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CARIBBEAN: Officials Fight on Two Fronts to Lower AIDS


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 life.

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 immunodeficiency virus.

"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 by patients.

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 demand.

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 full-blown AIDS.

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 them.

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.


Copyright © 2001 -Inter Press Service, Publisher. All rights reserved to Inter Press Service. Reproduced with permission.Reproduction of this article (other than one copy for personal reference) must be cleared through the Inter Press Service, IPS-ONLINE, World Desk via Panisperna 207 00184 Rome, Italy. Email IPS visit Inter Press Service.

Information in this article was accurate in June 15, 2001. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.