Published: Abril, 2007
Outcomes and Conclusions: Honduras Forum on Access to Treatment and Human Rights for People Living with HIV/AIDS
By Eugene Schiff*
On February 8th, 2007 the Agua Buena Human Rights Association organized a Forum on HIV/AIDS, Human Rights and Access to Treatment in Tegucigalpa, Honduras. More than sixty individuals participated in the Forum, including approximately 30 people living with AIDS, coming from different regions of Honduras, from Olancho to Southern Honduras, as well as San Pedro Sula, Trujillo, Tela, Ceiba, and Tegucigalpa. Key decision makers and representatives from the Pan America Health Organization, the Ministry of Health (including Jenny Meza, the Minister of Health) and the National HIV/AIDS Program, UNDP, the President and Technical Secretariat of the Country Coordinating Mechanism for Global Fund Project in Honduras, Medicos Sin Fronteras, Abbott Pharmaceuticals, FORO Nacional de SIDA, Comunidad Gay Sampredrana, Casa Renacer, Instituto Nacional del Torax, Hospital Escuela, and Hospital Mario Catarina Rivas, and donor agencies – including HIVOS international and regional offices, whose financial support allowed for the conference to take place. Additionally, members from several other institutions, NGOs, activists, counselors, caregivers, and press also participated. The goal of the conference was to facilitate participation, discussion and exchange of information, ideas, and strategies for overcoming key barriers to access to treatment and care for people living with HIV/AIDS in Honduras.
Several of the key issues discussed in presentations or panels in the conference are highlighted below.
Urgent need for access to antiretroviral medicines and related care in Olancho, Western Honduras, and the Miskito Coast (Gracias a Dios Department) where people living with AIDS receive minimal and insufficient care and must travel long distances just to access CD4 tests and antiretroviral medicines. Despite millions of dollars that have been pouring into Honduras for many years related to HIV/AIDS projects, these essential tests and medicines are still not available to those living in several regions of Honduras. Individuals must travel from these regions to seek care in the closest treatment centers in other cities is expensive, inconvenient, time consuming, and therefore impossible for many of the sickest and poorest people living with HIV/AIDS in Honduras. While for years the official posture is that the government is slowly moving forward to address these needs, equip new treatment centers and train additional health workers to form interdisciplinary teams effectively providing comprehensive health care for people living with HIV/AIDS, most government officials, and even NGO staff and international agencies are concentrated in the capital city and other major cities and until now clearly focused on other personal, institutional and operational priorities. Discussion during the conference signaled the urgent need to provide medicines and lab tests to all individuals currently suffering from advanced AIDS in local hospitals in these regions in order save their lives and further reduce AIDS related mortality and stigma before treatment centers are officially opened.
User Fees stigmatize, further impoverish, and penalize poor people living with AIDS. Honduras is currently the only government in Central America and one very few countries in the region that insists upon maintaining an unjust, unnecessary (as experience in other countries in the region has shown), and potentially dangerous policy of collecting fees from people living with AIDS for antiretroviral medicines and CD4 tests. Social workers subjectively “evaluate” individual patient’s economic status to determine how much they can afford or are willing to contribute to receive the drugs, often charging “symbolic” fees such as $2 or $3 US dollars.
However, it is evident that these fees collected are real and hardly symbolic, and must be considered an additional burden alongside other costs associated with getting to the treatment centers and seeking care, which also contribute to creating a deadly barrier for many of the poorest people living with AIDS to gain access and constantly adhere to antiretroviral medicines. Furthermore, far from a theoretical discussion, finding the money to pay these fees is often just one of many additional challenges most faced in a daily struggle to meet their own and their family’s basic needs. While millions of dollars are potentially available (and often squandered) for HIV/AIDS from donors such as the Global Fund, USAID, tax revenues and government health budgets, the user fee policy remains. Such fees place a disproportionate burden on the sick and the poor, and are therefore one of the cruelest and most inefficient ways of financing any health system and the purchase of ARV medicines.
