Shortage of ARV and essential drugs in Manipur

[Guest guest]

Dear All

Greetings from ANP+

(Please see the message from Dodo Namaram on drugs shortage in Manipur)

Its is realy sad news for us (PLWHA) who taking medicine as well as well wisher.

we all know that we have mantain adharence, but how? its a big questionmark. If

this people are resistent ART, will NACO going to provide 2nd line drugs? Still

NACO people not ready or discussed about 2nd line therapy. Also we are facing

probleem like co infection of B and C.

We are not puppets. Goverment people can not play with our life. All the time

they can't blam us for our situation

It is a shame. Why is health ministry and other dept like MSACS, do not reply to

us. Are they going take responsiblty for our life.

We need answer from them?

Request them that NOT TO PLAY IN OUR LIFE.

Jahnabi Goswami.

e-mail: <jahnabig@...>

_________________________

Message from Kishalaya Dodo Namaram

Dear All,

A lot of life-threatening things are happening here in the north east of India,

Manipur and NEIHRN as a network wish to share with you all the current situation

which had added fuel to the fire.

Correct me or advice me pliz if I am wrong ? and pliz suggest us ways and means

to ease out from this serious situation. I know no human situation is simple,

but I guess we can at least share and do something. Can we ? We must !

Its been two-three days back, people are talking about the problems of non

availability of essential medicines in the state, both in the market as well as

the Government setups.

Quite out of the blue, we were taken by surprise and awe when the news of “acute

drug shortage” including “essential medicines” came out in the local newspapers

– how could the state government or the person responsible do such a thing to

its people and patients ?

Now, the question is, what should we do as people/social worker/activist working

in the field of health care and management of HIV/AIDS? And what about those

living with Diabetes ? or Alzheimer or whatever chronic.

With the imminent shortage of drugs in the state, and among the worst affected

and most vulnerable community/patients are the people, especially women,

children and people living with HIV/AIDS and Hep-C or simply “co-infected”.

Its an irony, when we all are seeking 2nd line ARV (Anti retroviral) and PEG

Interferone for Hep-C in the region, one could not even get access to simple

essential medicines, forget the medicines for chronic illnesses.

In an effort to unite and work together for the affected and infected community,

several representatives from various NGOs in the state gathered at the office of

the Manipur Network of Positive People, (MNP+) earlier on August 11. One of the

thing we had agreed is to “submit a memorandum to the concerned authorities in

charge of health.”

That is yet to happen.

Perhaps, non-availability of proper medicines is the ultimate end of human

civilization or perhaps for those living with a chronic diseases. Considering

the ever-happening of lawlessness and lack of humane heart, the degrading

socio-economic factor, the need for essential medicines drives men, women and

children to depend on " meagre quotas " of medicines provided freely by Government

institutions and some NGOs by waiting for their turns amidst long queues and

discriminatingly prying eyes.

Is the idea of providing timely medicines for proper adherence policy an

illusion? Top officials and lawmakers understand the social activist' and

patients concern and are doing their best to shift those priorities.

But it is a downward escalator struggle and if things go the way as it is now;

the future of " HIV/AIDS Interventions " , " Alternate approaches " and “NACP-III” in

Manipur is more in doubt than ever. At least for the anticipated future, the

need and enthusiasm of its success has yet to show itself.

Until then, we remain,

Yours truly,

Dodo.

P.S. Below here are the texts extracted from the local news papers:

1) “Problems in HIV/AIDS treatment highlighted” and

2) “Is an acute drug shortage imminent in Manipur?”

Problems in HIV/AIDS treatment highlighted

IMPHAL, Aug 11: In an effort to increase the treatment efficacy and assess the

immunological state of people living with HIV, a one-day seminar was organized

by CARE Foundation at the Conference Hall, Shri Shri Balumukunda Dev, Music

College, Palace Compund, Imphal this afternoon. The seminar was supported by

Catholic Relief Service.

Altogether 100 individuals including people on ARV attended the seminar. During

the session, experts and resource person spoke on the occasion highlighting

different experiences with unique problems faced in the state. Participants and

representatives from different sections of the society asked several queries on

ARV adherence, regarding the signs and symptoms and the remedies to be taken up.

Speaking on the occasion as resource person, Dr K Priyokumar stressed the need

to maintain a strict adherence (upto about 95 percent) as far as ARV medication

is concerned. The senior doctor further pointed out that of all the patients on

ARV, about 20 per cent of them are irregular. This he said have led to a very

critical situation where the current first line treatment/medication becomes

resistant and useless.

Dr Priyokumar also advised that ARV must be taken within 12 hours gap everyday

in order to get the full benefits of the medicines. He also cautioned that while

starting medication, proper investigation must be done in order to select and

identify the right combination of drugs.

