Africa, Development & Aid, Headlines, Health

/CORRECTION*/HEALTH-GUINEA: Killing AIDS Patients With Kindness

Saliou Samb

CONAKRY, Jul 13 2004 (IPS) - The debate on how best to provide anti-retroviral medication to HIV-positive citizens has taxed the ingenuity of many an African government – not least that of Guinea. However, the administration of this country now appears to be making citizens the victim of its own good intentions.

At present a government agency, the Central Pharmacy of Guinea (Pharmacie centrale de Guinée, PCG) is the sole importer of anti-retrovirals (ARVs) – drugs that are used to prolong the lives of people affected by AIDS-related diseases.

The Executive Secretary of the National Committee Against AIDS (Comité national de lutte contre le SIDA, CNLS), Mariama Djelo Barry, says the decision was taken because private firms that imported the drugs were charging too much for them.

“The authorities’ decision to forbid private companies from importing anti-retrovirals is an attempt to help the ill,” she told IPS. According to the CNLS, HIV prevalence in Guinea presently stands at about 2.8 percent for the adult population – and a frightening 55 percent rate for the country’s prostitutes.

Unfortunately, the PCG appears unable to keep up with the demand for ARVs in Guinea.

A consultant to the agency who chose to remain anonymous told IPS that “The PCG does not buy as much anti-retroviral medication as it should because the government insists that it be sold at the purchase price.”

“Unless the government decides to subsidize it,” the consultant added, “the PCG can only make a profit by selling imported medications. That’s why the agency prefers to give priority to other, more lucrative pharmaceutical products which are on the list of essential medications.”

These views are echoed by Lamine Conde, a representative of Laborex: the biggest private importer of pharmaceutical products in Guinea.

“They asked us to stop importing anti-retrovirals in 2001, but today we can see that the PCG, which often imported from India or China, does not have the means to buy these medications in large quantity. That’s why there’s a shortage on the market,” he told IPS. Laborex, which controls 80 percent of the market, is a subsidiary of the French firm, Pinault Printemps Redoute.

Previously, the company offered consumers in Guinea a combination ARV treatment that cost about seven times more than the treatment provided by the PCG.

The Director-General of the PCG, Houssein Bah, refused to give IPS comment for this article.

During the past decade, the price of a month’s supply of generic ARVs has decreased from about 487.5 dollars to 85 dollars – the price at which they are currently sold by the PCG. Previously, Laborex offered a combination of ARVs for about 600 dollars a month. More than 50 percent of the population in Guinea lives on less than a dollar a day, according to official statistics.

“The situation for those of us being treated with anti-retrovirals is worrying,” Tidiane Conte, an HIV-positive person told IPS.

“Now they’ve run out of stock, and brand-name products as opposed to generics are much more expensive. This is inadmissible,” he added.

In response to these shortages, Conte and Halima Camara – another person infected with HIV – created the Guinean Association of People Infected and Affected by HIV/AIDS (Association guinéenne des personnes infectées et affectées par le VIH/SIDA, AGUIP+) in Feb. 2003. Both believe that their country’s ARV policy is a death sentence for Guineans living with AIDS.

Anger towards the government deepened recently, after citizens were mistakenly informed that a batch of ARVs funded by a Swiss Company at a cost of 30,000 dollars could be used to treat 100 recipients. (The donation was administered by the Maman Henriette Conte Foundation, named after Guinea’s first lady.)

Officials later discovered that World Health Organisation (WHO) regulations requiring that AIDS patients receive a cocktail of three ARVs meant fewer people could be treated for that amount of money.

“The total cost of the donation was 30,000 dollars. Since the WHO now requires tri-therapy (triple therapy – the use of three drugs), the number of beneficiaries was thereby reduced. Some of those receiving treatment didn’t understand this situation,” Barry explained.

As a result, various HIV-positive persons threatened to voluntarily infect other citizens in protest.

“I understand those people, they’re desperate – even though I would never threaten such a thing myself,” Conte told IPS.

Mohamed Cisse, the physician in charge of patient care at Donka Hospital in the capital of Conakry, Guinea’s main treatment center for AIDS, warned that HIV-persons who took this action might worsen their own predicament by exposing themselves to other strains of the virus.

“In Guinea, the most common strain of the virus is HIV1. To try to infect others means that you risk raising your viral load by exposing yourself to HIV2. The patient’s situation would then be even more desperate since the majority of anti-retrovirals which come into Guinea are not effective against HIV2,” he noted.

The CNLS, which coordinates the fight against AIDS in Guinea, has received 20 million dollars in aid from the International Agency from Development, a World Bank subsidiary – and two million dollars from the Guinean government.

“Sixty percent of this money is for training personnel, buying anti-retrovirals and logistics. The remaining 40 percent will be devoted to prevention,” says Barry.

However, it is estimated that Guinea requires more than 116 million dollars per year to meet the needs of those who have contracted HIV.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), Guinea applied for a 22 million-dollar grant from the Global Fund Against AIDS, Tuberculosis, and Malaria in 2002. The country received 11 million dollars, to be disbursed over a two-year period (2003-2004) – of which only 1.5 million dollars has been released.

“Since we started operating, five of our members have died,” said Camara, of AGUIP+.

“Today we’re still up and running, thanks to support from the GTZ (the German overseas aid agency), which gave us 90,000 euros (almost 112,000 dollars) in April 2003 for our budget. We have an 18-month programme. Part of this money allows us to provide care for 30 of our members.”

“In addition to our 57 infected members, about 30 healthy people also participate in our activities as individuals affected by HIV/AIDS,” she added.

(* ATT EDS: The story filed 22:58 GMT Jul. 13 requires an addition in paragraph 27. Please note that the 90,000 euros referred to by Halima Camara equates to about 112,000 dollars.)