Road map to improved access to HIV/AIDS therapy in poor countries

Debbie A. Lubis, Contributor, Yogyakarta

Life seems quite unfair for Yanti (quoted with her permission). After surrendering her husband to AIDS last year, the mother of two children has to go on with her battle to fight HIV in her own and her second son's bodies.

Worst still, she lost her job because her colleagues were terrified of being infected by the deadly virus. The company actually was willing to cover her ARV treatment costs. Unfortunately, she is no longer able to afford antiretroviral (ARV) therapy for her and her 2.5 years old son.

ARV treatment has been proven effective in reducing the viral load until undetectable so that people living with HIV/AIDS (PLWHA) can lead a more productive life and mortality and morbidity caused by opportunistic infectious diseases among them can be reduced.

At present, a monthly package of imported, generic version ARV cocktails in Indonesia is worth Rp 650,000 (US$76) while patented ARV drugs cost ten times higher.

"My physical condition is deteriorating. My weight has dropped drastically to 37 kg from 55 kg previously. Actually, ARV helps us so much. I went up to 50 kg within five months of taking the miracle cocktails while my son went up to 13 kg from eight kilos before. He returned to being a cheerful boy again," Yanti said.

Rinaldy (not his real name) is also in a dire need of affordable ARV cocktails. His father abandoned the family as soon as he found out that his son was infected by the virus. Rinaldy was confined to bed for one year due to heart and lung disorders

"Maybe it's because of the drugs I abused," he said, disclosing that he used to share needles with other injecting drug users (IDUs) for five years.

"My salary is just enough for our daily needs but I must support and take care of my son. He is still young," he said. His mother collects money from her extended family to purchase the ARV drugs.

Yanti and Rinaldy feel lucky because they can get free or subsidized ARV treatment from a number of NGOs in Jakarta. But, out of 130,000 PLWHA who are in a dire of need of ARV treatment in the country, only 1,000 have access to the drugs they need.

The problem of access to ARV treatment is not unique to Indonesia. It is experienced by many developing countries in the world. Therefore, representatives from around 16 countries are scheduled to attend the Yogyakarta round-table meeting (JRM) from Sept. 1 through Sept. 4, to renew the spirit of a similar meeting in Canberra last year. The last meeting formulated a strategic framework for improving access to HIV/AIDS therapy in poor resources settings. The meeting will have delegates from the ASEAN countries, America, Cuba, Japan, Australia, France and India.

"The World Health Organization expects that by 2005, an estimated 600,000 PLWHA in the Asia Pacific region will have improved access to HIV/AIDS treatment. After one year from the first meeting, there must be many accomplishments and obstacles in achieving the targets that the participants can share," said Dr Samsuridjal Djauzi, coordinator of Access to Therapy and Diagnosis at the Working Group on AIDS at the University of Indonesia in Jakarta.

In Indonesia alone, the National Movement on Improved Access to HIV/AIDS Therapy (GN-MATHA) has targeted around 2,000 people with HIV/AIDS this year.

PLWHA, academicians, experts, government officials, representatives of international agencies, NGO activists, and journalists will actively take part in thematic lectures under main theme of From International Collaboration towards National Self-Reliance and the Role of Media in Combating HIV/AIDS.

Samsuridjal, who is also the initiator of JRM, said that the issue of self-reliance was included in a bid to reduce the reliance of poor countries on foreign aid and the developed countries in accessing ARV therapy. The press's role would also be significant in disseminating information on the therapy.

"We will also build up networks among the participants here because it is high time for developing countries to fight for their citizens's rights to health given the fact that there are many barriers imposed by the WTO and TRIPs," he said.