Section: Guatemala
Published: July 2003
Central
America gets reduced prices on HIV/AIDS drugs, but is it enough?
Jill
Replogle, Guatemala City
Felipe sits
in the tiny reception area of the Luis Angel García family
clinic in
Guatemala City’s
main public hospital, waiting to be seen by one of the four doctors
that works at the clinic. Felipe is a heterosexual, middle-aged
baker who is HIV positive. While he currently keeps healthy by eating
well and taking vitamins to boost his immune system, the need for
costly antiretroviral drugs could be in the near future.
Nevertheless,
Felipe’s meager monthly salary of around US$250 is one fourth the
cost of a month’s worth of brand name antiretrovirals. Because Felipe
is not covered by Guatemala’s national social security system (only
15% to 20% of the population is), his options for obtaining the
costly medication are few to none.
“I hope to God
that Doctors Without Borders will be able to give me the medication,”
said Felipe. Although Guatemalan president Alfonso Portillo promised
US$5.1 million in funding for AIDS prevention and treatment this
year, the money has yet to materialize, and the international organization
mentioned by Felipe is currently his only hope for obtaining the
antiretrovirals that are essential for preventing HIV from turning
into full blown AIDS.
For Felipe and
the other 1,000 patients that visit the Luis Angel García
clinic yearly, the recent deal struck between Central American governments
and pharmaceutical companies to slash AIDS prices in the region
unfortunately means little. The clinic, whose supply of antiretroviral
drugs is dependent on foreign donations, has only enough medication
to supply the HIV-positive children who visit the clinic – 67 in
2002. According to clinic administrator, Daniel Muralles, 25% of
the patients who come to the clinic die for lack of antiretroviral
medication.
On February
7, the Pan American Health Organization (PAHO) announced the “historic
reduction” in antiretroviral drug prices that resulted from the
negotiation carried out between the ministers of health of Panama,
Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua and five
drug companies – Bristol-Myers Squibb, F. Hoffman-La Roche, Boehringer-Ingelheim,
GlaxoSmithKline and Merck Sharp & Dohme. The average price reduction
was 55%, although agreements varied among the companies.
According to
the PAHO press release, the triple drug “cocktail” that is the most
common antiretroviral treatment in the region will now cost between
US$1,035 and US$1,454 per year per patient. HIV/AIDS education and
prevention workers, like Guillermo Murillo, from the Costa Rica-based
organization Agua Buena, generally applaud the agreement as a first
step towards increasing medical coverage for HIV/AIDS patients in
Central America. However, according to Murillo and many others,
the prices are still extremely high considering the income level
of most HIV/AIDS patients in Central America.
Furthermore,
generic drugs, many of which have been certified by the World Health
Organization and found to be equally effective as their brand name
equivalents, are available for three to four times less. A presentation
by Richard Stern, director of Agua Buena, reported that the lowest
price available in the region for a triple treatment, produced by
the Indian pharmaceutical company CIPLA, is US$360. Nevertheless,
CIPLA’s products have not yet been registered in all Central American
countries, reported Stern. Stern also reported that Costa Rica is
the only Central American country that produces generic drugs.
Even with more
access to generics, new versions of drugs produced by the large
pharmaceutical companies will likely carry high prices, noted Murillo.
Also, increased pressure on Latin American countries to comply with
patent laws in view of the potential Free Trade Area of the Americas
could further restrict access to generic drugs.
Despite these
concerns, Murillo said the real barrier that lies between antiretroviral
drugs and the people who desperately need them is in many cases
the governments themselves. “We’ve always denounced the high prices
of HIV/AIDS drugs, but the real problem now seems to be lack of
political will,” said Murillo. He said many Central American governments
claim they lack the infrastructure, funding and properly trained
personnel to ensure antiretroviral treatment to HIV positive patients.
While this may
be true for some countries, social stigmatization of the disease
and the populations within which it is most prevalent or perceived
to be most prevalent – for example, sex workers and homosexuals
– ensures that little ground is made in these areas.
According to
the PAHO, an estimated 180,000 Central Americans are HIV positive.
Honduras has the highest percentage of HIV positive adults in Central
America – 1.6% of the adult population, according to UNAIDS. Panama
follows with 1.5% of the adult population, and Guatemala comes in
third with 1.0%. This year, Honduras was duly awarded the largest
sum of money in the region from the Global Fund to Fight AIDS, Tuberculosis
and Malaria (US$41.1 million over five years). However, Panama was
awarded only US$600,000 and Guatemala was given nothing. Murillo
said that in Panama’s case, the minimal funding is probably a reflection
of the country’s high income compared to other countries in the
region. However, he emphasized that a healthy national income doesn’t
mean people with HIV are receiving the medication they need.
The denial of
funds to Guatemala, however, has shocked and alarmed health workers,
particularly those involved with elaborating the country’s funding
proposal. One member of the proposal technical committee, who wished
to remain anonymous, said the decision was likely a result of the
flagrant corruption and fund mismanagement that has increasingly
plagued the country in recent years. “I’ve spoken with people from
other Central American countries who worked on proposals and they
agree that Guatemala’s was one of the most well-structured,” said
the committee member.
The denial is
particularly baffling considering the United Nations Development
Program was proposed to manage the funds in Guatemala. Regardless
of the reasons, health workers agree that the lack of international
funding spells disaster for AIDS prevention and treatment efforts
in the country. Many AIDS education and prevention programs are
cutting employees, hours and coverage for lack of funds.
“I can’t tell
you how serious this is,” said Bill Latham, from the organization
HIV Meds for Guatemala. “We’re going back 10 years in AIDS education
in Guatemala.”
