AIDS drugs must be available at health centers

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.