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Is $33,000 Too Much for a Life-Saving Drug?

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The pharmaceutical giant Gilead, headquartered 20 miles south of San Francisco in Foster City, California, just released a new once-daily AIDS drug. It's called Stribild, and they're selling it at a cost of $28,500 per year (though a Walgreen's in San Francisco quotes it at $33,000 without insurance). Mainstream HIV/AIDS groups like the AIDS Healthcare Foundation criticized the drug-maker's pricing: "Prices are simply too high," says AHF president Michael Weinstein. And in August, 14 Congresspeople wrote to Gilead expressing similar concerns, but the drug-maker has barely budged in spite of its already incredible profits.

On Tuesday, the direct action group ACT UP San Francisco went further than letter-writing or public statements, unleashing two simultaneous direct actions in Foster City and SF's gay-centric Castro district. Their targets: apart from Gilead, high medication costs and drug company-profiteering everywhere.

Gilead made $2.8 billion in profits in 2011. Its CEO, John C. Martin, is one of the highest paid in the world, last year raking in close to $50 million. Meanwhile, the government commonly threatens to cut funding to the AIDS Drug Assistance Program (ADAP) for low-income people, and a new trade agreement between the U.S. and ten other countries called the Trans-Pacific Partnership (The Nation dubbed it "NAFTA on Steroids") is set to broaden laws around patents that will make life-saving drugs more expensive in other countries. If you're poor or middle class, medication could easily be out of your financial reach. As Dean Baker writes in The Guardian, new regulations could mean "a government-granted monopoly, often as long as 14 years, that prohibits generic competitors from entering a market based on another company's test results that show a drug to be safe and effective."

The fifteenth round of secret negotiations for the Trans-Pacific Partnership wrapped up on December 12 in Auckland, New Zealand, where hundreds of people showed up to protest. A rep with the protesters attempted to deliver several dozen cardboard boxes containing the signatures of 750,000 people who are opposed to the trade agreements, but she was denied entry.

But back to San Francisco and ACT UP (AIDS Coalition To Unleash Power). The organization's original incarnation was born during the AIDS crisis's first wave in the '80s. It's been back in the news thanks to a surge of actions by ACT UP SF and New York, and the release of three new films on the group, including the biographical documentary Vito, about ACT UP founder Vito Russo; the likely Oscar-contender How to Survive a Plague; and United in Anger.

ACT UP member Brett Thomas has lived in San Francisco for several decades -- long enough to witness first-hand the ravaging of the city's gay community in the '80s and early '90s. He says his collective chose to target the Castro for this latest action because it was "one of the hardest hit areas of the AIDS crisis." ACT UP San Francisco started in the Castro in 1987, so focusing on the gayborhood represents "a homecoming of sorts."

One interesting aspect of the new ACT UP SF is how it spans generations. Some of its members, like Thomas, were around for the first-wave crisis; others hadn't even been born yet. At 23, Alan Guttirez is too young to remember some of ACT UP's famous protests from the early '90s, like the one in which protesters casually entered the CBS News station in New York, infiltrated news anchor Dan Rather's soundstage, and interrupted his coverage of the Gulf War, shouting "Fight AIDS not Arabs!" as the government refused to take action around AIDS. However, Guttirez says, the number of youth involved in AIDS activism is growing, "because we care about our history. We still get [sexually transmitted infections], some of us are living with HIV and some of us are at risk." He says he's also influenced by feminist politics, and the fact that such a large number of queer people who spanned generations were lost to HIV/AIDS during ACT UP's early days.

The group's latest outing called specifically for free meds for low-income people, more affordable meds for everyone, and more transparency from Gilead on its pricing, research and lobbying.

People who have HIV/AIDS are able to live longer than ever before -- but only if they can get their hands on the drugs. AIDS is still very much a crisis. "Just ask someone in sub-Saharan Africa! In the non-industrialized world the lack of life-saving medications -- such as those made by Gilead -- is keeping AIDS at crisis levels," says Thomas. And in the U.S., "the rate of new infections in youth under 24 years old is rising. Many people who are infected don't know it and are infecting and re-infecting their partners."

Gutirrez adds, "Most people who think HIV/AIDS is not a crisis are people with stable housing, health insurance, steady support, and are documented cisgender citizens. The crises we see today in San Francisco are among young gay and bisexual men, poor and homeless folks, transgender women, and undocumented immigrants who will not be served under the Affordable Care Act.

"The price of Stribild may potentially stretch [the AIDS Drug Assistance Program] and make it challenging to sustain." Adding to that potential strain is the so-called "fiscal cliff," which may lead to less funding for necessary health services. Many people with HIV are already on state-instituted waiting lists for necessary drugs. The AIDS Healthcare Foundation's Michael Weinstein notes that "In the long run, the cost to Gilead to actually produce [Stribild] will be a small fraction of its selling price, which means Gilead can show restraint on...pricing and still make an enormous profit." This year Gilead also upped its prices for three other HIV drugs, Atripla, Complera, and Truvada, by about 7 percent.

Today's ACT UP is continuing the original group's legacy of protest where originality proved to be a useful tactic for getting media and the public's attention. A few weeks before November's election, ACT UP SF produced life-sized cut-outs of personae non gratae, such as Mitt Romney and Tennessee Senator Stacey Campfield. The politicians were the targets of a "condom toss"; passers-by were offered condoms filled with white hair conditioner to throw at their effigies. Had he won the election, Romney very well may have gutted HIV/AIDS funding (more so than President Obama, anyway); Campfield famously introduced legislation to make it illegal to discuss gay relationships in Tennessee public schools, and believed the urban legend that AIDS was spread to humans through a man having sex with a monkey.

This week, ACT UP's "weapons" were necklaces made of pill bottles; an ACT UP member, Kentaro Kaneko, dressed as a Gilead founder; and a Ustream live-stream that allowed supporters in the Castro to watch the action in Foster City. There, a group entered the company's HQ, shouting "Health care is a right!" and performed a new, arguably improved version of Charles Dickens's "A Christmas Carol" with Gilead CEO John C. Martin cast as Scrooge, as employees of the corporation looked on. The police also made a cameo, but there were no arrests.

High drug prices are now being fought by some people in Congress, like Vermont's Bernie Sanders, who has proposed a "Prizes Not Patents" system for AIDS drugs. His idea is simple: drug companies would get funding from the government for discovering new AIDS drugs, but they'd have to keep drugs low-cost when they come out. Last month, the AIDS Healthcare Foundation launched a related ballot measure for next November's election in San Francisco. The Foundation hopes to make drugs cheaper by starting a precedent in the city; if the measure goes through, city officials could negotiate directly with drug manufacturers for lower pricing. They're currently collecting signatures to get it onto the 2013 slate. The struggle's still on, though, as one of the new ACT UP slogans proclaims: "AIDS is not over. Neither are we."