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Archive for September 13th, 2009

GLOBAL: Countries pay widely varying prices for ARVs

Posted by African Press International on September 13, 2009

Photo: World Vision
Buying ARVs in large volumes does not necessarily make them cheaper

JOHANNESBURG, – Many countries struggle to pay for antiretroviral (ARV) drugs for all those who need them, but a new study has found that some nations are paying up to three times more for the life-prolonging medicines than others with similar HIV prevalence and income levels.

In 2007 Nigeria paid US$334 per patient per year for a combination of first-line ARVs that cost Congo only US$95. Both are low-income countries, but Nigeria has a higher HIV prevalence of 3.1 percent, compared to Congo’s 1.2 percent.

A working paper released last week by the AIDS2031 project, which draws on expertise from around the world to consider the most effective long-term responses to the HIV/AIDS epidemic, looks at why the prices of ARVs vary so widely from one country to another, and what can be done to improve affordability.

The price of first-line ARVs has dropped substantially in the last decade, but affording them is still a problem in low-income countries with high HIV burdens, many of which are experiencing the effects of the global economic downturn in donor countries.

About 4 million people are accessing ARVs worldwide, out of an estimated 10 million thought to be in need of them, and the need is expected to grow to around 22 million by 2015.

Moreover, an increasing number of people will develop resistance to first-line ARVs and need second-line regimens, which currently cost at least nine times more.

The authors of the working paper looked at price variations in 12 ARVs between 2005 and 2008, and identified some of the key factors behind the differences.

Pharmaceutical companies have long used a sliding scale to set ARV drug prices according to a country’s socioeconomic status, but this was not the only reason for the cost variations.

The ability of the Clinton HIV/AIDS Initiative (CHAI) to negotiate price reductions for its member countries, particularly for second-line drugs, was identified as one factor.

Whether countries purchased generic or brand-name versions of ARVs also played a major role – strict patent laws prevent some countries from buying generics.

The World Trade Organization’s Trade Related Aspects of Intellectual Property Rights (TRIPS) allows countries to override patents – for public health purposes – by issuing “compulsory licenses” that enable the generic manufacture of drugs still under patent.

However, few developing countries have exercised this right, citing a lack of capacity and legal know-how to negotiate the complicated paperwork required, and political pressure from foreign governments.

Surprisingly, the volume of drugs a country purchased did not significantly affect price; higher-prevalence countries buying large quantities of ARVs often paid more than lower-prevalence countries.

“On one hand, volume gives countries more power to negotiate,” the authors wrote. “On the other hand, the higher volume means that there are more people who will demand treatment, and the countries are facing political pressure to respond to this need, which could reduce their negotiating power.”

The paper recommends various strategies to ensure that all countries obtain the best possible prices for ARVs: strengthening the ability of lower-income countries to take advantage of compulsory licensing, and providing technical assistance for the production of generic ARVs, could help increase competition among manufacturers; improving production efficiency and buying cheaper active ingredients could reduce manufacturing costs.

The authors also note that prices of first-line ARVs are unlikely to decline much further, but there is ample room for reduction in second-line drug prices.

“Many more patients could be treated if second-line therapy were closer to manufacturing costs,” they commented. “Reducing the price of second-line therapy should remain a priority.”


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CAPE VERDE: Switch in donors disrupts AIDS funding

Posted by African Press International on September 13, 2009

Photo: Zoe Eisenstein/PlusNews
HIV/AIDS message on the streets of Sal island, Cape Verde

PRAIA, – People living with HIV in Cape Verde are worried that the HIV/AIDS programme may be disrupted by a change in funders. The World Bank pulled out in June after supporting the programme for seven years, and a US$5.3 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria has not yet arrived.

The government was hoping to sign a contract with the Global Fund in September to complete the transition, but “Negotiations have yet to be concluded and there is no confirmation on when the donation will be made official,” said Marcela Rojo, the Global Fund’s spokesperson in Geneva.

