TIME Infectious Disease

Half of HIV+ Gay Men Don’t Take Life-Saving Drugs

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A pack of Nevirapine 200mg tablets of antiretroviral (ARV) drugs is pictured at the Sociedade Mocambicana de Medicamentos (SMM) Africa's first public factory for anti-HIV drugs on July 21, 2012 in Matola, Mozambique. AFP/Getty Images

The latest survey from the Centers for Disease Control (CDC) shows dramatic deficits in treatment among those at highest risk of HIV infection

Since the mid-1990s, powerful anti-HIV drugs have helped turn HIV-AIDS into a chronic condition as opposed to a death sentence. But in the latest report, published Thursday in the MMWR, health officials at the Centers for Disease Control and Prevention (CDC) show that nearly half of people who could be benefiting from the medications aren’t taking them. Only 49.5% of gay and bisexual men diagnosed with HIV receive treatment, and only 42% of those taking medication have been able to keep virus levels in their body down to undetectable levels.

Especially concerning is the fact that the vast majority of men diagnosed with HIV will, in fact, see a doctor about treatment. The trouble is, many do not follow through with treatment and check-ups. The disparity between who gets treatment and who doesn’t grows even starker among young and African-American gay and bisexual men, says David Purcell, deputy director of behavioral and social science in the division of HIV-AIDS at the CDC.

The reasons why men don’t get—or stick with—treatment range from cost to misperceptions about the toxicity of current drug therapies to the enduring stigma of HIV. As such, Purcell says the CDC is shifting its prevention efforts away from safe sex and condom campaigns—although those are still important—to focus more on people who are living with HIV. “We’ve gone full bore on this, and shifted our HIV prevention strategies to reflect the increasing evidence of the dramatic impact that treatment can have on prevention,” he says. “It’s very high on our radar.”

If HIV positive people start anti-HIV drugs as soon after their diagnosis as possible, they can reduce the amount of virus in their blood to undetectable levels and lower their chances of passing on HIV to practically zero.

Last week, the CDC announced its “HIV Treatment Works” campaign, aimed at educating HIV-positive people about the best therapies for them, and the “Start Talking Stop HIV” effort targeting gay and bisexual men, to encourage them to ask partners about their HIV status and get tested regularly.

Preventing HIV is not about one “best” method, he says, but the fact that prevention strategies work best together — such as using condoms and getting tested regularly, or knowing your status and taking HIV medications faithfully.

TIME White House

Obama Hosts 51 African Leaders Amid Grumbling Over His Record

President Barack Obama speaks to participants of the Presidential Summit for the Washington Fellowship for Young African Leaders in Washington on July 28, 2014.
President Barack Obama speaks to participants of the Presidential Summit for the Washington Fellowship for Young African Leaders in Washington on July 28, 2014. Manuel Balce Ceneta—AP

Putting aside Gaza, Iraq and other distractions, Obama focuses on legacy

Barack Obama came to office representing the hopes and dreams of an entire continent. His father, after all, came to America not in the cargo hold of a slave ship hundreds of years ago, but on an academic scholarship from his native Kenya in 1954: for many on the African continent, Obama was the cousin who’d made it big in America. His election was a symbol of hope, and that maybe help was on the way.

Obama stroked those expectations and rapture with the reissuing of his book in 2005, Dreams from My Father, and with a triumphal African tour in 2006, which sparked the first speculation that he might make a bid for the White House. But in his first term in office, Obama visited Africa only once, stopping at the tail end of his first international trip in Cairo deliver his speech launching “A New Beginning” with the Arab world and spending 24-hours in Ghana where he outlined the four themes upon which, he said, the future of Africa would depend: democracy, opportunity, health and the peaceful resolution of conflict.

Those four “pillars,” as he called them, went all but neglected for the next four years as Obama’s attention swung from domestic priorities like health care reform to crises in Syria, Ukraine and Iraq. So, now, as Obama turns an eye to legacy, he is hosting 51 African leaders at the White House this week for a summit. But legacy requires achievement, and Obama has left much undone in Africa.

To be fair, Obama had a tough act to follow. His predecessor George W. Bush created the Millennium Challenge Corporation to boost foreign aid and the Presidents’ Emergency Plan for AIDS Relief, or PEPFAR, where he invested $15 billion for AIDS drugs—a program universally credited for bringing down AIDS deaths in Africa. Bush also had a security vision for Africa, establishing military bases and a joint African command. He helped create an autonomous government in South Sudan in 2005 to stop the genocide in Darfur. And Bush expanded a free trade agreement created under Bill Clinton called the African Growth and Opportunity Act, or AGOA.

