Subsidised, but HIV Therapy Only for Rich

[Guest guest]

Subsidised, but HIV Therapy Only for Rich

Sandhya Srinivasan

MUMBAI, Nov 22 (IPS) - India may be a major exporter of anti-

retroviral(ARV)drugs but barely 30,000 people are actually on

medication in this country which itself has a burden of five million

HIV positive cases.

In April 2004, the government announced a " treatment roll-out "

programme through centres in each of the six high-prevalence states

of Maharashtra, Tamil Nadu, Karnataka, Manipur, Andhra Pradesh and

Nagaland.

Two centres were also set up in the low prevalence, but politically

important state of Delhi, which houses the national capital.

India's population of HIV affected is the second largest in the

world and at least 500,000 people need to take drugs lifelong, to

keep from falling ill, to go back to work and to prolong their

lives.

The programme would offer a fixed-dose combination of first-line

drugs. Initially, the government planned to put 100,000 people on

anti-retroviral therapy (ART) by the end of 2005 but it would be

lucky to reach that target by the end of 2006.

Free ARV drugs were to be made available to HIV positive pregnant

women who visited government antenatal clinics, children under the

age of 15 and adults with AIDS (auto-immune deficiency syndrome

caused by the virus) who went to government hospitals for care and

treatment.

But as of July 2005, just 10,255 people were on the programme, the

government stated in parliament . Another 9,000 people are on ART

through schemes for government employees and workers in the

organised sector.

At about Rs 18,000 (400 US dollars) a year, the cost of privately-

funded drug therapy remained out of reach for most people known to

be affected and needing support.

" Not more than 30,000 people are on rational ART nationwide -

government and private sector, " said Jaydeep Gogtey, medical

director of Cipla Ltd, a leading manufacturer and exporter of ARV

drugs, in an interview with IPS.

Cipla's estimate is based on the industry's tracking of

prescriptions. It does not include irrational prescriptions.

Many more people may be on irrational treatment - short courses of

drugs, two drugs instead of three, sharing medicines etc, according

to Sanjay Pujari, a physician based in western Pune city,

exclusively practicing HIV medicine.

Activists and health care professionals also suggest that even the

limited government programme is poorly conceived and run. The

treatment centres are in the cities, while the majority of people

who need treatment live in rural areas and cannot afford to

sacrifice daily wages and travel long distances for the drugs.

Various tests are not free until the person is actually placed on

the programme, putting ARVs out of reach of the poorest, who are

most in need of free treatment.

" The doctors told me that my husband and I would have to spend at

least Rs 1,500 (33 dollars) each, to find out if we qualified for

the medicines, " says a member of a positive support group run by the

Committed Communities Development Trust in Mumbai. " I just sold my

gold earrings to pay for my daughter's treatment--that too in a

government hospital. Where am I going to get more money? "

Even when tests are free, the machinery in government hospitals is

often out of order, forcing patients to go to private diagnostic

centres.

There are reports that people are not properly informed of the

drugs' side-effects and serious adverse effects, and that teh drugs

need to bee taken regularly, life-long.

Vinay Kulkarni, another Pune-based physician, who specialises in HIV

treatment, challenges government claims of `'96 percent adherence to

treatment''. `'The reality is far different,'' he said.

Also, people do not always know that they may develop drug

resistance even with regular treatment, in which case they will need

second-line treatment, which is not available under the government

programme.

Talk of second-line treatment seems ambitious when even AIDS drugs

for children were not available through the government programme for

more than a year after the scheme started. The government had

earlier stated that children with AIDS would be given priority

treatment.

Likewise, people with Hepatitis B, or people being treated for TB,

should be given the three-drug combination with Efavirenz. But this

was not available for some months after the programme started and

has often been out of stock.

Irregular drug supplies have reportedly sometimes forced people to

buy the medicines from the market at their own cost--or risk falling

ill and developing resistance.

The programme for free AIDS drugs is the product of a long battle

starting in the late 1990s. Anti-retroviral drugs changed the

prognosis for people with AIDS - but at 10,000 to 15,000 dollars per

year, these patented drugs were priced out of the reach of most

people, even in the developed world.

International health activist groups, such as Medicins Sans

Frontieres, were at the forefront of the battle for affordable AIDS

drugs, challenging multinational drug companies.

They found an ally in Indian drug companies that had been

manufacturing cheaper generic versions of branded drugs and

exporting them to Africa and Asia. Indian laws permitted this, as

they did not recognise product patents at the time. Multinationals

fought the 'threat' to their patent rights, launching a legal suit

in South African courts.

In February 2001, the Indian pharmaceutical company Cipla Ltd

checkmated the multinationals by offering the three-drug 'cocktail'

of first-line drugs to international voluntary organisations at 350

dollars per person per year.

This eventually brought prices down across the board as other Indian

drug companies competed for a share in the emerging global market.

India has about 10 percent of the world's generic drugs market. It

is among the top five bulk drugs manufacturers, exporting drugs

worth 3.2 billion dollars to more than 65 countries.

So it is particularly ironic that while " about half of all drugs for

AIDS in the world come from Indian companies, their use in India is

very low, " points out Dr Amit Sengupta of the Delhi Science Forum, a

well known, independent policy think-tank. ''The majority of people

can't afford ART even at the lowest rates today.''

There are reports from all parts of the country of patients becoming

resistant to the first-line drugs. A study by YRG Care in Chennai

found that 20 percent of patients were infected with resistant forms

of the virus, requiring second-line treatment.

In eastern Kolkata city, the West bengal state project director has

reported that at least 50 patients in the government programme

require second-line drugs.

The second-line regimen is at least 10 times more expensive than the

first-line regimen, because most are under international patents and

completely unaffordable for an average person in India with AIDS.

No one knows whether the government will provide them through its

programme. " The big question is--will the Indian government issue

compulsory licences? " asks Sengupta. " That is something that we will

have to see. " (END/2005)

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