“We are worried,” said Daniel Delgado, president of the Esperana (“Hope” in Portuguese) Association, an NGO in the municipality of Santa Cruz, on Santiago Island, which relies on government-disbursed donor funds to distribute food parcels to orphans, HIV-positive people and their families. “The latest funds received were only enough to pay past-due bills,” he told IRIN/PlusNews.

Zaida*, 40, an HIV-positive beneficiary of the food parcel programme, said she had not received anything in August: “I’m unemployed and I don’t know what’s going to happen to me from here on.”

ARVs guaranteed until January

The national HIV/AIDS programme of Cape Verde, a small archipelago off Senegal in West Africa, has managed to reduce HIV prevalence from one percent to 0.8 percent and is seen as a model for other African countries.

Zaida is among the 405 HIV-positive people receiving antiretroviral (ARV) treatment, while 631 orphans are given psychosocial support and another 260 families affected by HIV receive food parcels.

Minister of Health Baslio Mosso Ramos said the transition between donors would not have any affect on the support provided to people living with HIV and their families because the government would take responsibility for supplying ARVs and support to AIDS orphans if the first disbursement of the Global Fund grant was delayed.

Cape Verde has enough HIV test kits and ARVs to last until January 2010, but Ramos warned that a lack of funds could jeopardize the ordering of new stocks, which could take months to arrive and be distributed.


“As CCS-SIDA [Coordination Committee for the Fight Against AIDS] is no longer performing the same role that it had alongside the World Bank, and because there were not enough resources to pay all of the employees, it was necessary to reduce the committee to a minimal structure,” said Ramos. The CCS-SIDA staff of nine was reduced to five when World Bank funding ended in June.

He acknowledged that the government had relied on the experience of CCS-SIDA staff to successfully apply for a Global Fund grant. “The Global Fund’s management requirements are much stricter than those of the World Bank – proof of this is that Cape Verde’s proposal was only accepted in the eighth [funding] round,” he commented.

CCS-SIDA will be the main recipient of grant money destined for the public sector, while an NGO platform will manage funds to be channelled to non-governmental HIV/AIDS organizations.

Ramos said a mission to the country by Global Fund representatives in July had found “weaknesses” and CCS-SIDA was instructed to improve its procedures for acquiring goods and services, while the NGO platform was asked to strengthen its human resource capacity and improve accounting practices.

Another Global Fund mission, expected in the next few weeks, will monitor improvements. Although no date has been set for signing the contract, the Global Fund’s Rojo was confident that “the Fund will work with Cape Verde so that the first disbursement comes as quickly as possible in order to guarantee the ARV purchase process.”

* Not her real name


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ETHIOPIA: Ringing in the New Year with an HIV message

Posted by African Press International on September 13, 2009

Photo: Keishamaza Rukikaire/IRIN

ADDIS ABABA, – The Ethiopian government is using modern technology and the countrys New Year celebrations as an opportunity to encourage citizens and their families to get tested for HIV.

New Year, new life! Test for HIV, test with your partner, get your children tested and brighten the future of your family! Free testing. Happy New Year! reads the text message sent to subscribers of the national telecommunication provider, Ethiopian Telecommunications Corporation, by the Federal HIV/AIDS Prevention and Control Office (HAPCO), ahead of Ethiopian New Year celebrations, which start on 11 September.

Ethiopia follows a unique calendar, seven years behind the standard Gregorian system. The year has 13 months.

HAPCO wanted to encourage everybody to know their status; the idea is to promote the testing so that people are aware of it, said Feleke Dana Tanga, HAPCO monitoring and evaluation team leader.

An AIDS activist, who requested anonymity, said the campaign was a welcome step, but noted that Ethiopia still suffered from stigma as a major hindrance to testing.

Its not enough just to offer free testing, more needs to be done on discrimination – at the moment people will think if you go to get tested you have the disease, he said. Also, the message does not give details about where you can go to get tested.

Ethiopia has an HIV prevalence of 2.1 percent; an estimated 2.3 million people test for HIV every year in more than 1,000 testing centres countrywide.


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