Under Obama—or, perhaps better said, the Republican cost-cutting Congress—Millennium Challenge funding has remained flat and PEPFAR has been cut from $6.63 billion to $6.42 bullion in fiscal 2013 and is expected to face another $50 million in cuts this year. South Sudan, whose independence America celebrated in 2011, fell into civil war this year after the U.S. neglected to appoint a special envoy for more than six months. And AGOA’s renewal remains stalled before a Congress full of members who want to rewrite it, or potentially kill it, much like the Export Import Bank, which finances most U.S. business on the continent.

While Obama did help intervene with NATO in Libya and sent special forces to Uganda in 2011 to hunt down the warlord Joseph Kony, who has yet to be found, Obama has otherwise taken a hands off approach militarily in Africa. In Somalia, he sent in seal team that took out an al-shabab leader but only after that group’s terrorist attack against a high-end Nairobi shopping mall attack, which killed 67 people from 13 countries. He declined to send troops into Mali with France but provided air support, but only after a terrorist attack on a gas plant in neighboring Algeria claimed the lives of three Americans.

“There were tremendous expectations,” says Carl LeVan, an African studies professor at American University, who has just written a book on Nigeria. “There were big expectations from some of the big emerging African players on the continent. What has emerge over time is an appreciation of the American presidency as a complex organization that speaks on behalf of a big country and not just one man.”

Obama second term African record has been better. Last year, he toured the continent with hundreds of business leaders in tow, touting American investment. His second national security adviser, Susan Rice, is largely credited with the U.S. intervention in Libya and has a long history with the continent, which she views as a priority. Ahead of that tour, Obama launched Power Africa, a $7 billion program to provide power to 20 million sub-Saharan Africans. He also started the Young Leaders’ initiative, which provides scholarships for young Africans to top U.S. universities.

Obama emphasizes how America’s innovation has helped Africa skip several steps of development. He points to the broad use of smart phones across the continent as evidence of how American innovation allowed Africa to skip poles and wires and still bring, not just phone service, but online global banking and Internet connectivity to the most rural of communities. America, he argued to The Economist last week, is “better than just about anybody else” at such applications of technology.

But America is no long Africa’s largest patron. As the U.S. is pivoting to Asia, Asia is pivoting to Africa. China’s investments in Africa surpassed those of the U.S. in 2010 and are now five times as big—$15 billion to U.S.’s $3 billion. China’s investment in the raw-resource laden continent is expected to reach as high as $400 billion over the next half century. While, Obama says “the more the merrier,” as he told The Economist, “my advice to African leaders is to make sure that if, in fact, China is putting in roads and bridges, number one, that they’re hiring African workers; number two, that the roads don’t just lead from the mine, to the port to Shanghai.”

To that end, Obama has a distinctly American message for African leaders. He has seized upon the conference to underline the power of democracy for emerging nations. It is not by accident that he invited so many former African leaders: a message to Africa’s many aging dictators that it’s okay to step aside and give someone else a chance. Obama has proven that he isn’t Africa’s savior, and there’s only so much he can do. “If there is any lesson regarding development and stability that has been consistent since the end of World War II and the colonial era,” says Anthony Cordesman, a top conflict analyst at the Center for Strategic and International Studies, “it is that we can only really help those states that are helping themselves.”

TIME Innovation

Five Best Ideas of the Day: August 4

1. Making the punishment fit the crime: A better way of calculating fines for the bad acts of big banks.

By Cathy O’Neill in Mathbabe

2. Lessons we can share: How three African countries made incredible progress in the fight against AIDS.

By Tina Rosenberg in the New York Times

3. Creative artists are turning to big data for inspiration — and a new window on our world.

By Charlie McCann in Prospect

4. We must give the sharing economy an opportunity to show its real potential.

By R.J. Lehmann in Reason

5. Technology investing has a gender problem, and it’s holding back innovation.

By Issie Lapowsky in Wired

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME HIV

Researchers Find New Way to Kick Out HIV From Infected Cells

Scanning electron micrograph of HIV-1
Scanning electron micrograph of HIV-1 Getty Images

The technique addresses the problem of hidden reservoirs of HIV in the body, and could herald a new way of battling the viral infection

Once HIV invades the body, it doesn’t want to leave. Every strategy that scientists have developed or are developing so far to fight the virus – from powerful anti-HIV drugs to promising vaccines that target it – suffers from the same weakness. None can ferret out every last virus in the body, and HIV has a tendency to hide out, remaining inert for years, until it flares up again to cause disease.

