AIDS Treatment Access in Latin America: The Year in Review

by Richard Stern*

The figures pale in comparison to Africa, but, in the year 2001, many thousands of Central and South Americans died of AIDS. They died as martyrs, unnecessarily, because the medications that would have saved their lives are withheld from them by those who hold power, an elitist group of physicians and bureaucrats masquerading as "health care" leaders.

I have been an observer of the world of AIDS treatment access for the last six years or so, with a focus mainly on issues related to Central and South America.

In the year 2001, we had UNGASS with its macro focus. Politicians who haven't thought about AIDS before or since flocked to the floor of the General Assembly to make speeches. UNGASS was not a bad thing as such, but its impact in Latin America seems to have been minimal. 80 percent of Guatemalans continue without access to anti-retrovirals in spite of declarations made by Guatemala's Health Minister at UNGASS focusing on universal treatment access.

El Salvador's Health Minister spoke at UNGASS of his government's commitment to Human Rights, and three months later, the Salvadoran Congress passed into law a bill permitting and encouraging employers to screen potential job applicants for HIV/AIDS by requiring an AIDS test. A section of the same law defiles science and indicates that condoms are not safe and should not be relied upon for AIDS prevention.

Prices for anti-retroviral medications in Honduras dropped 85 percent, down to about $1,300 yearly. Yet in bordering Nicaragua, a country even more impoverished than Honduras, the price for anti-retroviral treatment remains above $5000 yearly for most cocktails. This phenomenon occurs because UNAIDS implemented its "Accelerated Access to Care and Treatment" program in Honduras, successfully, and multi-national companies reduced their prices dramatically. However UNAIDS has not acted in neighboring countries including El Salvador, Guatemala, Belize and Nicaragua, or throughout much of South America.

UNAIDS argues that it must wait for governments to act decisively before initiating its "accelerated access," program. But, as a close observer of what occurred in 2001, in Honduras it is obvious that UNAIDS acted as a catalyst, assigning three full time Country Representatives to Honduras, and that the successes which resulted were a result of a "pro-active" interaction between UNAIDS and the Honduran government. The same occurred last year in Trinidad and Chile, where ARV prices have also dropped dramatically.

But UNAIDS' chief negotiator for this program, Badara Samb, is based in Africa and has only limited time available for other regions of the world, a situation which must change.

In 2001, Brazil was justifiably recognized throughout the world for its efforts on behalf of People Living with AIDS. By producing its own anti-retroviral medications prices have dropped to under $1500 yearly for anti-retroviral medications, and 105,000 people are receiving treatment. But Brazil has not taken the extra step of offering its medications for sale to its neighbors in Latin America. To do so would be a courageous action that would save thousands of lives in the region. At the moment, People Living with AIDS in neighboring countries such Paraguay, Ecuador, Guyana, and Perú try to cross the border into Brazil, hoping to be assimilated into Brazil's health care system.

The multi-national pharmaceutical company Merck and Co. offered significant across the board price reductions for its two anti-retroviral products, Crixivan and Stocrin, with clear-cut parameters that enabled developing countries to estimate where they stand with respect to medication costs.

But the other multi-national companies which produce anti-retroviral medications, Bristol-Myers, Boehringer Ingleheim, Hoffman La Roche, and GlaxoSmithKline have not followed suit, creating a chaotic situation of dramatically differing prices across borders. The situation would improve significantly if the other major companies would simply follow Merck's example.

Mysteriously, the Internet "list-serve," known as "Treatment Access" ceased to function during 2001, at a time when its functioning has become more critical than ever. "Treatment Access," which had over 1300 subscribers, provided an opportunity for advocates, People Living with HIV/AIDS, and NGO workers in different parts of the world to share vital information about a variety of themes related to treatment access. "Treatment Access" had been financed by the Ford Foundation.

