Kamala Sarup: Don't Make Profit On HIV Drugs

Asian countries are struggling to cope with the growing HIV/Aids epidemic because they do not have the same access to the new and expensive drugs used in the western countries. In countries where no free drugs are provided, the problem is worse.

In Asia, HIV/AIDS positives have been deprived of CD-4 Cell Count facility, and also deprived of the widely available ARV drugs. Standard treatment with antiviral drugs is just too expensive for most people in the region. An effective HIV/AIDS vaccine is still a dream. HIV people have a question why are these drugs so expensive?

In Vietnam, India, Thailand, Bangladesh, and in Nepal for example, patients buy cheap black market drugs, or only take the drugs when they can afford them, stopping when they cannot afford them and restarting again.

Dr Mark Nelson, director of HIV services at London's Chelsea and Westminster Hospital, said to BBC News On-line: "patients were unlikely to be denied the drug because of its high cost". Many patients in Asia with infectious disease live in poor, rural areas, so they cannot afford the often costly diagnosis, treatment, and prevention plans.

Though the life-prolonging drugs ARVs bring relief to the lives of people living with HIV/AIDS and increase their life expectancy, poor people have not been able to afford them and it is also beyond the government's budget capacity to provide the drugs to all HIV/AIDS patients for life. With the cost of counselling, social support and medical care, the figure is a lot higher.

"Western drugs and pharmaceutical raw materials have become so expensive in Asia because many medicines are not available. Those medicines that are available have experienced dramatic price increases or are available only on the black market". PM Coordinator Amrit Pandey said.

"The problem is more acute for even South Asian countries, who do not have the money to fund the expensive anti-retrovirals drugs. The cost of the medicine is high, so the local people do not have easy access to buy it," he further said. Even recently, the 146-nation World Trade Organization decided, to allow poor nations to make copies of branded medicines to fight killer diseases.

Even the check-up charge is costly because of the kit, which is very expensive. If CD-4 count is persistently below 500, the immune system is considered to be slightly weak and the patient is at a gradually increasing risk of infections. And if it drops below 200 patient are at increased risk.

It is useful to have CD-4 count measured regularly by the HIV infected to monitor the immune system and help decide if and when to take anti-HIV drugs and begin treatments to prevent infections. Similarly it also helps monitor the effectiveness of any anti-HIV drugs the patient is taking.

The kit helps to monitor the viral load and the stage when to use the drug, which is impossible without the kit. On the other hand, six million people infected with HIV in the developing countries need access to Antiretroviral Therapy (ART) if they are to survive. Only four million have access to this facility.

"In combination with conventional drugs to treat opportunistic infections, ARVs can indefinitely prolong the life of an HIV patient as long as the treatment is not temporary,".Pandey further added.

He further said, "typically, the complaint has been that anti-retroviral drugs made by pharmaceutical companies are too expensive for the developing countries, and that what is needed are cheaper, generic drugs".

On the other hand, HIV patients in parts of Asia run a serious risk of developing resistance to antiretroviral drugs due to the range of drugs available to them, stop start treatment and lack of counseling and monitoring. Report by Treat Asia finds that there are so many companies and drugs that Asia is at risk of rapidly creating drug-resistant versions of HIV.

In China, where Nevirapine is a standard component of antiretroviral triple therapy, 50 percent of 500 rural patients who took the drug for up to 11 months have become resistant.

Dr Edward Telzak, director of the Aids programme at the Bronx-Lebanon Hospital Center in New York, says "The medicines often don't make people feel well. Gastro-intestinal upsets, diarrhea, weakness, rashes, and some people have trouble swallowing the large numbers of pills.

Resistance to drugs occurs because the virus can undergo genetic mutations when it replicates. What complicates matters even more is that people who develop a resistance to a certain drug are more likely to become resistant to the entire class of drugs. Patients who develop drug resistance to Nevirapine need to take different types of drugs, which are much more expensive and patented.

Jack Summerside from the UK charity Terrence Higgins Trust said: "Fuzeon is an important extra treatment option for people with HIV, particularly for those who have used up other treatments available. "But it is costly and even more difficult to take than existing HIV medications".

There are only three classes of HIV/AIDS drugs in Asia, which means poorly thought-out drug programs could leave patients much fewer treatment options and force them to take newer, more expensive drugs.

WHO expert Don Sutherland said "If you don't give the drugs to HIV/AIDS patient, you have 100 percent failure. What's wrong with saving 50 to 60 percent of those lives?"

"This is not just a medical issue, it has impact on every sector of the economy and society". HIV+ Nahara says in New Delhi.

