"CIPLA is a joke for me" said Yolanda, a person living with AIDS in Honduras. "More than 20 of us, with the help of our Doctor have pooled our money so that we have more than $7,000, and for months we have been in contact with Fabiana Jorge, one of CIPLA's representatives, but she won't do anything for us. We want to give CIPLA our money and get the medicines we need, but they won't give them to us."

According to Yolanda's physician, the $7,000 would buy anti-retroviral products for these 20 people for a year, at CIPLA's advertised prices of around $325 for some anti-retroviral coctails. But CIPLA remains unresponsive, six months after Jorge spoke at the Access to Essential Medicines meeting held in June of this year in Guatemala.

Yolanda and her physician were interviewed last week in Guatemala City, during the second Central Ameican Conference on AIDS and Sexually Transmitted Diseases (CONCASIDA).

It is not clear what is preventing CIPLA from trying to deliver its products to this small group of individuals in and around San Pedro Sula, Honduras's second largest city. But one thing is sure --- most of them, in advanced stages of AIDS, will die if something is not done soon. The Honduran government has recently approved a $190,000 emergency allocation for anti-retroviral medications, but it is clear that only a small number of the country's thousands of people with AIDS can be treated with this budget. The government, following guidelines of the UNAIDS accelerated access program, will negotiate with the multi-national companies but not with generic producers.

After the Antigua conference in June, this writer has also pressured CIPLA to deliver on promises it made during the meeting and, although I have received e-mails from India indicating that registration of CIPLA's products is "in progress," the Hondurans thus far have not been able to purchase their medications.

It is important to remember that

1. There are many Central Americans who could afford the $325 a year which CIPLA charges in order to stay alive while they wait for their government's to provide ARV's.
2. CIPLA sells to Doctors without Borders for use in countries where its products are not registered, so it is not at all clear why it will not sell to other non-governmental organizations such as the one directed by the Honduran physician. The medications clearly would be delivered under the supervision of a qualified physician.
3. One could draw a conclusion, that a small market of 20 people is really not very interesting for CIPLA, because obviously there is not much profit if there is such a small number of people and/or that CIPLA has an infrastructure problem and just can't get it together to figure out how to get its product shipped to Central America.