At 83, AIDS activist Larry Kramer isn’t done ripping into his foes in pharma, FDA, and NIH

Over the course of three decades, the name Larry Kramer has become synonymous with the gay rights movement, patient rights — and savage attacks on public officials and drug companies.

Today, with controversy over drug prices and concern over public health funding, we were curious what Kramer had on his mind. We also wondered whether at the age of 83 he has mellowed.

He has not.

“I don’t mince any words,’’ he said.

His take on Francis Collins, director of the National Institutes of Health: “Collins is a wimp.’’

On Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases: “The consummate manipulative bureaucrat who speaks out of too many sides of his mouth.’’

On Gilead, manufacturer of the HIV-blocker drug Truvada: “Gilead is evil, pure and simple.’’

At the height of the HIV/AIDS crisis, Kramer co-founded the Gay Men’s Health Crisis, created ACT UP, and helped mount a pressure campaign against U.S. health agencies that were slow to provide access to experimental treatments.

Frail after a liver transplant and with hearing issues, Kramer asked that our interview be conducted via email. Even in print — he answered our questions in blaring capital letters — it was clear his tendency toward belligerence has not dissipated.

Kramer is as pessimistic about the state of public health as he was during the Reagan years, when he emerged as a strident voice denouncing the president for neglecting the AIDS crisis.

“Neither had/have any concern for public health,’’ he said of Reagan and President Trump. “The dismantling of the system started under Reagan. Trump’s just the latest in a long line of its executioners.’’ Regarding Trump, he said, “Most of us don’t know what to do. He is successfully barricading every avenue of help and progress.’’

Larry Kramer addresses members of the AIDS advocacy group ACT UP in 1991.

Kramer, who learned of his own HIV-positive status in 1988, asserted that “AIDS is worse than ever.’’ He said: “Most of the world remains untested for HIV. What we only hear about are the small pockets of success which lead to far too much self-congratulation.’’ Those pockets, he said, are “upper and middle class areas of white men in places like NYC and San Francisco.’’

AIDS is “exploding in countries like Russia, which denies it, Southeast Asia, huge swaths of Africa, South America, Mexico, even in parts of America, Texas, the south, West Virginia. It goes unattended to in these places for the same reasons it’s not been properly attended to here: it’s happening to populations of people that other people hate.’’

Did Kramer think there would be a cure for AIDS by now?

“I am totally convinced that if this were, from the beginning, considered a white male heterosexual disease there most certainly would be a cure by now,’’ he said. “As the late great Dr. Mathilde Krim always maintained, ‘AIDS was allowed to happen.’”

Kramer rebuffed the notion that AIDS activists like himself bear responsibility for leading the Food and Drug Administration to rush risky drugs to the market.

In a recent ProPublica article, Gregg Gonsalves, a former member of ACT UP, said he fears AIDS activists “opened a Pandora’s box.”

Asked to respond, Kramer said, “I don’t think it makes any difference. The FDA is inept whatever they do. Bad drugs turn up on the market both because and despite what the FDA does or doesn’t do.’’

The exchanges with Kramer seemed like a trip back to the peak of the AIDS epidemic; many of his targets are familiar.

Asked about Collins, he raged: “For too many years the NIH has been a cesspool of mediocrity. I don’t know how they’ve managed to get away with it. Has it never occurred to anyone how few cures for anything have come out of the NIH?’’

Asked about Kramer’s critiques, Fauci and Collins responded with strikingly similar restrained statements. They both described him as a hero, even as they rebuffed his criticism.

Collins said: “Larry Kramer played an heroic role in the progress against HIV/AIDS. However, I disagree with his assessment of the progress made in treating HIV/AIDS. The disease was a certain death sentence in the 1980s.  Today, those with HIV on antiretroviral treatments can live nearly as long as someone without HIV. I’m not saying that we’re done, but we have come a long way. That said, I have and always will appreciate and respect Larry’s tenacity.”

Fauci said: “Although Larry can be confrontative and combative, I consider him a friend and a hero of the AIDS activist movement. He is correct that much remains to be done in HIV research, but here he clearly understates the accomplishments of NIH and our partners in advancing HIV treatment and prevention research. Of particular note is the decades-long NIH support for the development of 30+ licensed anti-HIV drugs that can provide many people living with HIV a nearly normal life expectancy.’’

Kramer leveled particularly harsh attacks on Gilead, which manufactures the HIV-prevention drug Truvada.

“Research on Truvada was paid mostly by the American taxpayer via grants to the NIH with which Gilead shares the patent,’’ he said. “All the meds Gilead makes for HIV and Hep B cost only pennies to manufacture, for which they charge tens of thousands of dollars, which is beyond the reach of most people who need them. I think it is evil to possess something that will save a person’s life and prevent them from having it. That is murder, to my mind. Yes, Gilead has saved many lives. But they have made many billions of dollars doing so. How unchristian, how undemocratic, how selfish can you be?’’

In response, Sonia Choi, vice president of public affairs for Gilead Sciences, said, “We recognize that many people who are at high risk for HIV infection still face challenges in accessing Truvada for PrEP. We are in regular dialogue with public health officials, advocates and physicians to better understand and, where possible, help to address these challenges. Based on feedback from partners and our work in the field, we believe that one of the greatest barriers to Truvada for PrEP access today is limited awareness of Truvada for PrEP’s role in HIV prevention, which is why we commit significant investments to educating both consumers and healthcare providers.’’

Kramer, who is also a prominent screenwriter, novelist, essayist and playwright, said he was devoting much of his time now to one more book.

“I spend my declining years writing pieces and speeches and finishing what I hope will be my farewell achievement, my two volume history of homosexuality that I call ‘The American People,’” he said. “In the many years of writing and researching it, I have been appalled how we have been treated like s— since the very beginning of America.”

Looking to the future, is there anything that gives Kramer hope?

“The advent of Trump guarantees pessimism,’’ he said.