ARV sustainability dangles in developing countries

Despite all efforts to increase access to affordable antiretroviral (ARV) pills over the past years, all people living with HIV (PLHIV) who need them most are still struggling to have them in developing countries. The access to these essential medicines is further decimated by the ever changing rules on trade globally. Brazil was a pioneering country where a compulsory licensing mechanism was opted specifically for Efavirenz and this led to the reduction in the cost of the drug and helped put many more PLHIV on treatment within same resources. According to Francisco Viegas Neves da Silva,  this initiative on putting flexibility in the TRIPS is economically efficient while at the same time, improved access to drugs. This pioneering action of Brazil inspired community activism for greater access to life saving drugs.

With the continued efforts of lobby groups, there is also a persistent increase in the prices of ARV drugs which has limited access for developing countries and made it more difficult for them to sustain treatment for those PLHIV who are already on it and put new PLHIV who qualify for treatment.

According to a multi-country study done by the Medicines Patent Pool (MPP), practices of different industries in different countries on the use of voluntary licensing or non-exclusive license given to generic producers from an originator company may work. This practice though, pose problems and challenges like limited transparency, patenting and some sanitary registration.

The World Bank's income-wise categorization of countries impacts the ways and processes by which these countries will be able to avail ARVs. Kajal Bhardwaj, a noted health activist, said that, many of the middle income countries, who are members of the World Trade Organization (WTO), are now applying the TRIPS agreement, patents on second- and third- line ARV drugs, and are currently negotiating free trade agreements (FTAs) - all of which is likely to jeopardize access to these essential medicines.

According to Kajal Bhardwaj, universal access to treatment in low and middle income countries maybe derailed. This is alarming and is brought about by the categorization of countries as  low-income countries (LIC), middle-income countries (MIC) etc. This will mean leaving out some countries in Asia Pacific Region from accessing specific drugs, for example, tenofovir (China and Philippines), cobicistat ( China, Philippines, Thailand and Indonesia), elvitegranvir ( China, Philippines, Thailand and Indonesia).

However, the World Bank criteria for countries to determine HIV funding and treatment gained support with parameters that these countries fund their HIV programmes and treatment. In reality, this is not the situation compounded by the intellectual property barriers. Also evidence-based programmes for marginalized populations that exist in these countries are funded by external donors and may not be sustained in the long run if external support is declined and governments refuse support.

With the given approach, countries need to adopt evidence of treatment as prevention (TasP) and fund their own HIV programmes as far as possible otherwise these countries may lose progress achieved in the last decade in fight AIDS and undermine the goal of universal access.

Nenet L Ortega - CNS

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