead recently reaching a deal with the Trump Administration to donate enough drugs to treat 200,000 patients for 11 years — one of the largest pharmaceutical donations in our nation’s history — it’s not nearly enough to cover the million-plus people who need treatment. It’s a fake move, and people are dying for it. 

HIV is still classified as a global epidemic, and the U.S. Government consistently fails to treat the disease as the lethal threat it can be. The continuation of unnecessary deaths is disproportionate along lines of class and race, which I argue isn’t by coincidence. It’s important to recognize where we are protected and where we are not. 

Sex and sexual health rights within communities of color have long been used as a weapon by the government and private corporations alike. As a journalist and, more importantly, a woman of color, I do my best to spread the word when I hear about how the powers that be choose to handle our bodies. Hopefully, we can use what we know to gain more autonomy over our own bodies, drawing power from education. 

Use rubbers. Get tested. Ask your doctor about PrEP. Be open with your partners. We can learn a lot from what is being stolen from us and channel that into advocacy, awareness, and action. 



For more information on what PrEP is and how it works, click here

To join the activism surrounding access to the life-saving drug, check out the #BreakThePatent campaign

For New York Times Daily podcast episode on the subject, click here


Photos (in order of appearance) via breakthepatent.org and by Dariana Portes. Art by Brigid Stafford.