None, that is, until now. Kamel Khalili, director of the Comprehensive NeuroAIDS Center at Temple University School of Medicine, and his colleagues took advantage of a new gene editing technique to splice the virus out of the cells they infected – essentially returning them to their pre-infection state. The strategy relies on detecting and binding HIV-related genetic material, and therefore represents the first anti-HIV platform that could find even the dormant virus sequestered in immune cells.

MORE: Treatment as Prevention: How the New Way to Control HIV Came to Be

Even more encouraging, they also used the system to arm healthy cells from getting infected in the first place, by building genetic blockades that bounced off HIV’s genetic material. “It’s what we call a sterilizing cure,” says Khalili.

His work was done on human cells infected with HIV in cell culture, but, he believes the results are robust enough to move into animal trials and eventually into testing the idea in human patients.

The key to the strategy is the gene editing technique known as CRISPR, a way of precisely cutting DNA at pre-specified locations. CRISPR acts as a customizable pair of molecular scissors that can be programmed to find certain sequences of DNA and then, using an enzyme, make cuts at those locations. Because HIV is a retrovirus, its genetic material comes in the form of RNA; the virus co-opts a host cell’s genetic machinery to transform that RNA into DNA, which it then inserts into the cell’s genome. HIV’s genes, which it needs to survive, then get churned out by the cell.

MORE: David Ho: The Man Who Could Beat AIDS

Khalili designed a CRISPR that recognized the beginning and end of HIV’s DNA contribution, and then watched as the enzyme snipped out HIV from the cell’s genome. “I’ve been working with HIV almost since day 1 [of the epidemic] and we have developed a number of molecules that can suppress transcription or diminish replication of the virus. But I have never seen this level or eradication,” he says. “When you remove the viral genes from the chromosomes, basically you convert the cells to their pre-infection state.”

The advantage of the system lies in the fact that CRISPR can recognize viral genes wherever they are – in infected cells that are actively dividing, and in infected cells in which the virus is dormant. Current drug-based strategies can only target cells that are actively dividing and releasing more HIV, which is why they often lead to periods of undetectable virus but then cause levels of HIV to rise again. That’s the case with the Mississippi baby, who was born HIV positive and given powerful anti-HIV drugs hours after birth and appeared to be functionally cured of HIV when the virus couldn’t be detected for nearly four years, but then returned.

MORE: Rethinking HIV: After Five Years of Debate, a New Push for Prevention

Khalili admits that more work needs to be done to validate the strategy, and ensure that it’s safe. But it’s the start, he says, of a potential strategy for eradicating the virus from infected individuals. That may involve excising the virus as well as bombarding it with anti-HIV drugs. “We can get into cells, eradicate the viral genome, and that’s it,” he says.

TIME Aids

This Is What We Lost Aboard Malaysia Airways Flight MH17

UKRAINE-RUSSIA-POLITICS-CRISIS-MALAYSIA-AUSTRALIA-AIDS-FILES
Leading AIDS researcher Joep Lange during a conference on AIDS in Paris on July 14, 2003 . Jean Ayissi—AFP/Getty Images

Late last night, a terrific HIV vaccine researcher, Wayne Koff, sent me a quick note, indicating Joep Lange perished aboard the jet senselessly shot down over Ukraine. I reeled. Joep was one of the group of “Young Turks” from Amsterdam, amazing AIDS researchers that in the 1990s led the way to our modern treatment era.

This morning’s news is still uncertain, but it seems Lange was on board along with some 100 of his Dutch compatriots, and many of the passengers shared an ultimate destination – the twentieth International AIDS Conference in Melbourne, Australia. Some probably highly premature news accounts indicate a third of those shot out of the sky were en route to the conference. One additional has been confirmed – Glenn Thomas, AIDS specialist in the World Health Organization communications office.

There was a time when we convened in these meetings and whispered the names of friends, colleagues, and loved ones that wouldn’t be coming this year because they died of AIDS. In our gatherings in the 1980s, grief hung like a curtain over everything, alongside anger over the way governments were responding, the lack of funding, the stigma, and so many other aspects of what it was like to live in the World of AIDS before there was treatment. We fought through the mourning to get the job done, whatever that job might be: activist protesting, scientific investigation, fundraising, even journalism. The great oratory leader of the early AIDS fight Jonathan Mann would whip us into a fever of determination to stop discrimination against people with AIDS, fight for research funding, and find a cure for the devastating disease. Jonathan, who started the first global AIDS program at WHO, was the early pandemic cheerleader, pushing everybody forward, encouraging teams of scientists to work together in ways biologists and clinicians never previously had, for any disease struggle.

