By Gerry Scoppettuolo
It was 1987, I was visiting a local gay club in Nashville, Tennessee where I had just moved. I noticed what looked like many small paper hearts taped on the far wall. As I got closer, I read the handwritten notes on these cards: “$10 for Jimmy to help with groceries”. “Someone to drive Ricky to the clinic to get a blood draw”. “Frank needs a buddy to help him with stuff around the house”. These notes were little pleas to help local support for working class gay men with AIDS who needed help with necessities of life at a time when there was no state or federal support for such things.
Everywhere the only help available was what we could generate from our own community while at the same time we had to contend with the deaths of our lovers and friends as well as ever present stigma. The peak year for AIDS mortality in the U.S.was that year with 50,000 deaths of overwhelming gay and bisexual men. That number has now been surpassed by today’s death toll of approximately 750,000. At least 44 million have died and in just three or four years HIV will be the second deadliest pandemic in global history after the Black Death of the 1300’s.
Despite this harrowing fact the public-private pharmaceutical industry had literally to be forced to develop helpful medications by a desperate and dying community. In the late 1980s the Federal Drug Administration and the NIH were still dragging their feet to provide clinical trials for any drug that might help. Not until ACT-UP, (the AIDS Coalition to Unleash Power) and the spinoff Treatment Action Group resorted to direct action and countless rallies, protests and arrests was the first drug, AZT, released. It had to be taken four times a day. It would ultimately prove not to be of much help.
My roommate took it every four hours, day or night. He also took experimental underground concoctions like AL-721 derived from egg lecithin, which he mixed with orange juice which he froze into ice cubes to make it drinkable. It also proved useless. When effective protease inhibitors became available later in 1996, case managers would still be taking leftover drugs after their clients died, and stash them in the trunks of their cars to give to their living clients who could not afford medications.
My old friend was always arguing with his doctors, demanding answers and decrying the fact that no hospital in Nashville wanted to be known as the “AIDS hospital”. As a result, the city of Nashville created the Lenz clinic which was soon flooded with 1500 clients with AIDS. This reminder of the old days is remembered now to try to come to grips with what is happening today globally. Today the United Nations Global Fund provides 25% of all HIV prevention and treatment resources for the planet but is now under constant new pressure since the Trump administration dismantled US AID and withdrew most of its $6 billion from this year from the Fund so as to take direct control of it.
These life-saving funds are appropriated annually by Congress via Pepfar, the President’s Emergency Plan for AIDS Relief. Since its inception in 2003, Pepfar has provided $110 billion over the years and is credited with saving over 25 million lives. But it has done so with mixed motives. U.S. foreign aid has historically accompanied other “investments” meant to under developed countries abroad in order to keep them
dependent on the World Bank and the IMF, to enforce dollar diplomacy and interfere with indigenous liberation movements. Pepfar is a form of soft imperialism, akin to the Kennedy-era Peace Corps and Alliance for Progress, created to put a smiley face on U.S. hegemony.
Currently the Trump State Dept has shed any humanitarian purpose, choosing to use harsher methods of imperialist control. U.S. taxpayer funds (totaling $6 billion this year) are now being misdirected, diverted, and in some cases used to extort trade concessions from African countries like Zambia and Zimbabwe by denying payments for life-sustaining HIV medications if they refuse to trade so-called precious minerals used for data centers and weapons of war to this country. Marco Rubio’s state dept. will now resort to “using sticks” according to a memo leaked to the New York Times, to threaten the lives of the 1.3 million people living with HIV in Zambia, for instance.
The U.S. State Dept. has now seized direct control over which countries will receive billions in Pepfar aid by the use of so-called bilateral agreements negotiated (that is forced) upon its recipients. These agreements bypass U.N. mandates defined by the Global Fund for AIDS which in the past received these funds directly from the U.S.
Furthermore, this arrangement is being made with the direct cooperation and partnership of Gilead Pharmaceuticals, the planet’s biggest manufacturer and profiteer of HIV anti-viral drugs. Gilead has agreed to license generic forms of its new “miracle” PreP drug, Lenacapavir (trade name, Yeztugo), at 2 million doses a year at $48/yr, to be sold to high HIV incidence countries. This new drug acts like a vaccine, making it impossible for one to be infected by HIV from sexual intercourse if taken every six months by injection. But generic Yestugo will not even be available for at least a year and only a few thousand doses have thus far been given to high HIV incidence countries.
At an annual non-generic retail cost of $25,000, only several thousand doses have been given to the tens of millions that would benefit. In the west, Yeztugo is very profitable to those with good insurance and who can afford it. Sales were $166 million dollars in just the first three months of 2026. It is unclear as of this writing if the U.N. Global Fund can step in to guarantee access to these drugs given the precarious state of the global economy due to the U.S./Israeli War on Iran.
This new dangerous development is happening at the same time that heroic efforts to curtail the HIV/AIDS epidemic seem to be working. The U.N. has set a goal of ending the pandemic by 2030, but given the prioritization of industry profits and billionaire demand for profits, only nationalization of pharmaceutical companies and socialist economic reconstruction can guarantee that resources will eventually be allocated according to humanity’s needs.
For example: Gilead’s lifetime HIV sales total $260 billion. After subtracting massive corporate overhead, marketing, and the billions poured into global Research and Development (R&D), Gilead’s overall net profit fluctuates between 35% and 50% of sales. Applying that profit rate to Gilead’s sales of HIV drugs, this adds up to $100 billion to $120 billion in pure net, after tax profit for the company over the last two decades. At least half of this goes to stockholders, the rest is plowed back into the company as capital accumulation, or subtracted from wages as surplus value.
Need for a New Restored Fighting Movement
ACT-UP’s first demonstration was against Wall Street in 1987 demanding affordable AZT. Today there are seven remaining ACT-UP chapters in New York, Cleveland, Philadelphia, Pittsburg, Chicago, Los Angeles, Boston and Bangor, Maine. Chapters are developing in Denver and New Mexico.
