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REPORTS: LATIN AMERICA |
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Access to Anti-AIDS Drugs Varies Widely
in Latin America
Diana Cariboni*
MONTEVIDEO, (IPS) - A year ago, 52
Bolivians living with HIV/AIDS
complained to the Inter-American
Commission on Human Rights that their
government refused to provide anti-AIDS
drugs free of charge, in violation of
the country's international commitments.
Only 33 of them are alive today.
David was the last to die, in November,
when his hopes were extinguished, along
with his battle, as the leader of the
VIHDA network in the central Bolivian
city of Santa Cruz, for the
antiretroviral drugs (ARVs) that could
have extended his life.
A mere 3.7 percent of the known number
of people living with HIV/AIDS in
Bolivia receive ARVs -- which strengthen
damaged immune systems, helping patients
to resist and recover from opportunistic
infections -- says a study by the local
non-governmental Human Development
Institute (IDH), signed by physicians
Edgar Valdez, Andrés Vargas, Daniel Ruiz
and Anna Sauden.
ARVs are essential to allowing people
with HIV to live longer, healthier
lives.
Although the official statistics
indicate that there are 537 people
living with HIV and 466 suffering
full-blown AIDS in Bolivia, a country of
8.2 million, the real number of cases is
in the thousands, say local
non-governmental organisations (NGOs).
The cost per patient of treatment with
ARVs in Argentina and Brazil has been
brought down to a low 50 to 110 dollars
a month, depending on which drugs a
patient needs.
But in Bolivia the cost ranges between
1,000 and 1,500 dollars a month -- ''An
inconceivable sum for most people,''
said Valdez, at the Human Development
Institute. Indeed, the minimum monthly
salary, 56 dollars, would pay for just
one day of treatment.
''We have no access to the medicines,
and people are dying every day,''
HIV-positive activist Violeta Ross with
the Bolivian Network of People Living
with AIDS said in an e-mail
communication with IPS ahead of World
AIDS Day (Dec. 1).
Nevertheless, South America is one of
the regions in the world where treatment
with ARVs is most widely available, the
World Health Organisation (WHO) reports.
Of 40 million people living with the
disease worldwide, only 400,000 receive
ARV therapy, a significant proportion of
whom live in South America, mainly
Brazil, according to WHO statistics.
Under a programme launched in Brazil in
1996, all people living with HIV/AIDS
have the right to ARVs provided free of
charge by the public health system. This
year, a projected 175 million dollars in
public spending will go towards treating
people with the disease.
''I have been taking the medicine since
eight years ago, when I fell ill with
pneumonia and discovered that I had
AIDS. I started out with AZT, the only
ARV available then, and later I began to
take the cocktail when the Health
Ministry started to distribute it in
1996,'' Silvestre Gonçalves Maia, a
39-year-old high school physical
education teacher, told IPS.
Gonçalves Maia now dedicates his time to
helping AIDS patients, as general
coordinator of the National Network of
People Living with HIV/AIDS in Campina
Grande, a city in the interior of the
state of Paraíba, in northeastern
Brazil.
Although he praised the public health
programme for distributing high-quality
ARVs free of charge, the activist said
that in Campina Grande, the blood tests
to determine the HIV viral count are not
carried out frequently enough, which
makes it difficult to orient the ARV
cocktail therapy for each patient.
Of the 215,000 registered cases of HIV
followed by the public health system in
Brazil, 135,000 are receiving ARVs, and
the remaining 80,000 have low viral
counts. But the government estimates
that the real number of people living
with the disease is closer to 400,000,
out of 174 million people.
Since 1996, Argentina and Uruguay also
provide ARVs to anyone who needs them,
at no charge.
But government programmes providing
treatment to those living with HIV
entail a constant struggle to keep costs
down, through a range of initiatives:
the use of generic medicines,
negotiations with manufacturers for
reduced prices, and even threats to
waive patent rights.
Brazil's patent law provides for
''compulsory licensing'', which permits
the manufacture and use of generic drugs
without the agreement of the
patent-holder, in cases of ''national
health emergencies.''
Brasilia took its fight to the World
Trade Organisation (WTO), where poor
countries were successful in their
struggle to obtain an agreement allowing
them to override patents on lifesaving
drugs in emergency situations, under the
principle that public health takes
precedence over intellectual property
rights.