The Young Turks from Amsterdam were a special breed. There were so few of them yet they accomplished a long list of spectacular breakthroughs in understanding how HIV disrupted the human immune system, smart ways to prevent transmission of the virus among drug users, careful but rapid drug discovery and testing. Joep and Jaap – two prominent Dutchmen we foreigners had trouble pronouncing. What is the world is the difference in saying Joep Lange and Jaap Goudsmit? We marveled at the pragmatism of the Dutch. To put it bluntly, they got the job done.

In 1996 the one and only joyous AIDS Conference convened in Vancouver – a meeting marked by announcement of successful combination therapy that knocked the dastardly virus down to levels undetectable in blood. There was hope for a cure, thanks in large part to the Dutch work. Some dared to speak of eradicating HIV all together.

Two years later, as hundreds of thousands of HIV-positive men and women living in wealthy countries were thriving on those treatment combinations, hope dominated the pandemic, until 1998 when Swissair Flight SR11 crashed off Nova Scotia, killing all on board. Among them, Jonathan Mann and his new wife, AIDS vaccine researcher Mary Lou Clements. Their sudden loss felt like a kick in the gut for the world AIDS community.

Here we are, sixteen years later, facing airline tragedy again. As I write this in haste we don’t have more names and the scale of the AIDS community’s loss is unclear. But the loss of one is tragedy.

Like so many of the great AIDS scientists that toiled through the years of extreme loss and urgency before there was effective treatment, Joep Lange absorbed the political dimensions of the pandemic, and gained the skills necessary to translate lab and clinical findings into high-level battles inside the United Nations and across the global stage. He became a leader, in the fullest sense of that word. Like Jonathan Mann, Joep blended science, medicine, and an activist spirit to help bring the life-sparing medicines to people in all of the world – not just rich countries.

The last time Joep and I spent time together we argued, I’m sorry to say. And I may have been completely wrong, he completely right. The saga we argued about hasn’t played out yet. Joep believed without hesitation that effective treatment, “is like a vaccine,” as he put it. The global epidemic could be stopped, he said, simply by getting every HIV+ person on the planet put on an effective regimen of treatment. Once on medicines, he insisted, the load of viruses in their blood, vaginal fluids, and semen would drop so low that they would not be contagious. And that, he said with a grin, will be the end of AIDS. I was skeptical – there were too many cases of drug resistance, non-adherence to treatment, supply chain failures to deliver vital drugs to remote or impoverished areas. I resented use of the word “vaccine” to describe universal treatment – we still desperately need an actual HIV vaccine, I insisted.

I want Joep’s optimism about eliminating AIDS through treatment to win out. I want to be wrong.

I just wish Joep was going to be around to see the great experiment play out.

A Tweeter asked me if the loss of Joep, Glenn, and other AIDS researchers and activists possibly on board MH17 would prove a major set-back in the fight against AIDS. No, I said. One of the glories of the AIDS community is that its bench is deep, its talents enormous, and its sorry history of processing grief and moving on is unparalleled. The dead, as has always been the case since this awful virus emerged in the late 1970s, will be mourned. And then energies will be mustered, to get the job done.

Until there is a cure.

Laurie Garrett is a senior fellow for Global Health at the Council on Foreign Relations. This essay also appeared on http://lauriegarrett.com/blog/.

TIME Australia

After MH17 Ukraine Crash, Global AIDS Researchers Mourn Lost Colleagues

The cause of HIV/AIDS research will be set back because of experts lost in the Malaysia Airlines Ukraine disaster

[UPDATE: 7/18/14, 11:52 AM EDT]

There was a pall over the 20th annual International AIDS Conference in Melbourne even before the crash of Flight MH17 in eastern Ukraine, which killed an estimated 100 delegates who were en route to the meeting. [Update: Later reports suggest that the number of delegates lost is much lower.]

In the past couple of years the vibrant showcase event—part serious science, part activist networking and carnivalhas been headily optimistic, as HIV treatments improved and the possibility of a cure no longer seemed so far off. “The mood is always an important part,” says Professor Mike Toole, an international communicable diseases veteran with Melbourne’s Burnet Institute who has been at the HIV/AIDS front line since the pandemic began some 30 years ago.

