Health and Fitness
Subsidised, but HIV Therapy Only for Rich in India
may be a major exporter of anti-retroviral (ARV) drugs but barely
30,000 people are actually on medication in this country which itself
has a burden of five million HIV positive cases.
April 2004, the government announced a "treatment roll-out"
programme through centres in each of the six high-prevalence states of
Maharashtra, Tamil Nadu, Karnataka, Manipur, Andhra Pradesh and
centres were also set up in the low prevalence, but politically
important state of Delhi, which houses the national capital.
population of HIV affected is the second largest in the world and at
least 500,000 people need to take drugs lifelong, to keep from falling
ill, to go back to work and to prolong their lives.
programme would offer a fixed-dose combination of first-line drugs.
Initially, the government planned to put 100,000 people on
anti-retroviral therapy (ART) by the end of 2005 but it would be lucky
to reach that target by the end of 2006.
ARV drugs were to be made available to HIV positive pregnant women who
visited government antenatal clinics, children under the age of 15 and
adults with AIDS (auto-immune deficiency syndrome caused by the virus)
who went to government hospitals for care and treatment.
as of July 2005, just 10,255 people were on the programme, the
government stated in parliament . Another 9,000 people are on ART
through schemes for government employees and workers in the organised
about Rs 18,000 (400 US dollars) a year, the cost of privately-funded
drug therapy remained out of reach for most people known to be
affected and needing support.
more than 30,000 people are on rational ART nationwide - government
and private sector," said Jaydeep Gogtey, medical director of
Cipla Ltd, a leading manufacturer and exporter of ARV drugs, in an
interview with IPS.
estimate is based on the industry's tracking of prescriptions. It does
not include irrational prescriptions.
more people may be on irrational treatment - short courses of drugs,
two drugs instead of three, sharing medicines etc, according to Sanjay
Pujari, a physician based in western Pune city, exclusively practicing
and health care professionals also suggest that even the limited
government programme is poorly conceived and run. The treatment
centres are in the cities, while the majority of people who need
treatment live in rural areas and cannot afford to sacrifice daily
wages and travel long distances for the drugs.
tests are not free until the person is actually placed on the
programme, putting ARVs out of reach of the poorest, who are most in
need of free treatment.
doctors told me that my husband and I would have to spend at least Rs
1,500 (33 dollars) each, to find out if we qualified for the
medicines," says a member of a positive support group run by the
Committed Communities Development Trust in Mumbai. "I just sold
my gold earrings to pay for my daughter's treatment--that too in a
government hospital. Where am I going to get more money?"
when tests are free, the machinery in government hospitals is often
out of order, forcing patients to go to private diagnostic centres.
are reports that people are not properly informed of the drugs'
side-effects and serious adverse effects, and that teh drugs need to
bee taken regularly, life-long.
Kulkarni, another Pune-based physician, who specialises in HIV
treatment, challenges government claims of ‘’96 percent adherence
to treatment’’. ‘’The reality is far different,’’ he said.
people do not always know that they may develop drug resistance even
with regular treatment, in which case they will need second-line
treatment, which is not available under the government programme.
of second-line treatment seems ambitious when even AIDS drugs for
children were not available through the government programme for more
than a year after the scheme started. The government had earlier
stated that children with AIDS would be given priority treatment.
people with Hepatitis B, or people being treated for TB, should be
given the three-drug combination with Efavirenz. But this was not
available for some months after the programme started and has often
been out of stock.
drug supplies have reportedly sometimes forced people to buy the
medicines from the market at their own cost--or risk falling ill and
programme for free AIDS drugs is the product of a long battle starting
in the late 1990s. Anti-retroviral drugs changed the prognosis for
people with AIDS - but at 10,000 to 15,000 dollars per year, these
patented drugs were priced out of the reach of most people, even in
the developed world.
health activist groups, such as Medicins Sans Frontieres, were at the
forefront of the battle for affordable AIDS drugs, challenging
multinational drug companies.
found an ally in Indian drug companies that had been manufacturing
cheaper generic versions of branded drugs and exporting them to Africa
and Asia. Indian laws permitted this, as they did not recognise
product patents at the time. Multinationals fought the 'threat' to
their patent rights, launching a legal suit in South African courts.
February 2001, the Indian pharmaceutical company Cipla Ltd checkmated
the multinationals by offering the three-drug 'cocktail' of first-line
drugs to international voluntary organisations at 350 dollars per
person per year.
eventually brought prices down across the board as other Indian drug
companies competed for a share in the emerging global market.
has about 10 percent of the world’s generic drugs market. It is
among the top five bulk drugs manufacturers, exporting drugs worth 3.2
billion dollars to more than 65 countries.
it is particularly ironic that while "about half of all drugs for
AIDS in the world come from Indian companies, their use in India is
very low," points out Dr Amit Sengupta of the Delhi Science
Forum, a well known, independent policy think-tank. ''The majority of
people can't afford ART even at the lowest rates today.''
are reports from all parts of the country of patients becoming
resistant to the first-line drugs. A study by YRG Care in Chennai
found that 20 percent of patients were infected with resistant forms
of the virus, requiring second-line treatment.
eastern Kolkata city, the West bengal state project director has
reported that at least 50 patients in the government programme require
second-line regimen is at least 10 times more expensive than the
first-line regimen, because most are under international patents and
completely unaffordable for an average person in India with AIDS.
one knows whether the government will provide them through its
programme. "The big question is--will the Indian government issue
compulsory licences?" asks Sengupta. "That is something that
we will have to see."