AIDS activists offered a critical response to the first of an expected flurry of announcements from pharmaceutical companies of amorphous or spurious drug donation schemes.
Durban,South Africa (13th International aids conference) — Yesterday, Boehringer Ingelheim released a statement announcing a five-year nevirapine donation program (brand name : Viramune) to developing countries for prevention of perinatal transmission of HIV-1.
The release states that Boehringer Ingelheim believes « that our initiative...will help make an impact on the HIV/AIDS epidemic » but provides no structure or timeline for implementation and no details for involvement with participating governments — common characteristics of drug company announcements of donations, which ultimately offer very little medication for very few people.
Further, Boehringer Ingelheim acknowledges that « providing Viramune is only one component of making prevention of HIV-1 mother to child transmission possible in the developing world », but refuses to offer affordable nevirapine as treatment for HIV infected adults.
« Boehringer Ingelheim intends to give pregnant women two doses of nevirapine and nothing more-when there are treatments available that could extend their lives » said Joe West of ACT UP. « The only acceptable program must provide a clear plan for treatment to women and other infected family members, as well as assurance of medical follow up and treatment for mothers and babies ».
An announcement of a donation, with no plan at all for providing for the care of the mother or child is completely unethical. Multiple issues are not substantially addressed, including informed consent, voluntary counseling and HIV testing, and breastfeeding.
ACT UP offers no support for this program unless and until acceptable responses are provided to these concerns :
Any ethical MCT prevention program must be part of a comprehensive program for treatment of HIV positive women, children, and other family members. Boehringer Ingelheim’s announcement makes no mention of the need to connect HIV prevention in newborns to access to HIV treatment for adults, resulting in countless needless deaths of both parents and orphans.
As one of five participating companies in the UNAIDS/Big Pharma ’partnership initiative,’ Boehringer Ingelheim has revealed the lack of coordinated effort from the 5 participating companies. Rather than providing a substantial plan for improving nevirapine access for treatment—not only prevention—the Boehringer Ingelheim announcement proves that the UNAIDS initiative is nothing but smoke and mirrors that holds no significant promise for any real provision of combination therapy.
A donation scheme must not be allowed to obscure efforts to increase access through means such as compulsory licensing and parallel importing. Any country doing generic production or importation of nevirapine must not be excluded from this offer, if it is indeed genuine. « To save lives, including those of children born to HIV positive mothers, we need widespread access to combination therapy, requiring broad coordination between companies » said Laura McTigue of Health GAP Coalition. « They’re not even talking to each other, they had their day in the sun with their announcements, and they’ve all gone home. Drug donation announcements are no substitute for verifiable and sustainable public health measures to increase access ».
« These announcements raise the hopes of millions of people with HIV worldwide. When drugs do not materialize, or programs are so small as to have virtually no impact, people with AIDS are left with despair instead of treatment » said Julie Davids of ACT UP. In addition, community leaders in Kenya and Uganda have reported that the UNAIDS announcement in May created tension between doctors and patients : people with HIV and their families heard of rumored discounting but were still unable to access medicine and concluded that local doctors were getting free or cheap drugs but holding out at a higher price to make a profit. « Announcements follow announcements and each actor tries to keep its image clean but the reality of people living with HIV/AIDS remains the same » said Gaëlle Krikorian of ACT UP-Paris. « It is imperative for countries to find their own solutions, by using generic medications produced by national drug companies, by building up regional markets, and by purchasing from suppliers that offer reasonable prices. »
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