SOUTH AMERICA:
AIDS Meds for All, But
at Higher Prices
By Fabiana Frayssinet*
RIO DE JANEIRO, (IPS)
- In under a decade,
programmes providing
universal free access to
antiretroviral medicines
have greatly decreased
AIDS mortality in
countries like Argentina
and Brazil, but this
progress is now
threatened by the rising
prices of new formulas
patented by the big
pharmaceutical
companies.
The Brazilian Health
Ministry guarantees
access to antiretroviral
medications for all
people with HIV/AIDS.
According to the
National Programme on
Sexually Transmitted
Diseases and AIDS (PN-DST/AIDS),
180,000 people in Brazil
are regularly taking
these drugs, which
reduce the HIV (human
immunodeficiency virus)
load in the body,
improving quality of
life and preventing
opportunistic
infections.
Between 1996 and 2004,
antiretrovirals
contributed to lowering
AIDS mortality by 27.5
percent, and between
1996 and 2003,
AIDS-related hospital
admissions fell by 80
percent. This saved the
health services 635,000
hospital admissions and
an estimated 1.7 billion
dollars in health costs,
according to official
figures.
The same trend is seen
in Chile, which achieved
universal antiretroviral
coverage in the public
health sector in 2003.
"The effects of
widespread use of these
drugs can already be
clearly seen, and
AIDS-related health
indicators have
improved," Patricio
Novoa, coordinator of
the holistic healthcare
department at Vivo
Positivo (Living
Positive), an umbrella
group of Chilean
organisations for people
living with HIV, told
IPS.
In Argentina, the Health
Ministry says that in
1996 -- before
antiretroviral treatment
was available -- AIDS
mortality stood at 60
percent, while by 2004
mortality had dropped to
38 percent, "and the
figure is doubtless even
lower now," the
executive director of
the non-governmental
Fundación Huésped, Kart
Frieder, told IPS.
These indicators are
accompanied by other
non-quantifiable
benefits, says Veriano
Terto, coordinator of
the Brazilian
Interdisciplinary AIDS
Association (ABIA).
"The big change that has
occurred since
antiretroviral meds
became available is that
as patients' quality of
life has improved, the
link between being
HIV-positive and death
has been broken, the
idea that because one
has AIDS one is doomed
to die. AIDS and the
stigma of death have
been separated," Terto
said.
The Joint United Nations
Programme on HIV/AIDS (UNAIDS)
considers Brazil's
programme one of the
best and most successful
in the world. Seventeen
drugs are included in
the anti-HIV cocktail
used in this country:
eight of these are
imported and nine are
produced locally, in
government laboratories
like Fiocruz.
Production of generic
drugs, which have the
same active ingredients
as patented medicines
but are far cheaper,
knocked down the average
cost of treating one
patient for one year
from 6,240 dollars in
1997 to 1,336 dollars in
late 2004, said
Mariangela Simao, the
director of PN-DST/AIDS.
These savings were
achieved by a combined
policy of government
funding for
manufacturing generic
medicines, and vigorous
negotiation with the big
transnational
pharmaceutical companies
to bring prices down.
The negotiations were
successful, for
instance, when Brasilia
threatened to impose
obligatory licensing, a
mechanism under
international trade
rules that in effect
annuls the patent in the
country where it is
enacted. This persuaded
Roche to reduce the
price of Nelfinavir by
40 percent, leading to
savings of 40 million
dollars a year, and
Merck to accept a 60
percent price cut for
Efavirenz, saving the
Brazilian state another
43 million dollars a
year.
The most publicised case
came earlier this year,
when the failure of new
negotiations to cut the
price of Efavirenz
prompted the Brazilian
government, for the
first time ever, to
require obligatory
licensing for public,
non-commercial use of
the drug, a pioneering
step in Latin America.
Brazil based its action
on the intellectual
property agreements
adopted by the World
Trade Organisation (WTO),
which established the
priority of public
health over patenting
rights, in order to
allow countries to take
such measures when
facing health
emergencies.
Buying the generic
version of Efavirenz, at
first from laboratories
in India, will lead to
savings of 30 million
dollars a year in health
spending, said Simao,
and this money "can be
invested in other
measures to improve
health care for people
living with AIDS," she
added.
