AIDS Healthcare Foundation (AHF), founded in 1987, is the largest, community-based HIV/AIDS medical care provider in United States, serving more than 413,000 clients across the world. It operates in 36 countries with a budget of $1.1 billion for fiscal year 2015, according to its website. The group, which operates 43 AHF Healthcare Centers and 37 pharmacy outlets in the United States, has been accused of a far-reaching kickback scheme that extended to 12 states, according to a lawsuit unsealed last week at a federal court in South Florida. But it also has a history of practices that have spurred controversy or raised ire with some in the HIV/AIDS community and government officials.
In this suit, the three plaintiffs claim the agency paid employees and patients for patient referrals to increase funding from Medicare, Medicaid and the Department of Health and Human Services HIV/AIDS grant programs. AHF is a federal contractor, and the suit alleges that these bonuses are "illegal remuneration" and thus in violation of the federal anti-kickback statute.
AHF President Michael Weinstein has dismissed the merits of the lawsuit, defending their "linkage to care" practices. AHF does offer "small incentives" and commissions, he told Frontiers LA, adding that there was "nothing wrong" with doing so.
Linkage to care is a critical component of HIV treatment in the HIV continuum of care, which promotes increased diagnoses of new infections, rapid connection of clients to care, retention of clients in treatment, prescription of antiretroviral medications, and reducing their viral load. Of the 1.1 million Americans living with HIV, only 25% are virally suppressed, according to the Centers for Disease Control and Prevention (CDC). The lawsuit claims that AHF's incentive-based "linkage to care" strategy was the "key to its business model."
The lawsuit will take some time to resolve. However, its filing has brought new attention to AHF's history, business and media practices and what some have called aggressive tactics.
Shortly after the filing of the suit, TheBody.com contributor Mark S. King posted a report saying that AHF "withdrew funding from an upcoming HIV advocacy event in Louisiana because one of the [lawsuit] plaintiffs is involved in its planning." King explains that "in a voice mail to [plaintiff Jack] Carrel, a local AHF staffer states that Carrel's involvement in the whistleblower case was the reason for AHF's withdrawal."
"I'm only surprised that it took so long for a whistleblower lawsuit to be filed," San Francisco-based Michael Petrelis, a longtime HIV/AIDS survivor and human rights advocate, told TheBody.com. "Over the years, I have called on AHF to post its IRS 990 forms on its website but they have refused," he added, referring to the annual filing required of federally tax-exempt organizations that details programs and finances. "It's considered standard, voluntary transparency these days to make 990s available. Many Christian evangelical groups post three years of 990s, as [do] GLAAD and the Human Rights Campaign."
AHF vs. Los Angeles
The current suit is not the first time that AHF has been accused of financial mismanagement of government funds. Los Angeles County officials accused AHF of overcharging by $1.7 million for HIV/AIDS services. In turn, AHF filed a federal lawsuit in 2012 claiming that the audit was "retaliation" for its criticism of county programs and policies. This was one of a series of lawsuits filed by AHF against the county -- all of which were later dismissed. The Los Angeles Times reported that subpoenaed emails "included vitriolic remarks made by [Weinstein] about Los Angeles County supervisor Zev Yaroslavsky."
AHF and Los Angeles County also were on opposing sides of a 2012 ballot measure -- largely bankrolled by AHF -- to require porn actors to wear condoms. Weinstein claimed that "thousands of performers have been infected with thousands of STDs over the last few years." Opponents maintained that new HIV infections are very low within the porn industry because of safeguards -- and questioned why AHF spent considerable resources to fund the measure.
Aggressive Business Practices
AHF is most closely identified with Southern California but it boasts a national and global network of clinics and programs. Its domestic expansion strategy has been criticized by several HIV/AIDS policy and treatment advocates.
"They go into cities where there are already HIV services offered. Then they open locations across the street or around the corner from existing clinics," said one HIV/AIDS policy official who preferred to remain anonymous. "In one case, they opened a clinic in the exact same building as an existing clinic. They are more like a corporation."
