|Access to Drugs (UNAIDS, 1998, 12 p.)|
Living with advancing HIV infection is complicated with a variety of symptoms and medical conditions, many of which are manageable with drugs. The classes of drugs most important to persons living with HIV are:
· anti-infective agents to treat or prevent opportunistic infections;
· anti-cancer drugs to treat malignancies such as Kaposi sarcoma and lymphoma;
· palliative drugs to relieve pain and discomfort, both physical and mental;
· antiretrovirals to limit the damage that HIV does to the immune system.
Access to even the most basic of these drugs is seriously lacking in many parts of the world. The most important obstacle to access is affordability but legal, infrastructural, distribution and cultural factors are also serious impediments. The influence of each of these factors is different from country to country, just as frequencies of diseases also vary greatly.
As HIV/AIDS is quite recent in medical history, most drugs created especially to treat the HIV infection and its related diseases are proprietary and therefore expensive.
Improving access to drugs for people living with HIV presents challenges on a variety of levels. Most countries face the following challenges to some degree: limited financial resources, problems with prioritization of drug needs; inadequate health care infrastructure; inadequate distribution and administration systems.
Ensuring better access to drugs on a global level demands new relationships and alliances at international, country and local level. Responses that are proving useful in various parts of the world include:
· including care of people living with HIV or AIDS as part of national strategic planning;
· improving methodologies for rational selection of AIDS-related drugs, including creation of national essential drug lists;
· improving affordability through actions such as: negotiation with pharmaceutical companies for better prices; competitive procurement through generic tendering and therapeutic class tendering, local production; working with private sector drug distributors in order to reduce the mark-up on price between the supplier and the consumer;
· ensuring physical availability of drugs through actions such as: group purchasing arrangements by groups of people living with HIV; facilitating supply of priority HIV-related drugs through NGOs; involving local associations of pharmacists and licensed drug sellers in promoting safe dispensing; strengthening regulatory control of drug registration, quality assurance and drug outlets.
While responsibility for deciding how to allocate public funds rests with the government, based on the public health and economic context of the country, experience shows that the challenges of access to AIDS-related drugs can best be met when the government enters into partnerships with other sectors. Strengthening the role of persons living with HIV in care partnerships is of central importance in this. The role includes advocacy for building political commitment, providing information to aid in the process of prioritization, and finally in advising on delivery and administration of drugs.
At the same time, strategic partnerships are necessary at international level. UNAIDS is currently working with its Cosponsors and several multinational pharmaceutical companies to improve access to drugs for persons living with HIV.