“As the northern Indian state of Rajasthan rolls out an ambitious universal health care plan, the discontent of the state’s doctors stands in stark contrast to the joys of the 68 million people who will benefit from the scheme,” Inter Press Service reports. “Just a little over a year ago, the state government began supplying free generic drugs to its massive population, effectively stripping doctors of the ability to prescribe more expensive branded medicine,” IPS writes. The news service notes, “Some 350 essential generic drugs are now being distributed free of cost,” and, “[a]ccording to news reports, over 200,000 people are currently taking advantage of the program.”
Treatment and Prevention Strategies
Writing in USAID’s “IMPACTblog,” Dereje Bisrat, monitoring and evaluation adviser for the Supply Chain Management System (SCMS), discusses the PEPFAR-funded program, which is administered by USAID and “works with Ethiopia’s Pharmaceutical Fund and Supply Agency (PFSA), nine regional health bureaus, and more than 1,717 health facilities to improve access to HIV/AIDS treatment” in the country. She tells the story of Neima Mohammed, an Ethiopian refugee who, after living in Djibouti for 10 years, returned to her home country to seek treatment through the program, writing, “This story might have ended with Neima’s fateful decline in health. Fortunately, thanks to friends back home, Neima learned Ethiopia was embarking on efforts to provide free antiretroviral treatment to thousands of people living with the disease” (11/6).
IRIN examines how patents and intellectual property protection in South Africa affects patients’ access to medicines. “A form of intellectual property protection, patents are typically awarded to companies that can prove their product is new,” IRIN writes, adding, “Not so in South Africa, say activists and researchers, who claim the country’s patent system allows pharmaceutical companies to apply for new patents on existing drugs based on immaterial changes — like adding table salt to a formulation or changing a pill’s color.” The news service continues, “While pharmaceutical companies cash in, patients face staggering health care costs, and medicines like cancer treatments, third-line antiretrovirals (ARVs) and treatments for drug-resistant tuberculosis (DR-TB) are often priced out of reach.”
The Associated Press examines access to antiretroviral treatment in Myanmar, which “ranks among the world’s hardest places to get HIV care, and health experts warn it will take years to prop up a broken health system hobbled by decades of neglect.” The country, also known as Burma, has been hindered by decades of rule by a military junta and economic sanctions imposed by developed countries, including the U.S., the AP notes, and writes, “Of the estimated 240,000 people living with HIV [in the country], half are going without treatment.” However, “as Myanmar wows the world with its reforms, the U.S. and other nations are easing sanctions,” the news agency writes, adding, “The Global Fund [to Fight AIDS, Tuberculosis and Malaria] recently urged Myanmar to apply for more assistance that would make up the shortfall and open the door for HIV drugs to reach more than 75 percent of those in need by the end of 2015,” as well as medications to fight tuberculosis (TB). The AP details one man’s efforts to obtain antiretrovirals, which are reserved for patients with CD4 cell counts below 150 cells, versus the WHO recommended 350 (Mason, 10/22).
In the last of a series of posts on the U.K. Department for International Development’s (DfID) blog examining the department’s work in Malawi, Neil Squires, DfID head of profession for health, looks at the sustainability of the country’s HIV/AIDS program. “Malawi’s success in increasing access to antiretroviral drugs for HIV is highly dependent on donor funding for medicines,” he writes, adding, “Malawi has to actively consider its resource allocation in order to maximize the benefits and the health gained from the limited resources available.” He notes a report commissioned by UNAIDS on Malawi concluded that “unless Malawi can reduce the incidence of new infections, the scale up in access to antiretroviral drugs will not be sustainable in the medium to long term.” He concludes, “This is an important issue for the Government of Malawi, but also for the key donors who have supported the massive scale up in access to drugs, particularly the Global Fund. Malawi will need to maintain high levels of funding from the Global Fund if it is to maintain its supply of antiretroviral drugs” (10/23).
The Center for Global Health Policy’s “Science Speaks” blog on Friday published two posts reporting on ID Week, which concluded in San Diego on Sunday. “Wafaa El-Sadr of Columbia University offered an ID Week presentation Thursday about the impact of treatment on the global epidemic and the new promise of changing the trajectory of the epidemic by scaling up treatment both to save lives and reduce HIV incidence,” the blog writes in the first post, adding, “She reminded her audience that treatment has already had a major impact” (Lubinski, 10/19). “A trio of presentations on HIV, Women and Child Health [on Friday] morning told a story of success in preventing transmission of HIV from parents to children in the United States that has yet to be duplicated in developing countries, of options that could make a difference, and, in a look at the burdens children born with HIV will carry into adulthood, of some of the relatively rarely discussed consequences of gaps in efforts so far,” the blog writes in a second post (Barton, 10/19).
“Sub-Saharan Africa is likely to see a more than 200 percent increase in the number of older people living with HIV in the next 30 years, thanks to improvements in life-saving treatment, experts said Thursday,” Agence France-Presse reports. “Three million people aged 50 or older currently live with HIV in sub-Saharan Africa and that figure is expected to rise to 9.1 million by 2040,” the news service notes. “It’s mainly driven by the fact that people are being treated with antiretroviral drugs and therefore will survive to be old,” Robert Cumming of the Sydney School of Public Health at the University of Sydney said at a conference on aging in Africa, according to AFP. Cumming added the problem is “being ignored,” and the news service writes, “Policy makers on the continent were also not acknowledging the growing age group which has doctors and others working in the field worried.”
The Canadian Medical Association Journal (CMAJ) reports on HIV in the Kingdom of Swaziland, writing the country “now has the dubious distinction of having the world’s highest rate of both HIV and tuberculosis (TB).” The journal notes “[a]bout 26 percent of adults aged 15-49, or about 202,000 of all the citizens of Africa’s last absolute monarchy, are HIV-positive, according to the Swaziland government,” and asks, “Why are the 1.2 million people of this landlocked kingdom … in such dire straits?” CMAJ writes, “A host of underlying factors appear to be at the root of its woes: politics, history, culture, economics, poverty, gender inequity, and much more.”
“An HIV/AIDS report by advocacy organizations in Uganda indicates that new transmissions are on the rise amidst troubling trends of increasing prevalence and incidence,” Uganda’s New Vision reports. “The findings are contained in a report titled: ‘The Change We Need to End AIDS in Uganda,’ which describes a 10-point plan to halt the trend,” the newspaper notes. “Some of the 10 points include ending harmful policies that further marginalize vulnerable groups; endorsing and expanding safe medical circumcision; and tackling health challenges that hold back the response to AIDS,” according to the newspaper.
PlusNews examines challenges and concerns over an announcement by the Zimbabwean government that it plans to train nurses to prescribe and administer antiretroviral drugs (ARVs) to people living with HIV in the country. “Previously, nurses were allowed only to administer the drugs after a doctor had prescribed them,” the news service writes, adding, “Now, changes made in the job descriptions of nurses by the Nurses’ Council of Zimbabwe will see them prescribing the medication.” Owen Mugurungi, director of the HIV/AIDS and TB unit in the Ministry of Health and Child Welfare, said, “I need to point out that it’s not enough that a professional council allow nurses to administer drugs; this should be followed up with measures to capacitate nurses to do this work correctly,” according to PlusNews. The news agency looks at how the possibility of work overload for nurses, a government hiring freeze on nurses, and ARV availability could affect the country’s plan to reach 85 percent of the population in need of HIV treatment by the end of this year (10/16).