THE VIRUS. The fever. The disease. The cocktail. The alphabet soup. The death. By any other red ribbon or name, today is December 1, World AIDS Day, and much of the day’s significant news on the topic comes, for better or worse, from India. (Photo: “An Indian sex worker wears AIDS symbols as she takes part in a rally in Siliguri,” AFP via Yahoo! News.)
For better, former US president Bill Clinton announced yesterday in Delhi a deal to dramatically reduce the price of effective treatment for children with HIV/AIDS. Among other things this is a fascinating example of a new approach to achieving health outcomes that combines public action with market tools. With funding from five countries, three European and two South American, the foundation has negotiated volume discounts on behalf of 40 destination countries. Thanks to the bulk purchase, the Indian generic manufacturers Cipla and Ranbaxy can sell single-pill tri-therapy drugs at 460 for a whole year’s supply. So the $35 million put up by France, Britain, Norway, Brazil and Chile ends up going a long, long way. $35 million! That’s NOTHING. Imagine if, say, the United States tossed in a little spare change from its daily Iraq expenditure. Grrrrr…..
Anyway, here’s a news story with details:
Only about 80,000 of the 660,000 children with AIDS who need treatment now get it, the United Nations AIDS agency estimates, and half the children who do not get the drugs die by the time they turn 2 years old. The United Nations Children’s Fund, or Unicef, has described children as the invisible face of the AIDS pandemic because they are so much less likely than adults to get life-saving medicines. …
Cipla and Ranbaxy Laboratories, Indian generic drug manufacturers, will be providing pills that combine three antiretroviral drugs into a single tablet, a formulation that is easier to transport, store and use than multiple pills and syrups. The combination tablets also need no refrigeration, an important advantage in poor countries lacking electricity, and can be dissolved in water for babies and infants too young to swallow pills.
Sandeep Juneja, the H.I.V. project head for Ranbaxy, said in a telephone interview that the company was able to provide the lower prices because of the larger volume of sales and because the Clinton Foundation, buying on Unitaid’s behalf, would consolidate many small purchases. He explained that the market for pediatric AIDS drugs was relatively small, fragmented and spread thinly across many countries.
“It would be a nightmare handling those small orders,” he said.”Imagine 40 to 60 countries buying a few hundred bottles individually, with no way to predict how many bottles would be needed.”
The new prices for 19 pediatric AIDS drugs are on average 45 percent less than the lowest rates offered to poor countries in Doctors Without Borders’ listing of AIDS drug prices, and were more than 60 percent lower than the prices the World Health Organization reported were actually paid by developing countries, the foundation said.
On the other hand — and here’s the “for worse” part — even the most abundant supply of inexpensive drugs can’t overcome poor distribution networks and, even worse, bonehead ignorance, especially when it comes from the people in charge of administering AIDS programs. Here’s a horror story this week from rural Gujarat:
Eighteen impoverished Indians with AIDS died in one district in western India in the last two months because the nearest state supply of free drugs is hundreds of kilometers away, an HIV advocacy group said on Tuesday.
“The absence of a regular supply of anti-retroviral (ARV) drugs has claimed 18 lives in the past 60 days,” said Umashanker Pandey of the Kutch Network of Positive People in Gujarat state.
Pandey told Reuters the deaths highlighted the failure of India to reach much of its HIV-infected population, the majority of whom live in rural and small-town India.
The 18 patients had been either too poor or too sick to make the journey every month on an overnight train to Ahmedabad, the state’s main city, to receive treatment and pick up their government-supplied drugs, he said.
D. M. Saxena, the head of the State AIDS Control Society, confirmed that 18 people with AIDS had recently died in and around the large town of Bhuj, and said he was looking into the matter.
But Sujatha Rao, head of India’s National AIDS Control Organization, said she had seen no evidence that the deaths were caused by AIDS.
“I can’t understand why an overnight train journey would deter them,” she said. …
NACO considers Gujarat to be a “moderate prevalence” state. It estimates there are 102,684 people with the virus, but only 7,599 cases have ever been reported in the state as of October this year.
The Gujarat Network of Positive People says a true estimate is closer to 200,000 infected people.
Meanwhile, a study of 252 Indian truckers finds that over 40 percent have passed an STD to their wives, and that many believe that AIDS is a white man’s disease from which they are racially immune. Only 11 percent use condoms.
The struggle continues.