Toole remembers that the landmark Durban International AIDS Conference back in 2000 demonstrated to this eclectic crowd—a disparate crew of laboratory researchers, front-line health workers, activists and people living with the infection—their powerful potential. It was in Durban that the commitment to deliver then-prohibitively expensive antiretroviral drugs to the world’s poorest populations ignited, and was carried through over the next few years by organizations like The Global Fund and the U.S. President’s Emergency Fund for Aids Relief.

The past two International Aids Society (IAS) meetings, in Vienna and Washington DC, have been buoyed by signals that a breakthrough was close, and the expectation was that the momentum would continue into Melbourne. Then, barely a week ago, came a serious blow. For over a year many members of the HIV/AIDS community had been pinning their hopes for a breakthrough on the so-called Mississippi baby, an HIV-positive infant that had apparently been cured through aggressive drug treatment soon after birth. But on July 10, news came, that the child was showing symptoms that the virus had returned.

Although there are other programs that indicate that it might be possible to eliminate HIV infection from a human body, the apparent relapse of the Mississippi baby “depressed people incredibly,” says Toole.

Then came yesterday’s tragedy. For Toole and others HIV/AIDS experts the crash summoned up ghosts. “It reminds me of the Swissair flight, New York to Geneva, when Jonathan Mann died,” he says. Mann then the founding director of the World Health Organization’s global AIDS program was killed with several other researchers, including his wife Mary-Lou Clements-Mann, en route to AIDS meetings when the plane crashed in Canada, September 3, 1998. “I lost five friends on that flight.”

In Sydney, at a pre-conference gathering on July 18, about 200 delegates spent the day closely monitoring Twitter and exchanging snippets of news, desperate for updates on who would and would not be joining them in Melbourne. The word there was that a substantial number of the 100-plus delegates reported to be on the downed aircraft were part of the global network of activists and people living with AIDS.

With only a handful of names of the deceased confirmed by Friday, it’s difficult to measure the overall impact on HIV/AIDS research and advocacy. But the loss of internationally renowned Dutch researcher Joep Lange—a former president of the IAS—would be a massive blow. “It will have a big psychological effect,” says Toole. “He was one of the leaders in the field.”

Another known casualty was Glenn Thomas, a British media officer working for WHO in Geneva. Thomas was to be part of a media launch on July 20 revealing new tools to reduce harm to users of intravenous drugs. He was also recognized as a particularly effective communicator on the links between HIV/AIDS and tuberculosis, says Toole. (The risk of developing TB is up to 20 times greater in people infected with HIV, and in 2012, of the 8.6 million new cases of TB diagnosed internationally, 1.1 million were among people with HIV.)“And the other hundred [on board]—we don’t know who they are, what it means.”

The annual AIS conferences are like no other medical gathering, says Professor Rob Moodie of the University of Melbourne, a former senior WHO official and longtime Australian public health specialist. “You have this incredible mixture of scientists and clinicians, public health people, civilian organizers, human rights activists, people who have the virus … who all have some sort of sense of ownership and collective leadership.”

The energy and collaborations of these gatherings have helped drive the huge advances achieved in understanding and responses to HIV/AIDS in a relatively short time. “We learned more about HIV in the first 10 years than we did in a century with other diseases,” says Moodie. The involvement of grassroots activist groups—as well as lab researchers—has been key to that success. MH17’s toll would not only be measured in the loss of medical expertise, but of advocacy, understanding and hard-won personal experience.

“There is a black cloud on this conference,” says Toole. “I don’t think there is anything that can retrieve that.”

Still, Toole was confident that delegates would be driven to achieve as much as they could in memory of their colleagues. He welcomed the move by the City of Melbourne on July 18 to cancel fireworks that had been scheduled to kick off the conference, but was disappointed that that’s night fixture in the Australian Football League competition—to which AIDS2014 delegates had been given tickets as part of the cultural program—did not pause for a minute of silence.

TIME Infectious Disease

WHO Says All Men Who Have Sex With Men Should Take Antiretroviral Drugs

A nurse takes blood for a free HIV test, during an HIV/AIDS awareness rally on World AIDS Day in San Salvador
A nurse takes blood for a free HIV test during an HIV/AIDS awareness rally on World AIDS Day in San Salvador on December 1, 2011. Luis Galdamez—Reuters

Warns of 'exploding epidemics' of HIV among gay men

The World Health Organization has suggested for the first time that all men who have sex with men should take antiretroviral medicine, warning that HIV infection rates among gay men are exploding around the world.

