November 14, 2024
Any new HIV prevention method is
not meant to sit on the shelf but to be used by the people
who need it to protect themselves from HIV. We have to
ensure that new HIV prevention technologies that are coming
out of the scientific research pipelines, are accessible to
people everywhere – especially those who are more at risk of
HIV acquisition. Jim Pickett has passionately called for
translating scientific gains into public health outcomes –
not with delay, but with equity and justice.
Currently
Jim Pickett serves as a Senior Advisor for AVAC and directs
their Choice Agenda programme focussed on HIV prevention
research and its implementation.
Inconvenient
truth
When asked what has changed between
2018 and now, he said: “COVID-19 reshaped our entire world.
Traumatizing as it was, it also changed some things for the
better, I think, globally. We got better at finding new ways
to deliver healthcare. We also learned that we could develop
a vaccine quickly and that was a win. But we failed to
deliver it equitably in many parts of the world.” Jim was
speaking with CNS at the 5th HIV Research for Prevention
Conference of the International AIDS Society (IAS) in Lima,
Peru.
Sadly, equity and justice are not
driving our health responses. “We have had some
exciting scientific developments in the HIV prevention
space. We have cabotegravir- a once-in-two months injection
that can prevent HIV. But accessibility is a different
issue. It is available in our country, but it is extremely
expensive. It is also complex to deliver. So the number of
users is very low. It is available, but not accessible for
many,” he said.
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“We now have another long-acting
injectable lenacapavir- two shots a year- that is on its way
to being approved. And people are calling it game-changing
and transformative in terms of HIV prevention. But it
remains to be seen what access will look like. Peru, Brazil,
Argentina and Brazil are among the countries that have been
left out (from the 120 countries list) by Gilead (makers of
lenacapavir) to provide it at reduced costs, despite these 4
countries being part of the clinical study of the drug,” he
added.
Imagine the injustice: people
of countries which participated in the clinical study of
lenacapavir for a greater common good, will not be able to
get the best of benefits when it comes to its rollout, as of
now.
“I am also excited about the tenofovir-medicated
rectal douche as Pre-Exposure Prophylaxis (PrEP) for men who
have sex with men- a douche that provides hygiene before
anal sex, and then leaves the drug behind that provides
protection against HIV. In an early Phase-1 study examining
its safety and acceptability, majority of the participants
stated that they would prefer the douche over daily oral
PrEP,” said Jim.
“If PrEP douche passes through
phase-2 and phase-3 studies, and then move to regulatory
approvals and get into the market, it would be our
first-ever behaviourally congruent intervention, which means
harnessing a behaviour that people already do,” he
said.
PrEP is a medication for HIV negative people to
protect them from getting infected with HIV.
A
choice should be accessible
Science finds new
tools to create new HIV prevention options for people, but
then to have success in terms of making it accessible to all
so that we can reduce new HIV infection rate, continues to
remain a struggle. “It is like science gets you to the top
of one Mount Everest and then we find that there is a second
Mount Everest of ‘access’ to climb. And that might even be a
taller version of the first Mount Everest,” rightly said
Jim.
“While I am really excited for these new choices
that we will have, I am also frustrated that they will not
be real choices, unless people can truly access them. There
is no change in the game if you cannot get on the field, and
there is no ‘transforming’ anything if that drug looks
really good on paper, and then it sits on a shelf, and the
people, who really need it, do not have access to it. It
needs to be cheap, affordable, and accessible to everyone
anywhere in the world. We definitely need to have some
strategy for this,” he added.
We cannot put
profit above people’s health
“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.
Shobha
Shukla – CNS (Citizen News Service)
(Shobha
Shukla is the award-winning founding Managing Editor and
Executive Director of CNS (Citizen News Service) and is a
feminist, health and development justice advocate. She is a
former senior Physics faculty of prestigious Loreto Convent
College and current Coordinator of Asia Pacific Regional
Media Alliance for Health and Development (APCAT Media) and
Chairperson of Global AMR Media Alliance (GAMA). She
coordinates SHE & Rights Media Initiative (Sexual health
with equity and rights). Follow her on Twitter
@shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
This post was originally published on here
