KINGSTON, Jun 15 (IPS) - Jobless and infected with the virus
that causes AIDS, Devon is one of thousands of Jamaicans who
cannot afford drugs to lengthen or improve the quality of his
Even when he had a job, his weekly wage of 33 dollars was
woefully inadequate to buy a cocktail of anti-retroviral drugs
that costs up to 1,300 dollars per month.
The 36-year old father of two, who asked that his last name be
withheld, is among 15,000 Jamaicans and as many as 1.8 million
people throughout the Caribbean living with HIV, the human
"At present prices, the average Caribbean person would have to
work for twenty years in order to pay for one year's
treatment," says Manuel Pena, the Pan American Health
Organisation representative in Jamaica.
This could soon change. Regional officials are pursuing
parallel opportunities to reduce or eliminate the costs borne
On one hand, the Caribbean Epidemiology Centre (CAREC) and the
Caribbean Community (CARICOM) Secretariat are negotiating a
deal with pharmaceutical companies that could lower prices by
as much as 70 percent, says Yitades Gebre, the head of
Jamaica's sexually transmitted disease and HIV programme.
On the other hand, government officials plan to discuss
subsidies and financing that would enable them to lower prices
further or provide the drugs to patients at no cost. These
discussions will be taken up at the UN Special Session on
HIV/AIDS, scheduled for Jun. 25-27 in New York, says Pena.
Details of the first set of negotiations - including the names
of the drug makers involved - are unavailable but this much is
clear: Devon and thousands like him will continue to find that
the drugs are just beyond reach.
Gebre says a deal with three pharmaceutical firms is close and
will enable CARICOM member countries to buy anti-retrovirals
for between 750 dollars and 2,000 dollars per patient per year
- down from as much as 1,300 dollars per month. The actual
price paid by each country will depend on its gross domestic
product and the specific combination of drugs it purchases.
Sources involved in the talks say the price reductions have
become possible in part because multinational drug companies
face competition from producers of generic equivalents and
because arrangements are being made to order the drugs in bulk,
assuring the companies sizeable contracts and predictable
Devon says that even if he got his job back, 750 dollars per
year would be impossible on his salary. What's more, Gebre
cautions that Jamaica likely will have to pay the high-end rate
of 2,000 dollars per year.
More is at stake than Devon's finances, says Ian McKnight, head
of the non-governmental group Jamaica AIDS Support. "Who can
buy it will live, who can't will not," he says, referring to
anti- retroviral treatment.
Groups that care for HIV and AIDS patients cannot escape that
disheartening reality. Raymond de la Cruz, a priest with
Jamaica's Missionaries of the Poor, says his organisation has
been able to provide only antibiotics and other "minimum types
of drugs" - in effect, struggling to ease the suffering of
patients doomed to premature death.
"If they could afford the medication, they would live longer. A
lot of deaths are symptom-related and if they had the
medication, they may still have been alive," he says.
Such lessons are not lost on regional officials. Sarah Flood
Beaubrun, St. Lucia's health minister, is pushing for cheaper
prices than those envisioned by the deal now being ironed out
with the drug makers. She says she hopes to tap the United
Nations for extra assistance.
So far, only one drug, Nevirapine, is provided free of charge
to pregnant women under a UN-sponsored project to reduce the
incidence of HIV being transmitted from mother to infant during
birth. Demand exceeds supply.
Lending urgency to the quest for cheap and free drugs,
officials say national health budgets throughout the region are
under tremendous strain.
Jamaican Health Minister John Junor says that even using the
cheapest form of care, the government would need 18.6 million
dollars to treat the island's HIV-positive population. That is
more than 10 percent of the entire health budget. Comprehensive
AIDS treatment would cost 240 million dollars per year - more
than the total budget and beyond the government's reach.
Much of the expense is incurred in treating opportunistic
infections, like the flu and thrush, which prey on patients
whose immune systems have been severely eroded. A 1999 review
found that, in 1988, some one million dollars was spent to
treat just 200 such cases - each requiring an average of 12.6
days in hospital. The review also found that it cost 800
dollars per person per year simply to provide outpatient
treatment for the skin rashes, fevers, coughs, headaches,
nausea and shortness of breath suffered by people with
The treatment of more serious opportunistic diseases including
tuberculosis and pneumonia can cost up to 6,500 dollars per
month for drugs alone, officials say.
Improved access to anti-retrovirals would help reduce spending
on the treatment of opportunistic infections, says Gebre. But,
he cautions, "It wouldn't make sense for us to get the drugs
for a few months and then they stop making them."
The anti-retroviral cocktails consist of 36 HIV drugs in
several combinations, administered in some 60 dosages. They are
reputed to be the most effective way of treating HIV and AIDS
but often produce debilitating side effects.
Experts say that before any large-scale distribution can take
place, health systems must be restructured to provide proper
management and support structures.
The highly toxic nature of the drugs calls for close
supervision and adequate laboratory facilities to track the
amount of virus in a patient's body, the drugs' side effects,
and the effectiveness of the various combinations.
Also needed are guidelines to manage the drugs, counselling
services, treatment for side effects - and referral systems
that would ensure that those who need the drugs have access to
Rates of HIV infection in the Caribbean are second only to
those in sub-Saharan Africa. The UN Joint Programme on AIDS
reports 210,000 new cases in the region since the end of 1999.