[Ip-health] Re: [e-drug] Using ARVs to fill empty stomachs

[Kevin Outterson]

A few comments on this unfortunate story.

First, while the supply chain was terrible, the story indicates that at
the end of the day a stigma-adverse low-income patient received needed
ARVs.

Second, this example should not discourage us from greatly expanding
generic-priced (or marginal cost) access to patented pharmaceuticals in
low- and medium-income countries.  Diversion within a low-income market
(Kenya) is quite different than diversion from low-income to high-income
markets.  The article didn't say or even imply that they were the same,
but many times drug companies have conflated these categories.

Finally, I am still waiting for any verifiable examples of large scale
diversion of equity-priced medications from low-income markets to
high-income markets.  As I've said elsewhere (www.ssrn.com), it would be
far easier to simply counterfeit ARVs in the US than to collect them
from impoverished people in Kenya for shipment to the US.

Kevin Outterson

Associate Professor of Law
West Virginia University
304 293 8282
kevin.outterson@mail.wvu.edu
LL.M. (Cantab.)
J.D. (Northwestern)
SSRN Author Page:  ssrn.com/author=340746
>>> "E-Drug" <e-drug@healthnet.org> 06/19/06 8:04 AM >>>
E-DRUG: Using ARVs to fill empty stomachs
-----------------------------------------
[Patients on ART need indeed more than ARVs alone. This story from Kenya
is worrying. Thanks to Rob for the pointer. Copied with fair use from
M&G South Africa. WB]

Using ARVs to fill empty stomachs

Joyce Mulama

http://www.mg.co.za/articlePage.aspx?articleid=274450&area=/insight/monitor/#


14 June 2006 01:59


Kenyan activists at a rally to promote HIV/Aids awareness in Nairobi.
(Photograph: AP)
"Yes, I get the ARVs, but I cannot afford to put a simple meal on the
table," says Wa Kimani*.

"This is why I had to register at two treatment sites, so that I could
get ARVs [anti-retroviral drugs] twice: utilise one set from one site,
then sell the other batch from the second site, so that I can get
something small to put in my stomach."

Wa Kimani sat outside one of the centres where he receives treatment,
awaiting the client who buys medication from him. The stigma that
continues to surround Aids in Kenya has apparently made the client wary
of obtaining ARVs through official channels -- something he fears may
lead to his HIV-positive status being made public.

Wa Kimani, who is unemployed, began selling the drugs last year. He
charges his client just less than $7 for a month's worth of medication.

"This is not much, but at least it helps me purchase some basic food so
that I do not take the medicine on an empty stomach. It can be
dangerous, you know," Wa Kimani says.

"I remember once, before I thought of the trade, I would take the
medicine without any food -- just porridge alone. I nearly died. I got
so weak, I developed ulcers which have not healed well until now."

Until the beginning of this month, government facilities had been
charging about $1,4 for the same amount of ARVs. However, the fee was
waived from the beginning of this month. About two million people are
living with HIV/Aids in Kenya -- more than 200 000 of whom require ARVs.
Wa Kimani's case does not seem to be unique.

Patricia Asero, a member of the Kenya Treatment Access Movement, says
she has heard of six other people receiving ARVs from more than one
centre. "I got interested and investigated the matter further because
these people belong to the same support group as me. I found out that
they had registered in more than one treatment centre so that they could
get extra drugs to sell and buy food to take with medication," she said.

In some cases, patients who only have one source of drugs will also sell
their ARVs to buy food, added Asero.

"They will tell you that their medication got lost; others claim that
their bags were snatched by thieves. But when you interrogate them
keenly, you get to know the truth," she noted.

With official figures indicating that about 56% of the population lives
below the poverty line, the temptation HIV-positive Kenyans face to sell
their medication is huge. "The fight against HIV/Aids must be coupled
with the fight against poverty. If not, we are wasting our time," says
Omu Anzala, a senior lecturer in the department of medical microbiology
at Nairobi University's School of Medicine.

The Kenyan government claims to have steadily increased the number of
people receiving ARV medication in recent years: 39 000 patients were
treated in 2005, up from 24 000 in 2004.

"The government should get away from giving us numbers. It should be
concerned about the quality and sustainability of the service. These
numbers mean nothing when the majority of the patients are skipping or
selling drugs," says Anzala.

The alleged sale of ARVs by some patients, and the erratic way in which
others take the medicine, has raised fears of drug-resistant strains of
HIV in Kenya.

"When we talk about comprehensive care in HIV/Aids, nutrition is part of
it. But the government has neglected it; it only provides nutritional
counselling and that is it," notes Asero.

"Some treatment centres may only give a packet of ujimix [porridge
flour] per month. This is nothing."

* Not his real name


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