Groups, Individuals Using ‘Creative Routes’ To Supply Developing Countries With Low-Cost Antiretroviral Drugs
Not-for-profit groups and some individuals are using "creative routes" to provide antiretroviral drugs to HIV-positive people in developing countries, the New York Times reports. Some organizations channel unused medications from U.S. patients who have changed medications, taken a break from treatment or died to patients in developing countries, and other organizations purchase low-cost generic versions of the drugs in other countries and import them, sometimes illegally, into neighboring countries. An estimated 5% of HIV-positive people in developing nations who need antiretroviral treatment are able to secure the medicines, according to the World Health Organization. While the exact figures are unknown, thousands of patients who would otherwise go without treatment now get drugs through programs that recycle them, informal physician networks that donate unused drugs and people who purchase the drugs on the black market. While it is illegal to redistribute prescription drugs in the United States, many developing countries do not have laws against the practice. Aid for AIDS in Manhattan -- a not-for-profit group that has branches in Italy, Spain and Switzerland -- collects unused AIDS-related drugs and redistributes them to more than 500 people in Africa, the Caribbean and Latin America. Other groups and individuals take advantage of price differences in other countries, traveling, for example from South Africa -- where an antiretroviral combination regimen costs between $2,000 and $2,200 -- to Lesotho or Namibia, where generic versions of the drugs cost $300. Some groups, such as Doctors Without Borders, get permission to import the drugs, while others distribute the lower cost medicines illegally.
Lack of Oversight
A "thriving black market" has developed because of the lack of oversight of such groups and individuals, and some health care workers have reported the sale of substandard drugs, such as drugs leftover from clinical trials in other countries. Many health experts are concerned that the lack of oversight and the substandard quality of some drugs may create serious public health problems. Inappropriate or inconsistent use of antiretroviral drugs can create serious side effects and drug resistance. Drug resistance is of particular concern, following reports last week that almost 10% of newly infected HIV-positive people in Europe were infected with drug-resistant strains of the virus. "I'm not sure that groups donating medications have spent a lot of energy" considering the fact that antiretroviral treatment must be lifelong, Henry Chang, executive director of AHF Global Immunity, said, adding, "If they don't distribute drugs carefully and do it well, they could be doing more harm than good." AHF Global Immunity, a branch of AIDS Healthcare Foundation, has been working to minimize drug resistance by educating HIV-positive people and health care workers about the importance of adhering to proper antiretroviral drug regimens. The groups distributing the medicines to HIV-positive people in poor countries claim that the risk involved in the programs is one "worth taking," according to the Times. "There's no guarantee that we can keep the people we serve in treatment, but the alternative is far worse," Amar Sall, executive director of AIDS Empowerment and Treatment International, a Washington, D.C.-based group that buys generic drugs from India and distributes them to Africa and the Caribbean, said, adding, "If we don't give people anything, we know they'll die" (Lerner, New York Times, 8/22).