"UNAIDS takes a positive
view of measures taken
by a country to ensure
universal access to
medicines by its
population," the
agency's representative
for South America's
Southern Cone region,
Laurent Zessler, told
IPS.
Brazil, "a middle-income
country, has shown that
it is possible to
implement free
distribution of medicine
nationwide, and that
this is associated with
treatment compliance by
people living with HIV,"
he added.
The bad news, according
to Simao, began in 1995
"when more patients were
gradually coming forward
for treatment. Then when
new medicines came on
the market, individual
treatment costs began to
rise."
The greatest challenge
now is not only to
maintain the good
results achieved so far,
but to extend them
further, and guarantee
that they will be
sustainable in future,
warn non-governmental
organisations like ABIA,
represented by Terto.
"The new medicines are
increasingly expensive
and increasingly heavily
protected by patents,
and as the number of
treatment cases rises,
it will be difficult for
the government to
maintain its programme,"
Terto said.
The same obstacles may
affect the Argentine
programme, Frieder said.
"New medicines have
begun to appear, for
which no generic
versions exist, nor are
they listed in
pharmacopoeias. They are
used to improve the
patients' quality of
life, for example, they
involve taking one pill
a day instead of six,
and access to them will
be more difficult,"
Frieder said.
The price hikes are also
causing concern at the
international
humanitarian
organisation Médecins
Sans Frontières (MSF -
Doctors Without
Borders), which treats
more than 80,000
HIV-positive patients in
more than 30 countries.
An article published on
the MSF website called
attention to the "cost
explosion" of
antiretrovirals and said
its spending on these
drugs will double in the
next two years, as more
and more patients have
to move on to more
modern, second-line
treatments.
Around 50 pharmaceutical
companies throughout the
world are producing
these medicines, MSF
said, and new treatments
and potential vaccines
are being developed
because they have a
market in Western
countries.
However, the article
points out that of the
40 million people
infected with HIV/AIDS,
90 percent live in the
developing world, and
out of the six million
people in developing
countries who need
antiretroviral drug
therapy, only 440,000
are receiving it, based
on UNAIDS figures from
2005.
Solutions for the
future, whether
initiated by UNAIDS, MSF
or the William J.
Clinton Foundation, will
have to be based on
antiretroviral
donations, production
and technical training
networks.
Brazil, for instance,
donates locally produced
antiretroviral drugs to
11 countries: Bolivia,
Burkina Faso, Cape
Verde, Colombia, East
Timor, El Salvador,
Guinea Bissau,
Mozambique, Nicaragua,
Paraguay, and Sao Tomé
and Príncipe, according
to Simao.
In January 2006, Brazil
and Argentina signed a
cooperation agreement
for the building of a
pharmaceutical plant to
manufacture medicines
and diagnostic tests for
several diseases,
including AIDS.
The plant is to be built
in Argentina and will be
financed by investments
from both countries.
Brazil coordinates an
International Technical
Cooperation Network on
HIV/AIDS to which
Argentina, China, Cuba,
Nigeria, Russia,
Thailand and Ukraine
also belong. Its primary
purpose is technology
transfer for
antiretroviral
production.
These initiatives have
contributed to the
sustainability of
antiretroviral
distribution programmes
in countries like
Bolivia, where for the
past four years AIDS
victims have had access
to the medicines through
departmental
(provincial) health
services. Brazil has
donated antiretrovirals
to Bolivia since 2003.
In Venezuela, all
HIV/AIDS patients
registered with the
Health Ministry have had
access to the drugs free
of charge since the year
2000.
Between 20 and 30
million dollars a year
are spent on this
programme. The 17
medicines used are
bought from Cuba and
India, among other
manufacturing countries,
and Caracas supports
Latin American
negotiations with the
big international
pharmaceutical companies
to secure price
reductions.
The cooperation network
is beginning to take
shape in Paraguay, too,
where 1,184 people
receive the drug
cocktail through the
National Programme on
AIDS. The mortality rate
has been cut by 30
percent since 1996,
programme director
Nicolás Aguayo told IPS.
Paraguay also
participates in a
Brazilian government
initiative called
South-South Links, under
which 300 people,
including 21 children,
receive antiretroviral
medication.
(*With additional
reporting from Marcela
Valente in Argentina,
Bernarda Claure in
Bolivia, Daniela Estrada
in Chile, David Vargas
in Paraguay and Humberto
Márquez in Venezuela.)
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