The Barcelona World AIDS conference looms on the horizon as the major international event of 2002, but it is not clear to what extent Conference organizers will make saving the lives of those who do not have medications a conference priority. At this point it is no longer sufficient to simply include "People Living with HIV/AIDS" from the developing world in conferences at meetings. An outreach effort must be made to include "People Living with HIV/AIDS who do NOT have access to treatment," and to insure that their participation in Conference activities is meaningful. The Durban World AIDS Conference in 2000 focused the world's attention on the plight of those who live in Africa's poorest nations, and the Barcelona Conference offers a chance to focus on other areas of the world where access to treatment is still unavailable.

The much heralded Global Fund For AIDS, Malaria and Tuberculosis, becomes a reality in January, 2002, but it is still unclear what its newly selected Board of Directors will have to say about issues related to treatment access The Global Fund has about seven hundred million dollars available for this year, much less than what was originally hoped for, but still a significant sum of money.

Funding for progressive programs promoting grass roots treatment activism remain virtually non-existent in Latin America, significant exceptions being the Dutch Foundation HIVOS which supports nearly a dozen NGO associations run by People Living with HIV/AIDS in the region, and PASCA (Proyecto Accion SIDA Centroamerica) which has been very active in Central America promoting human rights for People with AIDS. Yet most significant changes in health care for People with HIV/AIDS in Latin America have come from grass roots groups which work with virtually no funds and completely outside of the elitist health care "establishment."

The Pan American Health Organization (PAHO) which is the Latin American counterpart of the World Health Organization, continued its woeful record on AIDS Treatment Access in 2001. PAHO Directors generate lots of publicity with their statements at International meetings and at Press Conferences, but, later on, it is hard to find the results of their promised actions.

Over two years ago, PAHO representatives promised the implementation of a Rotating Fund for the Latin American region, focused on reducing prices of Anti-retroviral medications. But, as of January 2002, there are no anti-retroviral medications in the Rotating Fund.

Incredibly, PAHO representatives in Costa Rica recently blocked the allocation of $50,000 in funds for local non-governmental organizations. The funds had been designated by UNAIDS during UNGASS as an emergency measure to help support organizations by and for People Living with HIV/AIDS in Costa Rica, but PAHO officials made it clear that those who criticize them will suffer the consequences. Costa Rican NGO's had criticized PAHO in Costa Rica for its failure to implement the UN mandated "theme group" in that country.

The non-governmental organization Doctors without Borders continued to play an important role in treatment access in the region. In June of 2001, Doctors without Borders sponsored a major regional conference in Antigua, Guatemala focused on "Access to Essential Medications." Doctors without Borders coordinates small programs in various Latin American countries which provide anti-retroviral medications to several hundred people, but it also plays a major role as an information broker with regarding to critical issues such as generic medications and intellectual property.

"Recycled" anti-retroviral medications donated by Agencies in Europe and the United States also enable perhaps as many two or three thousand Latin Americans to survive with AIDS.

Indian generic producers were big news in 2001, offering anti-retroviral cocktails at significantly reduced prices. But the impact of these reductions has been negligible in Latin America. The Indian companies have not made an effort to register and distribute their products in the region, perhaps because Latin American markets are small compared to those in Africa and Asia. Intellectual property laws are not the issue. There are no anti-retroviral medications patented in most Central American countries, or in the Andean region which includes Bolivia, Perú, and Ecuador. In Perú, 9500 people currently need anti-retroviral treatment, and prices offered by multi-national companies keep the cost of most cocktails above $5000/yearly. During most of 2001, I have exchanged e-mails with CIPLA, of India, in relation to selling their products in Central America, as well as Perú, but as yet, nothing has changed. The products are not available.

People Living with AIDS in Argentina were facing a crisis even before civil unrest erupted last month in that country. The government has not yet assigned a budget for anti-retroviral purchase in 2002, and thousands of People with AIDS face death as a result. Argentina, Chile, Venezuela, and Columbia have been providing anti-retroviral medications to a significant percentage of the population of People with AIDS, but in Bolivia, Perú, Ecuador and Paraguay, more than 90 percent of PWAs receive no anti-retrovirals. In Central America, only Costa Rica provides universal access. In the Dominican Republic, 9000 people with AIDS are without anti-retroviral access.

*Director, Agua Buena Human Rights Association
San José, Costa Rica
Tel/Fax 506-234-2411

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