California Voters Face Important Issues

Voters in California may be less than thrilled to realize that a whopping 17 measures have qualified for the ballot in the November general election. All voters may be wise to cancel their cable television subscriptions to avoid what is likely to be an unprecedented amount of political advertising. Three measures bear on HIV and hepatitis C, and Project Inform will be educating its constituents about their potential impact in coming months. We wanted to give PIPeNews readers some early word about them.

Proposition 61 would prohibit the state from purchasing any pharmaceutical for health care programs it runs, including MediCal, at a price higher than that paid for the same drug by the US Veterans Administration (VA). Project Inform has taken a neutral position on the matter. We are the founders of the Fair Pricing Coalition, which negotiates with drug companies over the prices of HIV and hepatitis C medications. We have worked extensively in many other ways to control the high and rising cost of medications, which have resulted in restricted access to lifesaving treatments for many people. Much more needs to be done to address the damage done by high drug prices. However, we are not certain that Proposition 61 represents the best way to do that.

California’s independent Legislative Analyst has been unable to determine whether the measure would be workable and in fact save money. Were the state unable to successfully negotiate the price of a given medication as required by Proposition 64, that drug could become unavailable to participants in state programs. California’s law could have the effect of driving up the cost of pharmaceuticals purchased by the VA, or in other states. Proposition 61 exempts certain state programs from its coverage, including, for some reason, a program in which its very proponent participates. And finally, we are concerned that the unbelievable complexity of the drug pricing issue does not lend itself either to so simple an approach or one that is best decided at the ballot box. Were this measure to have harmful or unintended consequences, they would need to be corrected through additional votes of the people. While we are not anti-democratic, we simply believe this may not be the best way to make timely and effective decisions on so important a topic.

Proposition 64 would permit individuals over the age of 18 in California to possess and use marijuana, establish a regulatory scheme for its cultivation and sales, and provide for its taxation. Project Inform is supporting this measure both because of strong evidence of the medicinal benefits of cannabis, and because, while the social harms done by alcohol far in a way outstrip those done by cannabis, the damage done by its criminalization constitutes a major social injustice.

Project Inform had a small but potentially significant role in the crafting of Proposition 64. A year ago, three different groups were vying to place pro-cannabis measures on the ballot. Given the fact that the legalization movement was launched primarily by HIV/AIDS advocates because of the medical benefits of cannabis, Project Inform approached all three groups with a request that tax revenue generated by legalization be earmarked for HIV/AIDS and hepatitis C care and prevention programs. Two campaigns eagerly agreed to do so. Organizers of the effort that was ultimately successful in getting to the ballot agreed to take a slightly different approach.

Proposition 64 earmarks most of the tax revenue it would generate for substance abuse treatment and prevention programs for youth and young adults. In keeping with this, Proposition 64 proponents included language in the measure that would permit that money to be used to prevent the transmission of communicable diseases. This provision will surely be helpful to supporting programs that will prevent HIV and hepatitis among some of the people most at risk of infection. If adopted, Project Inform will work hard to maximize the use of what is likely to be a very considerable resource to help end California’s HIV and hepatitis C epidemics.

We want to thank Lt Governor Gavin Newsom and State Senator Mark Leno, both of whom were instrumental in securing inclusion of our request in the language of Proposition 64.

Proposition 60 would require that condoms be used in all pornography filmed in the State of California. It mirrors a similar law previously approved by voters in Los Angeles County. Project Inform has yet to take a formal position on this measure. It is an issue we feel voters should not have to decide given its graphic nature and the fact that state agencies are capable of handling it. It was placed on the ballot due to a single organization’s unhappiness with California OSHA regulations on the topic.

In a letter to OSHA at the time of its rulemaking regarding the use of condoms in pornography, Project Inform expressed concern that limiting the protection of adult film workers from HIV and hepatitis C (which can be sexually transmitted) solely to the use of condoms represented an outdated and unscientific approach. It is well known that HIV-positive people who are effectively treated are up to 96 percent less likely to transmit to their partners. Additionally, PrEP can be at least 93 percent effective in preventing HIV-negative people from acquiring the virus. On this basis, and consistent with our belief in the importance of encouraging people to make their own well-informed choices about what prevention methods they use (beginning with knowing their HIV and hepatitis C status), we encouraged OSHA to more carefully consider its rules.