Some of the medicines would result in various side effects, he said and added

that with the right combination, HIV infection have become a chronic and

manageable disease.

Dr Raghumani, of JN Hospital who also spoke on the occasion seriously pointed

out the need for a holistic approach towards the treatment and management of

HIV/AIDS in the state. Among the gaps and liabilities, Dr Raghumani, said that

there is a lack of proper counseling amongst children and their parents.

The senior doctor from JN Hospital further pointed out the several dilemmas

faced in the state. He said, so far about 500 children have been mapped and

there are several number of children in the hidden community. He was however of

the opinion that proper nutritional support, regular health check up and

educational support would help the affected community live a positive lifestyle.

Senior Sister, L Radharani, JN hospital also pointed out that several individual

of the IDU (Injecting Drug Use) population are not keeping their medication

timings. Some of them, she said, would go and relapse into drugs use again -

thinking they are getting better. So the cycle of treatment and relapse are

repeated time and again amongst several patients on ARV.

This is one of the main reason for seeking second line therapy, she said and

added that there might be a time where there would not be any combination to

treat the person infected by a resistant virus, she cautioned.

(Courtesy - Imphal Free Press, http://www.ifp.co.in/FullStory.asp?NewsID=614)

____________

Is an acute drug shortage imminent in Manipur?

IMPHAL, Aug 11: An acute drug shortage is likely in Manipur post 15 August with

most of the major pharmaceutical companies not sending fresh stock of medicines

due to monetary demand from insurgent organisations.

It was reported by many of the drug stockists that since July 23-24 no fresh

stock of medicine has arrived in the state, with over 90% of the companies

ceasing their drug supply to Manipur. Most of the stockists and retailers said

that the decrease in drug supply is related to a certain insurgent group

demanding a hefty percentage from the profits of the companies.

The demands were refused on the ground of illegality and subsequently major

pharmaceutical companies left Manipur. It was also reported that some of the

companies have transferred their medical representatives from Manipur to other

northeastern states.

As per an official report, around 200 pharmaceutical companies are supplying

medicines to Manipur. Most of the wholesalers refused to comment beyond

admitting that there are shortages of some critical drugs. A pharmacist at

Pureiromba said, “For the last 15 days we are hardly able to get half of the

medicines we ordered.”

Terming such incidents as unheard of elsewhere, a reliable source from the

druggists fraternity said, “It is true that there is shortage and in the coming

few days it will become more serious.”

Kh Bobby, a person who is living with HIV/AIDS and who is currently taking the

second line ART, said, “For the last two months I had been unable to get the

drug Lopimune produced by Cipla. I was lucky enough to get the last piece from

Khalsa Medicos. I don’t know what will happen after this gets over. Are we to

wait for death?”

Bobby, who is also the secretary of MNP+, said that most of the life-saving

drugs that are being taken by the HIV positive people who are on ART are not

available in the market. He said that in ART drugs, adherence is most important

since in the absence of it drug resistance develops and this leads to

non-effectiveness of the first line ART that is being given free by NACO.

Dr Priyokumar, ART in-charge JN Hospital said, “The minimum level of adherence

for ART drugs is 95%, though 100% adherence is ideal. Anything below 95% could

lead to drug resistance and development of ARV-resistant virus. For those on

first line of ART, there is still the option of second line which is not free.

However, in the case of drug resistance to second line drugs, the option for

third line drug is not there in India. Naturally the patient will die.”

In a joint press release issued by MNP+, Kripa Foundation, Care Foundation,

Lifeline Foundation, SASO, SAVE, CFAR, MLSS and NEIHRN it was stated that the

non-availability of life-saving drugs at the ART centres, especially RIMS and

JNH, and in the market have caused much alarm among the people living with

HIV/AIDS. It was also decided unanimously to submit a memorandum to the

concerned authorities in charge of health.

The press communiqué also stated that due to the withdrawal of some medicine

companies from Manipur, there is widespread apprehension among the people about

the possible crisis arising out of non-availability of life-saving and other

drugs and even syringes.

Through the press release, the NGOs appealed to those responsible to clarify to

the people why the drugs are not available at the markets and ART centres.

(Courtesy - Imphal Free Press, http://www.ifp.co.in/FullStory.asp?NewsID=621)

____________________

Kishalaya Dodo Namaram

General Secretary

North East India Harm Reduction Network

Babupara Masjid Road, Opp Masjid,

Imphal West – 795004, Manipur State India

Mobile : +919862027734

Phone : 913852411343

Phone (off) : 91-385-2413936/2413850

e-mail : dodonamaram@...

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skype : dodonamaram