14th International AIDS Conference Barcelona, Spain - July 7-12, 2002

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrE1423)

Morales C, Brousselle A; Universite de Montreal, GRIS / CMIS, Hopital Sainte-Justine / Chilean Drug Access Initiative ANRS Study Group, Montreal, Canada

BACKGROUND: The informal market (IM) for ARV in Chile is perceived as a growing phenomenon, poorly documented and that constitutes major public health challenges. First, clients are exposed to several risks: ARV from doubtful sources may be of sub-optimal quality, discontinuity of supply may cause virus resistances, patients don't receive adequate counseling and are exposed to stress. Second, vendors selling their own ARV drastically undermine their health and may also develop resistances.

METHODS: The research was conducted in 09-12/1999 and in 06/2001 in the context of the evaluation of the UNAIDS/CONASIDA Drug Access Initiative in Chile. Direct observation and semi-directed interviews were performed with about 90 actors (NGOs, CONASIDA, health centers, pharmaceutical companies, patients).

RESULTS: The IM has several expressions. On the supply side: individuals buy ARV outside the country to sell them in Chile, patients that benefit from public therapies sell them to cover for more pressing needs (clothing, housing, feeding), and foreign NGO's and solidarity groups provide ARV to informal patient networks. On the demand side: privately insured patients (PIP) prefer to buy on the IM instead of disclosing their HIV status to their insurance company, patients enrolled in the public system (PS) with no access to ARV and no financial resources to buy on the official market, and occasional buyers that need short term emergency supply.

CONCLUSION: The fact that patients of the PS receive free ARV but PIP have to pay for their drugs, creates a double price system that encourages the existence of an IM. Thus, universal coverage for ARV is recommended. Meanwhile, increasing ARV access only for PS patients may increase the IM because there will be more patients tempted to sell their ARV. Finally, closer follow-up and widen access to viral load measures may help to better appraise the problem and to develop more counseling initiatives.

020707
ThOrE1423

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