AHF opened a clinic and pharmacy in San Francisco, which has no shortage of excellent HIV/AIDS services. "AHF faced opposition as it prepared to move its San Francisco clinic and pharmacy to the heart of the Castro," the Bay Area Reporter noted. "AHF sued gay District 8 Supervisor Scott Wiener and the city of San Francisco over legislation meant to tighten" retail chain zoning regulations. AHF ultimately won approval for its center, which is located only one block from the San Francisco AIDS Foundation's new health and wellness center.
Fighting Big Pharma
AHF has been criticized for being overly aggressive and litigious, but those same qualities have been praised by some advocates when it comes to the organization's combative relationship with pharmaceutical manufacturers.
AHF has filed or threatened to file suit against a number of pharmaceutical companies, and some of those lawsuits were settled in exchange for lower drug prices. One of three lawsuits AIDS Healthcare Foundation filed against Glaxo Smith Kline in the early 2000s accused the company of creating "exorbitant prices" on HIV/AIDS drugs in developing world. The lawsuit was dropped one year later after winning a 40 percent reduction. Another lawsuit filed against Abbot Laboratories and AbbVie in 2013 alleged cheating in drug pricing and a failure to provide legally required discounts of over $2 million to AHF.
"I disagree with their campaign against Truvada," said Petrelis. "But Michael Weinstein has done great and valuable work by addressing the high price of HIV/AIDS and hepatitis C medications."
Opposition to PrEP
In recent years, AHF and Weinstein's strident opposition to pre-exposure prophylaxis (PrEP) has caused an uproar across social media networks, gay blogs and among HIV/AIDS advocates and policy makers. Gilead's Truvada became the first and only medication to be approved for PrEP by the Food and Drug Administration (FDA) in 2012.
"AHF's opposition to PrEP was almost immediate when the results of the iPrEX trial were announced in 2010," said New York City-based psychotherapist and PrEP advocate Damon L. Jacobs, who has been a PrEP enthusiast and user since 2011. Jacobs created the popular Facebook group "PrEP Facts: Rethinking HIV Prevention and Sex" to foster discussion and counter misinformation.
"[AHF] began publishing ads against PrEP in gay newspapers and magazines. ... The fear mongering only increased after the FDA approved Truvada for PrEP in July 2012. They tried to sue the FDA, put out bogus press releases saying that FDA took bribes from Gilead."
"AHF basically has tried to stop PrEP for years," added Jim Pickett, the AIDS Foundation of Chicago's Director of Prevention Advocacy and Gay Men's Health. "I have no idea how much these campaigns cost. I would estimate this is millions of dollars of resources that could have gone into HIV/AIDS prevention or care."
Weinstein and AHF have attacked PrEP's potential to protect gay men who engage in condomless sex. Weinstein described Truvada as a "party drug" in a widely-cited Associated Press interview last spring.
Weinstein's remarks energized a new generation of PrEP advocates across social media and the Internet, according to many observers.
"There is room for concern in the PrEP discussion such as, 'How do we make sure it goes to those who most need it? How do we make sure this does not become a boutique intervention?'" said Pickett. "But calling it a 'party drug' was so over the top that it created a whole new generation of thousands of HIV-negative prevention advocates who we didn't have before."
Other critics note that Weinstein's attacks on PrEP ignore those who may need the intervention the most. Black men who have sex with men (MSM) -- especially younger ones -- are experiencing the highest new infection rates nationwide.
"Not everyone uses condoms. If we're serious about getting to an AIDS-free generation then it's incumbent upon us to make this option a tool in our prevention toolkit," said Steven-Emmanuel Martinez, a graduate student in public health at Brown University who is writing his thesis on the effectiveness of PrEP counseling among young gay and bisexual African American and Latino men.
Rod McCullom has written and produced for ABC News, NBC and Fox, and his writing has appeared in Ebony, The Advocate, the Los Angeles Times and many others. Rod blogs on politics, pop culture and Black gay news at rod20.com.