HIV positive? Pay for it, says the State

“This makes the government’s refusal to purchase these second-line medicines for the National AIDS Program rather nonsensical, despite the fact that India has a robust local generic production capacity and has companies that are already producing most second-line antiretroviral drugs in India at this time,” says Loon Gangte an HIV-positive activist fighting to ensure reliable access to essential medicine.

“I am not so hurt by the fact that I have AIDS, that I am terminally ill,” says Raju Shekhar (name changed). “It feels worse when you know a lot more can be done to fight the disease but the government is just not bothered to help.” Shekhar’s condition has deteriorated significantly over the past three months because he cannot afford second-line treatment.

“I had to sell my house to ensure that my second-line treatment could continue,” says Delhi-based Hari Singh. “I had the option. Hundreds I know did not. And they are dead. What is the government doing about it? Do HIV-positive patients not have the right to live?”

NACO’s response to Stern’s questions is that budgetary constraints are the reason for not providing second-line treatment through government channels. But, Stern points out, “NACO has approximately $77 million to facilitate drug access for HIV-positive people, but they have spent only about 4 per cent of this money. And none of this money has come from the government exchequer. It’s been provided by global donors. They (NACO) are not ready to spend a penny.”

International agencies and donors include the Bill and Melinda Gates Foundation, UNAIDS, the World Bank and the Clinton HIV-AIDS Initiative.

“There are certain second line drugs that are supplied in India by Cipla at four times the cost that is charged in the other, less-developed countries it exports to,” says Stern. “They are doing it because they know they will get this kind of money here. Why is the government not asking them to reduce prices?”

Experience shows that price negotiations by bulk ART buyers can bring down the prices. In a significant first, Médecins Sans Frontières in 2001 successfully renegotiated the cost of an ART originally priced at $10,439 in the international market down to $350.

“The government being the bulk buyer can effectively negotiate price reduction,” says Leena Menghaney, project manager, Campaign for Access to Essential Medicines. “Nearly 40 per cent of the cost of the drugs is due to packaging and marketing. That’s not applicable to the bulk buyer.” Gangte wants to know: “If Bill Clinton can negotiate a price cut (for ARTs for children) why can’t the government of India? Especially when India will have far greater leverage with pharmaceutical companies because it’s a bulk buyer.”

“There cannot be any justification for people dying for want of treatment here in the hub of the production of generic ART drugs,” says Singh. “Positive people also have the right to live. It is a simple case of absence of political will.” Someone somewhere has got to take note.