Earlier this week, pharmaceutical giant Gilead trumpeted some big news: they would donate a decade’s worth of the HIV prevention drug known as Truvada for PrEP for as many as 200,000 people.

On its surface, the news is a significant development for those most heavily impacted by HIV, including the LGBTQ community. Truvada for PrEP, despite having been on the market as an HIV prevention drug since 2012, is still only reaching roughly 200,000 Americans, in part because of its price tag: the brand-name drug currently retails for as much as $2,000 a month.

But some activists are muting their praise, skeptical of the true motivations by a multi-billion dollar corporation.

The skepticism centers around two parallel issues. The first is the actual impact Gilead’s donation will have on at-risk communities. Jen Kates, the director of global health and HIV policy at the Kaiser Family Foundation, pointed out on Twitter that even if the donated drugs wind up in the hands of 200,000 new patients — and there’s no guarantee existing patients won’t also benefit from the donation — it still leaves a large majority of the public uncovered.

Truvada for PrEP was approved in 2012. Today, only 18% (200K) of those for whom PrEP is indicated in the U.S. are on it, 7 years after approval. If the new donations bring this up to 400K (meaning, truly new people), that is only 36%.

— Jen Kates () May 10, 2019

Kates also noted that Gilead made no mention of how it plans to address issues of accessibility to the drug. A 2016 study found that despite black people making up almost half of the population living with HIV, they comprise just 11% of those prescribed to Truvada for PrEP.

The second, related issue is the actual cost of the drug. A monthly supply of Truvada for PrEP costs between $1,600 and $2,000, and there are currently no generic versions available to the American public. Activists at PrEP4All, an organization critical of the exorbitant price for the life-saving drug, say that if Gilead truly wanted to make an impact on the HIV epidemic, it would dramatically lower the price of the drug for everyone. Gilead plans on making a generic version of Truvada available in the U.S., but not until 2021, though a manufacturing deal with Teva — an Israeli pharmaceutical company embroiled in its own price-fixing scandal. 

The timing of Gilead’s announcement is also raising some eyebrows. Three weeks ago, the Washington Post reported that the Department of Justice was opening a review into the patent behind Truvada. A March report issued by Yale’s Global Health Justice Partnership found that the development and testing for Truvada was financed almost entirely by the federal government — in other words, by taxpayers — and not by Gilead.  The Centers for Disease Control has previously tried to enforce its patent on the drug by requesting royalty payments, but have so far declined to file suit against Gilead, which has refused to pay any royalties.

Breaking Gilead’s patent on Truvada for PrEP could potentially cost the company billions in revenue currently being generated by those paying for the drug, whether through insurance or out of pocket. With the federal government knocking on that particular door, Gilead has every interest in appeasing the Trump administration.

And as it happens, the Trump administration was in desperate need of good news this week. During his State of the Union address in February, Donald Trump surprised many in the health and LGBTQ communities by proclaiming his administration planned to end the HIV epidemic by 2030, a bold assertion coming from an administration that has done nothing but undermine spending on health care and demonize the LGBTQ community.

Sure enough, shortly after Gilead announced its donation, Donald Trump took to Twitter to take credit for the deal and praise the company for its “historic donation.”

Great news today: My Administration just secured a historic donation of HIV prevention drugs from Gilead to help expand access to PrEP for the uninsured and those at risk. Will help us achieve our goal of ending the HIV epidemic in America! https://t.co/wux5QasWgW

— Donald J. Trump () May 9, 2019

He continued to take responsibility for the donation on Saturday, retweeting accounts that offered praise, like this one:

Why is this not the #1 news on every major news outlet tonight? President Trump’s Admin secured a historic donation of HIV prevention meds for 200,000 people per year. This’ll save so many lives & it’s a good reminder that he’s the President of ALL AMERICANS! https://t.co/DqFnRmZbea

— Robby Starbuck () May 10, 2019

HIV activists remain unconvinced. In addition to the aforementioned motives, PrEP4All organizer James Krellenstein pointed NBC News to another: should Gilead get clearance for their newest PrEP drug Descovy during the decade-long lifespan of their donation, the company has announced they plan to switch their free Truvada supply to their newer alternative.

“What this is going to allow Gilead to do is essentially transition their entire Truvada PrEP base to Descovy right as Truvada is going off patent, and that’s worth a huge amount of money to Gilead,” Krellenstein said.