In guidelines published Friday, it said that it “strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection.” Similar guidelines were issued by the U.S. in May.

Gottfried Hirnschall, the head of WHO’s HIV department, says that infection rates among homosexual men are increasing again 33 years after the epidemic hit, partially because the infection doesn’t hold as much fear to a younger generation with access to drugs that enable users to live with AIDS.

“We are seeing exploding epidemics,” Hirnschall told reporters in Geneva.

Although HIV infection rates did drop by a third between 2001 and 2012, Hirnschall characterized progress as “uneven.”

[AFP]

TIME Aids

Girl ‘Cured’ of HIV Has Relapsed

Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi on March 3, 2013.
Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi on March 3, 2013. Jay Ferchaud—University of Mississippi Medical Center/AP

"Certainly, this is a disappointing turn of events"

A 4-year-old girl believed to have been cured of HIV showed detectable levels of the virus, federal officials said Thursday in a blow to anti-HIV efforts.

The Mississippi girl had been off of antiretroviral therapy for more than two years, and doctors believed that she could serve as a model for eradicating HIV in babies born with the virus.

But on Thursday, the National Institute of Allergy and Infectious Diseases said that researchers had found detectable HIV levels in the girl this month.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care and the HIV/AIDS research community,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a statement.

The girl was born with HIV, and doctors administered anti-AIDS therapy nearly immediately after her birth and continued with the treatment for months. After the girl and her mother missed several treatment appointments, doctors found that the girl was still HIV-free — leading them to believe that the early treatment may have successfully eliminated the virus. Still, experts say they knew a relapse was a possibility.

Since HIV was detected in the girl this month, doctors have resumed treatment. But despite her relapse, researchers say her case still provides a valuable understanding of early HIV treatment.

“The case of the Mississippi child indicates that early antiretroviral treatment in this HIV-infected infant did not completely eliminate the reservoir of HIV-infected cells that was established upon infection but may have considerably limited its development and averted the need for antiretroviral medication over a considerable period,” Fauci said in a statement. “Now we must direct our attention to understanding why that is and determining whether the period of sustained remission in the absence of therapy can be prolonged even further.”

TIME Health Care

Complaint Alleges Discrimination Against Those With HIV/AIDS by Insurers

Two health organizations claim that four insurance companies are violating the Affordable Care Act

The National Health Law Program and the AIDS Institute filed a complaint with federal health officials Thursday asserting that four insurance companies have structured their plans in a way that discourages people living with HIV or AIDS from choosing them. If the accusations are true, those insurance companies would be violating a civil rights section of the Affordable Care Act.

The two health organizations say the insurance companies, which offer plans in Florida through the federal online exchange, require that HIV and AIDS patients pay for a percentage of their drugs instead of a flat $10 co-pay. HIV and AIDS drugs can get expensive, so asking patients to pay 40% to 50% of the wholesale cost of their drug — thousands of dollars — becomes burdensome.

The two groups also allege that the plans require high up-front costs and too many prior authorizations. Federal health officials are reviewing the complaint.

TIME movies

Taylor Kitsch: Working on The Normal Heart Was “Gutting”

The actor discusses the making of the AIDS-crisis movie

Taylor Kitsch was at home in Austin when his manager sent him the script for The Normal Heart, the Ryan Murphy-directed adaptation of the seminal Larry Kramer play about the early days of AIDS (airing on HBO on May 25). The story traces the early days of the leading AIDS-advocacy group GMHC in the days when the disease was widely misunderstood, through the fictionalized stories of its founders.

As Kitsch recalls, his manager said that whatever he was doing at the time was less important than reading the script. Most of the other primary characters had been cast, but by the time the actor got halfway through reading it, he knew that he wanted to fight for the role of the Bruce Niles, a banker who becomes an activist despite remaining in the closet.

“It was an opportunity to tell something that’s bigger than all of us and still needs to be told,” he says.

But getting the role didn’t mean the hard part was over. As he discusses in the video above, telling the heart-wrenching story of a group of friends facing a devastating crisis proved, not surprisingly, to be a taxing experience. Kitsch says that emotions were already heightened on set, but that one particular scene involving the difficulties his character has to go through to retrieve a body from a hospital was “gutting.”

“That was something that I wasn’t hoping we would do too many takes,” he says. “You try to do this in any scene, but this one more in particular than others, of just like, you don’t need to dramatize this stuff as an actor. You just be honest to what’s in front of you and what’s going on.”

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