Broken Machines, Lack of Reagents, and Government neglect in the provision of critical laboratory monitoring procedures such as Viral Load and CD4 tests make it impossible for people living with AIDS to receive optimal care. People living with AIDS, physicians, nurses and others demanded that the authorities take more effective remedies to resolve the chronic delays, shortages, and the complete lack of these essential monitoring tests in several main treatment centers in Tegucigalpa, San Pedro Sula, and nationwide during the previous six months in Honduras since the fall of 2006. Without access to Viral Load and CD4 tests, physicians must rely on clinical symptoms alone to interpret the whether patients and PLWA should initiate or change their current treatment cocktails. In this situation even with the best physicians most careful and comprehensive efforts, most PLWA will only be able to access treatment when they are already sick or taking ineffective treatment with potentially serious side effects due to viral resistance to the medicines. AIDS related mortality and drug resistance will inevitably higher than if the appropriate lab diagnostics were accessible and provided without cost to all PLWA in Honduras on a regular basis.
Uncertain financing of current treatment program and future scale up including access to second line medicines due to rejection of previous Global Fund Round 6 Project Proposal. While the country is preparing a new proposal Round 7 of the Global Fund, there is still no guarantee that the project will be approved, even though the expansion and escalating cost of the treatment program and ARV medicines for an increasing number of people living with HIV/AIDS in Honduras has come to depend upon the Global Fund for a significant portion of resources available. Without further resources from the Global Fund, it is not clear if the Honduran Government alone is willing or able to assume the costs of this program in the absence of considerable resources from external donors. Sustainable and increased funding for treatment is essential, but currently the Global Fund is the only donor agency or external funding mechanism for purchasing of large quantities of ARV medicines in Honduras and a number of other countries in the region. The current Round 1 Global Fund Project in Honduras is expected to end in 2008.
Deadly Waiting Lists and Exorbitant Prices for Kaletra. The forum also included a special panel discussion featuring representatives from Abbott Laboratories, leading physicians dedicated to providing AIDS treatment in Honduras, and the medical coordinator for Honduras of the international NGO Medicos Sin Fronteras discuss pricing and access issues for Kaletra (Lopinavir/Ritonavir) and other second treatments in Honduras. Furthermore, the new version of Kaletra, which is heat stable and features several improvements over the original gel capsule formulation, but it is still not registered or distributed or available in Honduras and other countries in the region, or in most tropical or developing countries with the highest burden of cases of HIV/AIDS where this new formulation of the drug is needed most.
Need for Companies and Government Regulatory Agencies to register and facilate the inclusion of new drug formulations such as Kaletra (Lopinavir/Ritonavir) and Tenofovir, Truvada, Atripla and other recommended alternative first and second line medicines into the list of antiretroviral medicines available to PLWA and prescribing physicians in treatment centers Honduras. In the forum, representative from the Pan American Health Organizations noted that purchase and importation of these drugs could be facilitated by coordination between PAHO and government officials, through the regional strategic fund managed by PAHO for the procurement of drugs and other supplies related to HIV/AIDS. However, it remained unclear why these steps had not yet been taken in order to resolve critical shortages to these medicines and others. In addition to regulatory approval, true costs for second line antiretroviral medicines are another barrier to more widespread access to optimal drugs for treating PLWA. A demand was presented to Abbott Pharmaceutical and signed by most of the conference participants urging for the reduction in the price of Kaletra $2200 USD per year in Honduras to $500 which is the price offered to countries in Africa and elsewhere.
Additional presentations in the conference also highlighted needs related to staffing and medicines for treatment of children in Hospital Escuela, the lack of effective HIV/AIDS prevention and treatment programs in Honduran prisons, issues related to transparency and the development of the current round 7 Global Fund project proposal, and a discussion of the Country Coordinating Mechanism functioning and the true level of civil society participation related to the implementation of the Global Fund project in Honduras.
From the numerous presentations and discussions in the forum it was clear that these are all critical issues that must be considered and addressed and constantly monitored in order to ensure that sufficient resources reach target populations and sustainable treatment programs are expanded to include all people living with AIDS needing care in Honduras. It was also evident that a diverse array of people living with AIDS from all regions of the country can and must be educated, empowered, and included in organizing and presenting their perspectives in forums such as this one. PLWA must be provided with additional spaces for presenting their needs, ideas, and communicating as equals with, not as tokens, in addition to challenging, when needed, government authorities, international agencies, pharmaceutical companies, physicians and others to resolve the most critical needs affecting their lives and the lives of others in their communities.
Agua Buena Human Rights Association
San Jose, Costa Rica