In addition, throughout Asia there are few doctors to treat AIDS patients, so those who can afford the anti-retrovirals often obtain the drugs over the counter and self medicate.

"It is a human rights-based commitment on the part of drug manufacturing companies and governments to cut down the prices. Price of ART had to be brought down to make it accessible for the poor". Nahara further said.

Asian countries are very vulnerable as it has all the ingredients necessary for the spread of the virus. In addition, the prevalence of poverty provides a fertile breeding ground for the spread of HIV/AIDS. Many people migrate within and outside the country for employment. They often do not have access to information and early treatment of sexually transmitted diseases. "The high risk groups like sex workers, their clients, injecting drug users or migrant workers need to get the drugs first. There must first be a concerted national policy to address the epidemic and a well-organized mechanism to deliver therapy". Graduate in English Nahara 24 HIV+, further said.

Parts of Asia and south Asia are experiencing a devastating epidemic of HIV/AIDS. In some of the countries, an estimated 50 percent of the population may be infected. A record five million people were infected last year alone over one million of which were in Asia.

Asian women and children in the poor communities are particularly vulnerable in the region. The lack of funds is severely limiting the treatment of AIDS victims, which is increasing quite alarmingly in the recent years. An AIDS epidemic threatens the robust economies of Asia, with increasing trade, travel and migrant labor fuelling its spread.

In Asia, China is becoming a flash point for the disease. After years of neglect the Chinese government is finally taking action to stop the rampant spread of HIV/AIDS. Cambodia, one of Asia's poorest countries has the highest rate of infection of HIV/AIDS. The numbers are indicative of how HIV is moving from high-risk groups, like sex workers, to becoming a generalized epidemic.

Even UN Secretary General Kofi Annan warned that women were becoming the unwitting victims. He encouraged "leaders everywhere to demonstrate that speaking up about AIDS is a point of pride, not a source of shame."

However, on the other side, Asian manufacturers are having trouble keeping costs down because many of them rely on increasingly expensive imported raw materials.

Lack of access to ART is a global health emergency. The New York Times recently reported on an odd problem -- that there are too many companies making too many generic anti-retroviral drugs to treat HIV. UK pharma giant, GlaxoSmithKline (GSK), has also been criticized for a "scam" in failing to get its drugs to South Africans with HIV. Three years ago, GSK granted a so-called voluntary license to a South African drug-maker to make generic versions of its HIV drug. But not one pill has been produced since.

"We hear millions of dollars are coming for HIV/AIDS. But this is reflected in huge office buildings, expensive vehicles, advertisements, conference seminars and dinners. International organizations have made puppets out of the victims who are made to participate in their seminars, say something on behalf of the victims". Nahara says. "Unless there is a joint effort of the community, donors and the government, problems cannot be solved". She said.

Asia's HIV infection rate is up. It's sad and unfortunate that Governments are in the region are unable to provide affordable care for it's own patients.

"We can not forget how AIDS activists in Singapore called for the subsidize AIDS drugs. Unlike many other developed nations, Singapore does not offer a state subsidy for the drugs, which are too expensive for many Singaporeans". Aids activist from Nepal Namu Rana said.

Dr. Monica from local NGO said "Two types of HIV diagnostic tests are currently on the Asian market: enzyme-linked immunosorbent assay (ELISA) tests and rapid tests. ELISA tests are the most widely used HIV diagnostics in Asia and are the most accurate. However, ELISA tests are fairly complicated, require laboratory support, and do not provide immediate results.

Alternative rapid tests, which provide results in minutes and do not require laboratory support. Many ELISA tests are available (produced by companies such as Abbott Laboratories, Organon, Roche Diagnostic Systems, and Sanofi Diagnostics Pasteur), usually at a cost of $1.20-1.60 per test".

She also said "Paying for anti-retroviral medication for all Asian's HIV/Aids sufferers would cripple the regional health budget. Even international funding may not be enough to ensure a sustainable policy to give patients anti-retroviral drugs".

The governments in Asia has to ensure proper training of health staff for selecting patients, and there needs to be a well-organised infrastructure to take the drugs to the patients. If Asian countries don't unite their forces and take proactive measures to fight the disease quickly, an epidemic cannot be ruled out.

"But why Western countries are pressuring poor countries to relinquish rights to make generic drugs in bilateral agreements in return for free trade agreements". Nahara further says.

Drug companies in rich countries have often been accused of putting profits ahead of any commitment to combating an epidemic, which is decimating populations in Asian countries. Even drug companies in rich countries often put profit ahead of combating an epidemic in developing countries.

(Kamala Sarup is a Co-Ordinator of a media watch group - The Peace Media)

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