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Affordable Drugs not Easy to Come By By Judith Achieng NAIROBI - Affordable and available treatment for women living with HIV in Kenya is still one of the greatest challenges facing the healthcare delivery system, the government and activists fighting for the rights of people living with HIV/AIDS. For the 2.5 million adults in Kenya living with HIV, the majority of whom are poor, the only drugs that can be obtained are often provided at a low cost through hospital programmes, similar to one funded by Medecins Sans Frontieres (MSF) at a major hospital in Nairobi. These drugs, however, only fight opportunistic infections, such as tuberculosis and cryptococal meningitis. MSF is unable to provide anti-retroviral combination therapies used in treating the virus itself, due to their prohibitive cost and tight importation rules. In Kenya, according to MSF, which is spearheading campaigns for easier access to drugs, anti-retroviral cocktails are only available in urban hospitals and pharmacies, which have sophisticated infrastructure and the expertise to administer and monitor their use. But these drugs are far out of the reach of the average Kenyan. In May this year, the cheapest price negotiated by certain hospitals in Kenya came to USD 1, 620, making the drugs affordable to only about 2, 000 out of the 2.5 million HIV-infected Kenyan adults. Generic companies, like India's Cipla have been selling ARV combinations to African governments like Cameroon and Nigeria, for as little as USD 350 per patient per year. But Kenya is yet to enter into such an arrangement. The biggest challenge in accessing drugs in Kenya, according to MSF regional pharmacist Sofie Marie Scouflaire, is to get information on where, in the big towns, the cheapest drugs are sold. "It is difficult for everybody to know where to get the cheapest medicines. People who can only get good treatment are in the private sectors." For women, already marginalised by socio-economic factors, access to anti-retroviral drugs and essential medicines is further out of reach, although they need more special reproductive care than men. "Many of them suffer quietly and don't know that they need to go for treatment," Patrica Asero , an HIV/AIDS counsellor, says. Although few studies have been conducted on the specific problems faced by women in accessing the costly anti-retrovirals, it is believed that they are more disadvantaged since the majority of them are poor. "Women are marginalised in policy development. They are the majority of those unemployed. When they get sick, society still demands that they continue with their role of providing care to their families," says Eunice Odongo, the head of Women Fighting AIDS in Kenya (WOFAK). Women also in many cases, says MSF lawyer and campaigner Indra VanGirbergen, are left with little or nothing to buy drugs with, when men sell the family property to treat themselves without telling their wives. "In terms of financial support, we assume that women have less access than men. They are the majority of those infected and also the majority of those who are unemployed," Girbergen says. The problem of access also goes deeper than the cost of anti-retrovirals. It is a package that involves access to medicines used in treating opportunistic infections, and also the availability of testing equipment, a major requirement in the HIV treatment plan. Even with a reduction in the price of the anti-retrovirals, a coalition of 15 NGOs fighting for better access to AIDS drugs, argues that HIV will continue to be a major killer in Kenya, if the cost of other essential medicines remains high. In the villages, where the majority die due to lack of testing and treatment of infections like malaria and typhoid, the cost of testing for HIV treatment is too prohibitive. To improve access and information to women in the rural areas, organisations like WOFAK are now targeting traditional healers for training on how to prescribe the anti-retrovirals, particularly to expectant mothers. "However much the cost of anti-retrovirals are reduced, they will still remain inaccessible, if we do not out where the women are," Odongo adds. The Kenyan Parliament is about to pass the Industrial Property Bill, although the government has run late on its commitment to be TRIPS compliant by December 2000. The Bill will ensure that Kenya respects patent laws that protect drug companies from competition by generic manufacturers. But the NGO coalition is asking the Parliament to take advantage of the health safeguards provided for by TRIPS in cases of national emergency, like the HIV/AIDS pandemic, to save the lives of those already infected. "The
MPS must not miss this opportunity to include life-saving WTO/TRIPS
safeguards such as parallel importation and compulsory licensing
in the Bill," says Chris Ouma, a doctor with the British charity
ActionAid and a leading crusader for access to AIDS drugs in Kenya.
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