In a time when our healthcare system continues to resemble a top-tier dumpster fire, it feels like that system is coming down especially hard on the LGBTQ community.
ASHwell, a sex-positive and lifestyle-affirming nonprofit medical clinic and social-services center based in Austin, is meeting these hurdles head-on. The clinic will celebrate the opening of a new Austin location on Valentine’s Day, just as the pharmaceutical giant Gilead Sciences has canceled a significant funding source that the organization relied on to provide HIV-prevention medication for uninsured patients.
Ben Walker, director of client services at ASHwell and a graduate of The Woodlands High School, is a prominent leader in the healthcare field who is passionate about providing free access to PrEP throughout Texas. “ASHwell services the local populations at greatest risk of contracting sexually transmitted infections (STIs), with an emphasis on HIV prevention and treatment, in addition to Hepatitis C testing and treatment,” Walker explains. “We want to derail the fear-based approach and talk about sex in a way that is not stigma-based. Texas has a great history of scaring [kids in sex-education classes] into not having sex, but people are more empowered if they have all the information to make their own decisions about their sexual health.”
On January 1, Gilead Sciences, the manufacturer of two PrEP medications, stopped providing funding to safety-net clinics through the federal 340B drug-pricing program, a law that allows clinics that care for a disproportionate number of uninsured and low-income individuals the right to purchase pharmaceuticals at steep discounts through their in-house or contracted pharmacies. “Gilead was funding us so we could see our uninsured patients,” Walker explains. “Gilead would pay for them through 340B.”
A representative from Gilead tells OutSmart that “under the previous program model, some organizations would acquire deeply discounted bottles of the medicines, dispense them to program enrollees at no cost, and obtain reimbursement from Gilead at levels far above the amounts they paid for the drug. The use of this program as a funding mechanism for critical HIV services was never intended, and was unsustainable.”
ASHwell, and other clinics like it, say the reimbursement cuts were detrimental to the care they provide to folks who seek treatment or preventive care without worrying about high medical bills. These organizations are doing their best to change hearts and minds at Gilead. “We didn’t get a lot of advance notice. ASHwell and other similar programs told Gilead very clearly that we needed this money.”
In April 2021, Gilead announced changes to 340B. Those changes were put in place last month based on community feedback in order to align the program launch with organizations’ annual planning cycles and the open-enrollment period for various insurance programs. “Since January 2021, Gilead has met with the community regularly and responded to feedback by making adjustments to the program and implementation timeline. We are not able to further delay the implementation of these changes, as this would create confusion for program enrollees,” Gilead says.
“[Gilead’s funding] allowed us to tell the community that no matter what, they could come to us for free PrEP or HIV care. People are so worried about insurance and copays, but they ultimately move forward because they have to. The money aspect is scary, and it creates worry going into healthcare situations.”
The cutoff in Gilead funding left Walker and his ASHwell team scrambling to protect their uninsured patients. “It’s part of our mission to see [both] uninsured and insured patients, but now we are left covering the cost of thousands of uninsured patients.”
The abruptness of the change leaves Walker wondering what the future holds. “Texas has seen its first decrease in HIV rates in a decade, and that’s because we were able to tell the community that at ASHwell, and other clinics like ours, you can get free PrEP,” he says. “I anticipate that we are going to see a reversal in that decrease in HIV rates because we won’t be able to see the numbers of patients without insurance that live with that fear of the cost for their care. Worst-case scenario, we will possibly see an increase [in HIV rates].”
In spite of this setback, Walker and his team are excited to open the doors to their new brick-and-mortar Austin clinic located near the University of Texas. The space’s walls are covered in murals by queer artists that create a cheerful, non-intimidating healthcare space—a unique priority for the ASHwell team.
Gilead says its efforts to provide a free drug program to eligible individuals is separate and distinct from our participation in the 340B program, and that it plans to continue providing monetary contributions to advance life-saving healthcare. “Today, Gilead is the largest private funder of HIV programs in the U.S., providing more than $250 million in charitable contributions and grants in 2020 alone. We will continue to advance public-health initiatives to combat HIV. It is clear that much more needs to be done to overcome the remaining barriers to equitable access to HIV services, and it will take significant collaboration across the industry, government, and community to get there,” Gilead told OutSmart. “For our part, we will keep pursuing advances to address unmet needs in HIV treatment and prevention, continue striving to find a cure, and continue to partner and advocate on the complex issues enabling research and innovation to combat HIV in the U.S. and around the world.”
Although they have lost Gilead’s support through the 340B drug program, ASHwell’s Walker explains that there are other ways to support the clinic and those like it. “There’s so much need for sexual-health resources, no matter where you are in Texas. We knew our community needed us, and we were able to move forward with our new space, despite the Gilead change. It’s definitely going to constrain our ability to see uninsured patients moving forward, however,” he says. “Fundraising is super-important for us; donations make a huge difference. We are also funded through our insured patients. If [you live in Austin and want to] help maintain these services and expand access for uninsured patients, move your PrEP care to ASHwell. We get funded through that. You can keep your primary-care provider, but get your PrEP from us—or your local sexual-health clinic if you’re not in Austin.”
Walker offers another tip for supporting medical clinics that provide sexual-health resources and care: “People can contact Gilead and tell them they don’t think it’s right what they did, and we need them to ‘walk the walk’ to end the HIV epidemic. When our community goes to the government and says our clinics need more support, that makes a big difference.”
Ashwell is located at 3100 Red River Street in Austin, Texas. For more information, visit ashwellatx.org.