Today, December 1, is World AIDS Day, a day for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate the lives of those who have died from an AIDS-related illness, according to the World AIDS Day website. Across the world, approximately 38 million people were living with HIV/AIDS in 2019. As of the end of 2019, globally, 25.4 million people with HIV (67 percent) were on antiretroviral therapy (ART), the medication(s) necessary to suppress viral load and prevent transmission to a partner. This means that 12.6 million people are not currently able to access ART. As early adoption of ART regimens is critical to reducing HIV/AIDS-related complications and deaths, increasing lifespan, and reducing HIV transmission, inability to access ART is literally killing millions.
Imperialized countries have seen the greatest increases in HIV incidence and some of the lowest rates of ART adherence. In 2019, there were 20.7 million people with HIV (54 percent) in eastern and southern Africa, 4.9 million (13 percent) in western and central Africa, and 5.8 million (15 percent) in Asia and the Pacific compared to 2.2 million (6 percent) in Western and Central Europe and North America. In several West African countries, the percentage of people living with HIV receiving ART in 2017 was between 20 and 40 percent. The “missionary-style” nonprofit approach where imperial powers offer donations of ART drugs is woefully insufficient to address the scale of the crisis.
Pre-exposure prophylaxis (PrEP), is also critical to decreasing HIV transmission. Truvada, one of the most common forms of PrEP, works by blocking an enzyme called HIV reverse transcriptase, preventing the virus from replicating and creating more copies in the body. The once-daily pill reduces the risk of getting HIV from sex by more than 90 percent, and among people who inject drugs, it reduces the risk by more than 70 percent. Despite its high effectiveness in reducing HIV transmission, many people vulnerable to HIV exposure do not take it because they cannot afford it. In the United States, PrEP costs $20,000 a year for a patient without insurance, but according to ACT UP, the medication costs only $6 a month to manufacture. Reducing Truvada’s U.S. retail price even to Australia’s cost level of $340 per year could decrease HIV transmissions by half each year, demonstrating the destructive impact of capitalist profiteering on human life.
In 2005, Gilead Sciences notified federal regulators that it had suspended development of a potentially safer, more potent HIV-fighting drug than the one on the market, and it did not restart its FDA application until 2010. A coalition called PrEP4All Collaboration filed a petition on December 4, 2019, alleging that Gilead postponed development of the safer drug so it could continue to gain monopoly profits from its older combination HIV drugs, including Viread and Truvada, before those drugs went off patent and faced generic competition. PrEP4All also filed the petition to reject Gilead’s request for three extra years of patent life on the newer, safer PrEP drug Descovy, so that more affordable generic versions of the drug could begin to enter the market. The U.S. Patent and Trademark Office accepted Gilead’s request, allowing Gilead to maintain monopoly pricing on its HIV prevention drugs until 2025.
In 2013, UNAIDS published their 90-90-90 strategy to reduce HIV transmission and increase ART adherence, aiming for 90 percent of all people living with HIV to know their HIV status, 90 percent of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and viral suppression for 90 percent of all people receiving antiretroviral therapy by 2020. At the end of 2019, 81 percent of people living with HIV knew their HIV status, more than two thirds (67 percent) were on antiretroviral therapy, and almost 59 percent of people living with HIV globally had suppressed viral loads.
However, the HIV/AIDS pandemic that has so far led to 32.7 million deaths will continue to unnecessarily take lives under capitalism. Corporate profiteering has locked millions of at-risk members of the global working class and oppressed out of life-saving access to PrEP and ART, and will continue to do so as long as healthcare is driven by profit margins instead of saving human lives. Nationalizing drug production and healthcare industries to put them under worker control is critical to increasing PrEP coverage and ART adherence that will truly end the HIV pandemic. Ensuring that people living with HIV and AIDS have access to resources like free healthcare, housing, and food is also an essential step to improving treatment retention. As long as capitalism continues to reign supreme, the lives of those living with HIV and those who are at risk for contracting it will continue to be disposable to capitalists who need to turn a profit. This World AIDS Day, we must commemorate the lives of those who have died from AIDS-related complications and fight for those currently living with HIV by committing ourselves to the fight for socialism.