In October Funders Concerned About AIDS, a philanthropic body that describes itself as one to take ‘bold actions and push philanthropy to respond to HIV and AIDS’, recognised Gilead as being the number one philanthropic funder of HIV-related programs. 

The research has been accompanied by accusations from critics that the pharma company engages in business practices that are harming poor and minoritized communities, especially in the US. With $27 billion in revenue in 2022, Gilead is a giant in the HIV medicines space. The company has committed to provide more than $100 million to help fight the HIV/AIDS epidemic in southern US states, and made a $25 million partnership with the Elton John AIDS Foundation.

Yet critics say Gilead’s monopolistic practices have come at the expense of some of the most marginalised and long-suffering patients, erasing its philanthropic awards.

Jeremiah Johnson, executive director of the advocacy group Prep4all, describes the pharma giant’s practices more as targeted and strategic business investments instead of philanthropy. ‘An entity that on one side purportedly gives money to end HIV transmission and on another side sets prices for essential medications at a level they know will significantly limit access cannot be philanthropic,’ says Johnson.

‘If the purpose of philanthropy is to altruistically contribute first and foremost to the betterment of a community without personal or corporate gain, it’s hard to even call Gilead’s grants philanthropic. The company has a vested interest in using these funds to expand its markets, manage public relations, and deflect public and government criticism of egregious pricing decisions.’

Johnson is on a mission to end the HIV epidemic and says the tools are already available to do so. HIV medicines, also known as PrEP, are 99 percent effective in protecting against HIV infection and have the potential to completely end the HIV epidemic.

‘An entity that on one side purportedly gives money to end HIV transmission and on another side sets prices for essential medications at a level they know will significantly limit access cannot be philanthropic’.

But according to Johnson, Gilead’s dominance stands in the way of ending the HIV epidemic. Its prices for HIV antivirals are quoted as high as $20,000 per patient in the US, for the therapeutic use of Truvada, a well-known brand of PrEP. A contradiction is at play: while Gilead is named as the number one funder of programmes and services for BIPOC communities in the United States, only 25 percent of the people who most need PrEP have access to it.

‘One of our primary areas of activity since we were formed in 2018 has been to try and address the imbalances created by having such a corporate behemoth in the space; one that is dominating not just with treatment, where well over 80 percent of people living with HIV in the US are on Gilead treatment, but on innovation,’ says Johnson, speaking to Alliance in the early hours from his New York office.

Gilead’s dominance as a so-called philanthropic entity is a major cause for concern for Johnson, with the drug maker representing over 50 percent of all giving in the US to HIV/AIDS-based entities.

‘The reality of all that dominance is that there’s not enough of a balancing voice to make sure we are truly prioritising the communities that need access to PrEP, over the profit goals of Gilead,’ says Johnson.

Underhand profit-making tactics are also supposedly part of the story. According to a New York Times investigation, Gilead stopped pursuing a new HIV drug in 2004 using industry tactics to protect its monopoly despite top brass reportedly knowing that a new, updated medicine – despite having fewer side effects to patient kidneys and bones – risked the profits of Gilead’s existing, patent-protected drug.

As the New York Times states, ‘If they delayed the new product’s release until shortly before the existing patents expired, the company could substantially increase the period of time in which at least one of its HIV treatments remained protected by patents’.

Gilead did eventually introduce new HIV drugs in 2015. Its current patents now extend until at least 2031.

In a statement to Alliance, a spokesperson for Gilead said the New York Times claims of alleged delays in bringing medicines to the market were ‘without merit’.

‘For 35 years, Gilead has been a leading innovator in the field of HIV, driving advances in treatment, prevention and cure research. We continue our commitment to work together with the HIV community and policymakers to overcome barriers to HIV prevention, care and treatment, and to advance public health and health equity initiatives to combat HIV, particularly in regions hardest hit in the U.S.’

Gilead added that its Patient Assistance Programme provides free medication for ‘tens of thousands of individuals every month’ and that ‘approximately 50 percent of all individuals taking Gilead HIV medicines in the U.S. receive them through federal and state programs at substantially discounted prices.’

Johnson is unconvinced. ‘They reinforce disparities,’ he says, warning of long-standing ‘enormous inequities in PrEP access’ caused by Gilead’s monopolistic practices.

Recent estimates suggest some HIV antivirals are reaching some 36 percent of the 1.2 million Americans who most need access to them. But those figures disguise an even wider health disparity: while 94 percent of white individuals have reported access, only 13 percent of black individuals and 24 percent of Latinx individuals can access the medicine.

‘There are many problems that marginalised communities are facing in terms of access to all sorts of healthcare. That’s one reason that we are advocating for a national PrEP programme that will simultaneously try to eliminate causes of the barrier through federal funding,’ Johnson adds.

Editor’s Note: After publication Funders Concerned about AIDS provided the following response from Executive Director, Masen Davis: ‘Philanthropy is often the only source of unrestricted funding, and support for advocacy and community-led efforts – all critical to our collective efforts to end HIV. Yet, just 20 organizations – including Gilead – are responsible for 92% of that funding. It is the time to be calling all donors in to help us address the enormous social and political challenges facing HIV response right now.’

Shafi Musaddique is News Editor at Alliance magazine.