AIDS drugs must be available at health centers

By Samsuridjal Djauzi and Husein Habsyi

JAKARTA (JP): The actual number of HIV/AIDS cases in Indonesia is unknown. Officially, at the end of October, there were 599 people with the Human Immunodeficiency Virus, or with full-blown Acquired Immune Deficiency Syndrome. This figure includes both those who have died and those living with AIDS.

In the last three years, Pelita Ilmu Foundation, a non- governmental organization focused on HIV/AIDS, has had contact with 84 people living with AIDS, known as PWAs. Fifty-five of them have developed AIDS, and 10 have access to antiretroviral drugs.

Some buy the drugs on their own expense, but others are supported by their families or foundations. Most of the people are from the middle or lower economic levels.

PWAs follow the mass media reports about advancements in AIDS drugs, such as the use of antiretroviral combinations. They have hopes about the drugs, but they must also face the bitter realities of high prices.

This makes it necessary to stipulate a policy on the treatment of HIV/AIDS in Indonesia, especially in the public health service. People should be informed about what services are available to them at reasonable costs.

Most low-income people go to the health centers (Puskesmas) or resort to alternative medicine. Due to the increasing number of people living with AIDS in Indonesia, we must consider what drugs should be available at the health centers.

In general, treatment of HIV infection can be classified into three groups: supportive treatment, in terms of good nutrition and vitamins, as well as drugs to relieve symptoms such as fever and diarrhea; drugs to prevent and treat opportunistic infections which attack the body's immune system; and antiretroviral drugs.

Based on the state's capability, drugs which should be provided by the government are those classified for supportive treatment and dealing with opportunistic infections.

Considering the pattern of opportunistic infections in Indonesia, required medications are those for fungal infections, tuberculosis, diarrhea, Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) and herpes.

Except for the systemic fungus infections and CMV, drugs to treat these conditions are already available in the health centers. The government may not be able to provide the fungus and CMV drugs because they are costly.

The health centers should also have drugs for sexually transmitted diseases.

Antiretroviral drugs are not available at health centers, and so far there is no sign that the government will provide these high-cost drugs.

In Thailand, the government had originally provided AZT -- which can prevent perinatal transmission -- but this was discontinued due to the expense.

Although access to combination antiretroviral drugs in Indonesia is limited, there are actually many kinds available, including AZT, ddI, ddC, 3TC, Saquinavir, Indinavir and Ritonavir.

However, AZT and a similar drug plus one of a then-new class of drugs called protease inhibitors -- a cocktail of drug that created a euphoria a year ago -- has proven ineffective, according to a report from Reuters Saturday.

"Now it is clear the virus has not been vanquished, even when a fourth new drug is added to the mix," the news agency says.

Antiretroviral drugs not yet available here are d4T and Nevirapine.

PWAs who have obtained the "cocktail" combination drugs and want to embark on treatment often face problems. If one of the antiretroviral drugs is not available in Indonesia, it must be imported.

Some have obtained the combination drugs free of charge or at very low prices, and continue to use them. Most get the drugs from foreign NGOs. Others can join clinical trials of new drugs, in which there is no cost to the subject.

PWAs who take combination drugs to start therapy and for monitoring require viral load examination. They examination is available here, but it is expensive at about Rp 700,000 per test.

If discussion of HIV infection treatment focuses on the general public, the available fund allocation should be emphasized for supportive drugs and treatment of opportunistic infections.

These drugs should be available, especially where prevalence of HIV infection is high.

NGOs must play an increasing role in providing information on the treatment of HIV/AIDS. They can also enable the procurement of drugs required by PWAs, and lead them in helping each other in procuring these drugs.

The writers are activists in the Jakarta-based Pelita Ilmu Foundation.