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Section: Guatemala
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.”


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