Argentina -- where 140,000 people are
living with HIV and 25,000 are suffering
full-blown AIDS, out of a population of
37 million -- has achieved full access
to ARV therapy.
The Southern Cone country also has a law
enabling the use of generic medicines.
But it is of limited use in the case of
HIV/AIDS. ''The market (for ARVs) has
the typical shortcomings of an
oligopolistic market,'' including scarce
competition, the director of the
National AIDS Programme, Gabriela
Hamilton, commented to IPS.
As the range of experiences in Latin
America shows, there is no single magic
formula for bringing prices down.
In June, Argentina, Bolivia, Colombia,
Chile, Ecuador, Mexico, Paraguay, Peru,
Uruguay and Venezuela reached an
agreement with transnational drug
companies for massive reductions in the
price of ARVs.
Argentine Health Minister Ginés González
García said the successful negotiations
''will mean a savings of 150 million
dollars a year for Latin America,''
which could go towards expanding
coverage where necessary.
Colombia is an example of that need. ARV
therapy is received in only 9,000 of
220,000 registered cases of people
living with HIV. (The non-governmental
Colombian League Against AIDS puts the
total number of cases at 459,000, out of
a population of 44 million.)
Treatment with ARVs costs 500 dollars a
month per patient in Colombia, where the
public health services recognise only
seven of the 14 ARVs approved worldwide,
and do not cover the 200- dollar cost of
the blood test needed to determine the
HIV viral load.
Patients in Colombia have found it
necessary to engage in protracted legal
battles to obtain ARVs from the public
health system. Between 2000 and 2002,
the number of lawsuits increased 440
percent, and the Health Ministry had to
earmark 9.5 million dollars last year to
deal with the legal complaints.
''The unaffordable cost of the
medicines'' and the fact that only 9,000
people receive them ''are clear
indications that the rights of patients
are being violated,'' Cecilia López, a
former director of the Social Security
Institute, told IPS.
In addition, the problem with the
''generic drugs that are distributed is
that their quality is not certified,''
the director of the health publication
Indetectable, Mauricio Sarmiento,
remarked to IPS.
In neighbouring Venezuela, treatment
costs 500 dollars a month per patient;
in the Central American country of Costa
Rica the cost has been brought down from
625 dollars a month to less than 200 for
the use of generic medicines; and in
Uruguay, the drugs cost 400 dollars a
month.
In Chile, generic medicines are not
used. The cost of ARV therapy ranges
between 200 and 650 dollars a month, and
more than 90 percent of patients receive
treatment. But only pregnant women and
children receive the medicines at
absolutely no cost.
Costa Rica has reduced AIDS-related
mortality by 20 percent since 1988, the
director of the Social Security
Institute's AIDS programme, Solón
Chavarría, told IPS.
In Uruguay, the National AIDS Fund was
set up in 2001, financed by a one
percent tax on insurance policies and a
five percent tax on transfers of
professional football players.
AIDS-related mortality has been slashed
by 50 percent since 1996, the same
proportion as in Brazil.
But of the 1,200 Uruguayans receiving
treatment, ''we lose track of and are
unable to follow up on 10 percent of the
cases,'' the director of the National
AIDS Programme, Margarita Serra,
commented to IPS.
The Uruguayan organisation of people
testing positive for HIV/AIDS complains
of ''discontinuity in treatment'' and a
lack of effective quality controls for
generic medicines.
In Venezuela, just over 10,000 people
receive treatment with ARVs in the
public health system, less than 20
percent of the 70,000 people living with
the disease, according to NGOs. In 2001,
the Supreme Court ordered that the
cocktail therapy be provided to all
patients free of charge.
In June, Chile, one of the most
prosperous countries in Latin America,
received a 39 million dollar grant from
the Global Fund to Fight AIDS,
Tuberculosis and Malaria to ensure 100
percent access to ARV therapy for AIDS
patients.
But in Bolivia, the poorest country in
South America, where at least 70 percent
of the population lives in poverty,
Violeta Ross is still waiting for the
Global Fund to provide funds for
treatment for herself and more than
1,000 other patients.
* Marcela Valente (Argentina), Franz
Chávez (Bolivia), Mario Osava (Brazil),
María Isabel García (Colombia), José
Eduardo Mora (Costa Rica), Gustavo
González (Chile), Raúl Pierri (Uruguay)
and Humberto Márquez (Venezuela)
contributed to this report.
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