Ill World gays struggle for survival
(ein homosexual and i
Sexual transmission of HIV between men makes up a relatively small part of overall HIV incidence in the Third World. But, as Ken
Davis reports, the infection rate within homosexual and transgender sub-cultures in many countries are devastating.
In many cities, organisations of sexual minorities pre-date AIDS. In
Burma, China, Malaysia, Taiwan, Singapore and other countries tentative gay rights organising grew out of 1980s youth upsurges for democratic rights. In other Asian and African nations, the advent of HIV has allowed activists from homosexual and transgender communities to claim space and resources.'
Traditional transgender identities and sub-cultures are being transformed because of imperialist economic, ideological and cultural expansion, but also because of AIDS. The leiti in Tonga have their own association, sponsored by the royal household. Indian hijras, baklas in Filipino barrios, waria in Indonesia and kathoey in Thailand receive small international grants for AIDS peereducation. From Soweto to Suva, drag beauty contests are being transformed into health education rallies.
Gay organisations have gained some level of official recognition, at least with government health departments, through being able to initiate grassroots
AIDS education and support, and provide input to AIDS policy development and planning. Groups making full use of this limited legitimation include
Citra Usada in Bali, Gaya Nusantara in
Surabaya, Bombay Dost in Mumbai,
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International Viewpoint
Pink Triangle in Kuala Lumpur, Library Foundation in Manila, and FACT in Bangkok. In other centres, such as Fiji, Hong Kong and Singapore gay activism has been able to clothe itself in the garb of general AIDS service NGOs.
Last year's Ninth Conference on AIDS and Sexually Transmitted Diseases (STDs) in Africa, held in Kampala allowed a ground-breaking meeting of lesbians and gay men to establish an information network across dozens of African countries.
The added urgency of organising against HIV among homosexual subcultures, and the need for more open discussion of sexual behaviours has lead to demands for the repeal of colonial laws against homosexual activities still retained in countries such as India, Singapore, and Zambia.
In China and Vietnam, local pragmatism about AIDS prevention has allowed small, and discrete gay groups to form in major cities. In Beijing local health officials worked with a small gay group to produce a leaflet about HIV and safe sex to be distributed to men meeting for sex in parks. * Note 1. See Peter Drucker's article "Third World gays fight back," International Viewpoint #282, November 1996, pp. 13-16] more than ten percent of new HIV infections in the US are resistant to AZT, and these resistant strains of HIV are more powerful and more deadly than the non-resistant ones. Strains that are resistant to AZT are also more resistant to other reverse transcriptaese inhibitors, and even somewhat to protease inhibitors, a trait known as "cross resistance. The resistance and cross-resistance created by drug cocktails is clearly higher.
This means that people who "hit hard, hit early" and fail will be left in a few years with an infection that is more virulent, resistant to other available drugs, and probably resistant to many future drugs as well. AIDS service providers already report a new potential outbreak of resistant HIV as men on drug cocktails, whose viral load sometimes drops to undetectable levels, believe that they are not contagious and begin having unsafe sex with - and infecting their partners. Huge profits
What "hit hard, hit early" does unambiguously do is boost drug company profits, by putting people on expensive drugs who may not need them. And these profits have been enormous: The first protease inhibitor to be released, Hoffmann-LaRoche's Invirase (saquinavir), was priced at $7,000 per year. Then, Abbott released Norvir (ritonavir) at $8,200. Finally, Merck chose to distribute its protease inhibitor, Crixivan (indinavir) through a single pharmacy retailer, Statlander's, which marked up the drug 38% to over $6,000 per year.
A co-ordinated effort by several AIDS activist organisations of fax zaps, meetings and letter writing got Statlander's to agree to negotiate about the price. Finally, after four ACT UP/New York members were jailed for posting signs on Statlanders' store in a
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largely gay area of New York's Greenwich Village, the company agreed within 24 hours to lower the price to the still-ridiculous amount of $5,000 per year.
The prices of Invirase and Norvir have not yet budged, so that someone on a regimen of several drugs can pay up to $30,000 for a year's supply. Not surprisingly, Merck saw a 1995 after-tax profit rate of 22%, Abbott of 16%, and Hollmann-Lakoche of 22%, even after amortising their research and development expenses for these drugs.
These leading pharmaceutical companies are in full marketing mode, holding off on newly-developed life-saving drugs until the current ones have run out their profitability -like so many new model computer chips. Glaxo-Wellcome, the manufacturer of AZT, has already developed a new reverse transcriptaese inhibitor known as "1592," which is supposed to be ten times as effective as AZT and dramatically less toxic. But the company does not to want to begin large-scale (Phase I) clinical trials for "1592" until demand for AZT is exhausted. How much is YOUR life worth?
