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Section: Nicaragua
30 November, 2001

UNAIDS Sponsored Talks Result in ARV Price Cuts in Honduras

By Richard Stern*

Significant price reductions for anti-retroviral treatment have been achieved in poverty stricken Honduras as a result of negotiations carried out by UNAIDS and the Honduran government with multi-national pharmaceutical companies.

The negotiations, part of the UNAIDS "accelerated access" program took place November 22nd and 23rd in Honduras's capital city, Tegucigalpa.

GlaxoSmithKline and Boehringer-Ingelheim offered significant price reductions, which, when combined with those previously offered by Merck and Co. would reduce the cost of the triple therapy cocktail to about $1340. per year for some combinations of anti-retroviral drugs and about $1450. per year for others. Of the companies involved in the negotiations, only Bristol-Myers Squibb refused to lower prices of its products in Central America. Badara Samb, of UNAIDS, who had previously negotiated price reductions in other countries, was in Tegucigalpa for the second time in two months to direct the negotiations.

These reductions represent a significant breakthrough in Central America, where triple therapy prices were previously hovering around $4000 per year. However, at $1340 per year, the cost is still significantly higher than the figure of about $800 per year which was achieved in similar negotiations in Africa last year.

Generic producers do not participate in UNAIDS accelerated access negotiations. The Indian company CIPLA is in process of registering its products in Honduras, but product registration is expected to take at least four more months, according to a CIPLA spokesperson in Honduras. CIPLA offers some triple therapy combinations at less than $400 yearly.

The Honduran government recently approved an emergency allocation of $190,000 for anti-retroviral purchase and, according to National AIDS program director Marco Antonio Alvarenga, the government expects to begin purchase of anti-retroviral medications in December. Alvarenga pointed out that with the prices negotiated, the government will be able to purchase medications for approximately 160 people for one year. At prices offered by Indian generic companies, up to about 500 people could receive triple therapy treatment.

It is estimated that as many as 5000 People Living with AIDS in Honduras currently need retroviral treatment. Honduras's population is 6.5 million. The government has not decided how it will choose the first 160 people. A budget of an additional 22 million Honduran lempiras (US $1,400,000) has tentatively been approved and funds are to become available sometime around June of 2002.

During the negotiations, Honduran Health Minister Plutarco Castellanos indicated to participants that he expected that the price reductions offered would be applicable in Nicaragua, El Salvador, Guatemala and Belize, as well. It is estimated that an additional 8000 people are awaiting anti-retroviral treatment in these countries.

Samb, of UNAIDS, told participants in the negotiations, which included Doctors without Borders, as well as representatives from the Pan American Health Organization, government, and civil society, that he had recently negotiated prices of about $1,200 per year in Trinidad and Chile, and hoped that more movement was still possible in Honduras as well.

Olaf Valverde Coordinator of Doctors without Borders Access to Essential Medicines Campaign in Central America commented that "Big Pharma should arrive at these negotiations with clear ideas and appropriate offers. They know that there are many countries still waiting to participate in similar negotiations and they have to become more organized. While blasting Bristol-Myers Squibb, ("They should be ashamed of the attitude they have taken in Honduras") Valverde praised Merck and Company for "taking a serious and completely transparent approach on a world wide level."

Valverde also criticized Boehringer-Ingelheim. "They have offered prices up to three times lower for Nevirapine in other countries," he said referring to the price offered by the company in Tegucigalpa of $657. per year. Boehringer does offer Nevaripine free only to pregnant HIV+ women, an offer that has been extended to Central America.

Valverde also questioned the lack of participation of Abbot Laboratories and Hoffman La-Roche in the Tegucigalpa negotiations.

Author Comments:

These results represent significant progress in the struggle for treatment access in Central America. Hopefully the Honduran government will follow through on its part of the bargain and immediately begin purchasing medications and saving lives. It remains to be seen if Guatemala, El Salvador, Nicaragua and Belize can immediately take advantage of prices obtained in Honduras.

The results are encouraging and worrisome at the same time. In poverty stricken Latin America, the UNAIDS accelerated access program which resulted in these price drops has apparently only reached Trinidad, Chile, and now Honduras. The process, appears to be slow, cumbersome and random. UNAIDS indicates that government interest as well a budgetary commitment to medication purchase are required for a country's participation, but it is also clear that UNAIDS plays a great role in stimulating a country's motivation to be involved. Two UNAIDS staffers, Mary Guinn-Delaney and Juan Ramon Gradehly, worked full time for a year in Honduras paving the way for these negotiations.

In other countries in Latin America and the Caribbean this is not the case.In the Dominican Republic 8000 people have no access to ARV treatment and in Peru, perhaps as many as 10,000. But there is no movement towards accelerating access and prices remain in the $4000 - $5000 yearly range, for people just as poor as those who will now benefit in Honduras and Trinidad. UNAIDS must find ways to "accelerate" its own "accelerating access" program.

CIPLA, Rambaxi, and other generic producers could also be negotiating directly with poor governments in Latin America, but they have been slow to register their products. Except in Panamá there is no patent protection on anti-retrovirales in Central America.

*Richard Stern, Ph.D.

Director, Agua Buena Human Rights Association

San José, Costa Rica

Tel: 506-2280-3548


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