Care and support for people living with HIV/AIDS

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Care and support for people living with HIV/AIDSto be taken by health workers in the handling of body fluids. Other imperatives comeunder the general heading of health policy, such as the licensing of nurses or otherpractitioners to prescribe morphine, and the regulation of the supply of drugs(including antiretrovirals) in order to minimize the risk of drug resistance and counterfeiting.Where an intermediate care and support package is feasible, one would expect thatprevention activities requiring intermediate levels of technical and human resourceswould also be available. These include measures aimed at reducing mother-to-childtransmission of HIV, and antiretroviral treatment to prevent HIV infection in healthcare workers who have been exposed occupationally to the virus (post-exposureprophylaxis).Improve access to drugsImproving access to drugs of special interest to people living with HIV infection is apriority strategy for UNAIDS, and is currently mobilizing much interest worldwide.Making drugs more accessible requires a broad look at the underlying reasons forpoor access. One factor is the cost of drugs. Another is inadequate informationabout the drugs needed to manage HIV-related illnesses. Finally, drug access ishampered by the poor capacity of health systems in developing countries to selectand use drugs in a rational manner, to monitor patients’ progress and side-effects,and to manage their drug supply. This is linked in turn to inadequate financing of thehealth system in general and of the drug supply in particular.In the current context, attention has mainly focused on drug prices, and in particularthe price of antiretroviral drugs still under patent in high-income countries, whichmakes them financially inaccessible to most people with HIV. However, for the reasonsmentioned above, people with HIV also have inadequate access to the “essentialdrugs” for treating HIV-related illness, including drugs that are no longer underpatent. The poor availability of drugs for pain relief or respiratory distress and for thetreatment of many HIV-related diseases found in a survey of university teaching hospitalsshows how inadequate this access is, even at the highest echelon of the healthsystem (see page 89). Another indicator of inadequate drug access is the limitedcoverage of tuberculosis programmes, which, according to WHO, manage to diagnoseand treat only around 40% of TB cases. Overall, WHO estimates that accessto essential drugs for health conditions of all kinds is guaranteed for only 50% of thepopulation in developing countries.Through collaboration between the UNAIDS Secretariat, WHO and UNICEF, some ofthe obstacles to essential drug access are being tackled. First, beginning in 1997,15 new drugs of interest to people with HIV were included in the WHO Model List ofEssential Drugs. The next step was to pinpoint the reason why most wholesalers ofgeneric drugs were not distributing the newly included drugs, and why even several99
Report on the global HIV/AIDS epidemic – June 2000important older drugs were rarely on offer. Working with WHO and UNICEF, theSecretariat identified manufacturers and prices for 44 essential drugs whose procurementwas being hampered by insufficient information on cost and availability.This information has been posted on the UNAIDS, UNICEF and WHO websites alongwith an offer to assist countries in locating generic drug suppliers and organizingdrug procurement. Information of this kind is also used to help convince plannersthat it is feasible to include HIV care and support in national strategic plans onHIV/AIDS.Strategies for cost and price reductionOne of the lessons learnt from the UNAIDS Drug Access Initiative in Côte d’Ivoireand Uganda (see Box 19, page 103) is that, with determination and good will, it ispossible to negotiate a significant reduction in drug prices and improve the deliveryof health care. End-user prices of antiretroviral drugs in both Côte d’Ivoire andUganda decreased after negotiation with the pharmaceutical companies holding thepatents on those drugs. The companies that participated in the initiative eitherdonated a percentage of the drugs or agreed to sell them at a reduced price. Similardecreases in drug prices were achieved through a national drug access initiativeconducted in Senegal.Price reductions can be achieved through avenues other than negotiation withpatent holders. One strategy is to produce or import generic alternatives to proprietarydrugs. UNAIDS’ analysis of the patent situation of HIV-related drugs with WHOand UNICEF has shown that most proprietary drugs used in the treatment of peoplewith HIV are not patent-protected in the majority of developing countries.Table 2 shows the prices of proprietary antiretrovirals in the USA, Côte d’Ivoire andUganda, and some generic equivalents in Brazil and Thailand. The lower price ofgeneric products is partly explained by the lack, or low level, of investment inresearch and development by the manufacturers.100
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Care and support for people living with HIV/AIDS

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