Patience vs. Propinquity

By Marcus J. Hopkins, Blogger

If I’ve learned nothing from being diagnosed with HIV/AIDS, it’s that patience is not only a virtue; it’s a fact of life. Things take time, and more often than not, the best possible solution isn’t always immediately available. In the best of all possible worlds, every program would have adequate funding to help those who cannot afford the cost of treatment, and would offer them the best therapies on the market.

But, propinquity – being close to something – is a frustrating circumstance for those of us who have been in the HIV game since the beginning of the epidemic. “It’s 2015,” we huff in exasperation. “Didn’t we already solve all of these access issues?”

And, to be fair, we did solve a lot of the access issues. Now, more than ever before in the history of HIV/AIDS, more people have access to treatment regardless of their income or ability to pay. But, this isn’t something that came to be without a significant amount of work and struggle. Things like these take time, nothing happens, overnight, and despite our penchant for constantly reliving and memorializing the history of the AIDS crisis, we often fail to remember that it’s been over thirty years of struggle to get us where we are, today.

More to the point, those of us who are transitioning over from working in the HIV/AIDS-focused sector to the Hepatitis C world often fail to remember how long we worked to make the HIV treatment landscape what it is, today – broken and fractured, though it remains – and as such, we have this tendency to expect immediate results.

“Of course,” we aver, “HCV medications should absolutely be covered! All of them! Right now!”

A colleague of mine was recently reminded of this reality when we were discussing the state of HCV treatment coverage. What is unique, however, about HCV medications is that they are so far outside of the realm of affordability, it’s virtually impossible to come up with an affordable solution.

It’s certain that I’ve made this comparison, before, but the cost for Stribild (Gilead) to treat HIV, in West Virginia, is $37,000/year; the cost of Harvoni (Gilead) to treat HCV, in West Virginia, is around $96,000/twelve weeks.

Those two numbers are nowhere near comparable, particularly if the first round of Harvoni fails to adequately treat the patient. Additionally, we have far more HCV patients in West Virginia, than we do patients with HIV, and that is going to prove to be the case in virtually every state. So, we’re not just talking about a hundred or a thousand people; we’re potentially discussing the treatment of millions of people. Those numbers add up, and for states with limited resources and no real federal funding, it’s just not feasible to treat them.

And, so…patience. Patience must be the name of the game, when it comes to treating HCV, either for those mono-infected or co-infected with HIV. Yes – the need to treat co-infected patients is urgent and pressing; it is always, for many states, not financially feasible. Realistically, this is why so many states who ostensibly offer coverage for HCV medications like Harvoni/Viekira Pak (AbbVie) have strict “Prior Authorization” requirements – they can really only afford to treat the absolute direst of cases.

It’s a difficult reality for people who’ve worked so hard to create the current HIV treatment landscape to grasp, particularly when we’ve come so far in addressing those issues. We forget how long it took us to get here, and that, even though we have the technology (we can rebuild him), HCV is its own monster, and as such, will have to travel its own long and arduous path.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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