With these kinds of prices, drug companies have excluded all but the wealthiest Americans, and those lucky enough to have good insurance, from effective, up-to-date treatment. There is a joint federal-state program, known as the AIDS Drug Assistance Program (ADAP), which provides drug assistance to middle-income people with AIDS. However, in 35 of the 50 American states, ADAP does not cover protease inhibitors (coverage was saved in New York only through the dramatic and persistent interventions of AIDS activists), and is already running bankrupt in states that do cover them.
The federal government was forced to inject $167 million more into ADAP midyear in order to pay its share of the costs for protease inhibitors, but even so, the ADAP Working Group (a Washington-based industry/community lobby group) estimates that this money will fall $270 million short of demand. Without help from ADAP, Americans with AIDS are forced to spend themselves down to extreme poverty levels, so that they qualify for the social health program, Medicaid.
Meanwhile, AIDS is increasingly a disease borne by the poor and people of colour; new CDC estimates suggest that seven of ten newly-infected gay men are black or latino, and the numbers are even higher among IV drug users and heterosexuals.
To protest such high drug prices, ACT UP held a march last October in Washington, DC., on the weekend that the AIDS quilt was being displayed. In a deeply moving political funeral, protesters threw the ashes of about twenty-five people on the White House lawn to protest the federal government's lack of
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AIDS Coalition to Unleash Power OUTAGES ACT UP brought up price gouging when he met with pharmaceutical manufacturers twice last year. Nor has she since announced any concrete action on the topic.
Far less noted, but just as profound, is the ideological coup that the new drugs have created for the corporate research agenda. Only two years ago, it was widely accepted that the government had pursued high-tech drugs at the expense of a basic research agenda, while promising but unprofitable treatments were widely ignored. Studies of the effects of various vitamins and nutrients were not widely performed until 1994. Nor were cheap clinical trials of widely available substances that some people with AIDS were using, but which had not been clinically tested.* There was an effort in 1995 to restructure entirely the Office of AIDS Research (which was made acutely more difficult when right-wing senator Jesse Helms used this effort as an excuse to attempt to abolish the office), and move more funds into basic research (the way HIV causes AIDS is still not entirely understood) and broader
AIDS activists had been able to seize the government's failure as an opportunity to gain a great deal of publicity for some points they had been making all along: How the research agenda is governed by corporate interests, how its decisions are based on profitability and not the needs of people with AIDS, and how a more participatory program, directed by a wider range of doctors, epidemiologists, and people with AIDS - and notably not by corporate interests and representatives - could solve some of these problems.
Two years later, with drug cocktail makers promising miracles, AIDS activism has been largely reduced to issues around drug pricing and access, while larger questions of the research agenda will be ignored for as long as the current wave of high-tech drug lasts.
The purpose of this research agenda has been clear for some time. To quote ACT UP/Boston Member Rich Rochon, who gave the opening presentation for the VIllth International Conference on AIDS in Amsterdam in 1992: "Often I'm asked if I believe a cure will come and I strongly say No. I do believe that we, and I hope its we it wasn't; Rich died a year later], will see AIDS progress into a chronic, manageable disease. Just because I believe this does not mean that I'm not fighting for a cure. In my theory, imagine how much money a single drug company would make if it comes up with a cure. Imagine the profits. Imagine how much several drug companies can make by coming up with treatments for infections, keeping people with AIDS alive, allowing us to continue to get sick and be treated with drugs on an ongoing basis. Imagine the profits."
As long as drug pricing and access to treatment are the immediate and pressing issues, activists will be fighting tor them forcefully. But when the glory of the current set of high-tech drugs begins to fade, we must again raise the larger issues of who controls AIDS research and where those people are taking it. * Notes Tavis Barr is a member of the US socialist organisation Solidarity and of ACT UP/New York. 1. fully rebounded from his recent courtly disfavour (his research funds had been threatened the year before by those closer to the centre of the AIDS power structure, allegedly because he supported reform at the National Institutes of Health's Office of AIDS Research 2. The idea of using protease inhibitors against HIV has been around for at least a decade, and those currently available were developed by several different companies. 3. Currently, 53% of PWAs are covered by Medicaid, 22% by private insurance, 25% by neither. Of those insured, about 3/4 get their protease inhibitors covered. 4. For example, curcumin, an extract of turmeric that was claimed to boost levels of CD4; anti-depressant. Although these substances seemed to delay the onset of disease progression, their study and production were not supported at all by the federal government.
INTERNATIONAL INSTHTUTE FOR RESEARCH AND EDUCATION action. In response to ACT UP's actions, outgoing National AIDS Policy Co-ordinator
Do the workers have a country?
Patsy Fleming promised, "I would be happy to meet with [drug companies] about
" However, she did not lowering their prices.
indicate whether Vice President Al Gore by José liarte "Bikila"
• £2.50/$4. Cheque payable to P. Rousset, HIRE, Pos sterdam, Netherlands
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