Development & Aid, Headlines, Health, Latin America & the Caribbean

HEALTH: Access to Anti-AIDS Drugs Varies Widely in Latin America

Diana Cariboni*

MONTEVIDEO, Dec 1 2003 (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.