Global Policy Forum

By Katy Salmon

Shortages of discounted AIDS drugs are seriously endangering the lives of HIV/AIDS patients in Kenya by forcing them to switch to alternate medications or interrupt their treatment altogether.

Some of Kenya's largest health centres regularly find it takes more than two months to get vital supplies of anti-retroviral drugs (ARV), according to the Kenya Coalition for Access to Essential Medicines. Anti-retroviral drugs help prolong the lives of people infected with AIDS or the HIV virus that causes AIDS. The most serious shortages occur with Videx and Zerit tablets, produced by Bristol-Myers-Squibb.

Dr John Wasongo of Nairobi's Mbagathi Hospital says this is playing havoc with treatment of HIV/AIDS patients. ''One major problem I have experienced in my HIV clinic is that a majority of the patients, after I have given them the prescription, come back to me again and say that some of the drugs that are prescribed are not in the market,'' he explains. ''Therefore the pharmacists in the hospital where they've gone to collect the drugs either want them to change to another one or to take a different dose of the one that is available.''

Many patients are unable to afford the alternatives on offer and are forced to go without medication for several weeks. Without treatment, their health can rapidly deteriorate. Others decide to take the wrong dosages, for example a 40-mg tablet instead of the 30mgs prescribed. These extra toxins in the body worsen the painful side effects caused by the drugs. ''They are forced to take a higher dose which is not recommended by the manufacturer,'' says Wasongo.

Others, he encourages to cut up their pills with a razor blade.

''This is problematic for most of the patients because it is already complicated enough to take the drugs in the strict guidelines that we give them. But to ask them again to look for a sharp blade to cut the drugs into a quarter and dissolve it in water is a further disincentive.

''To convince the patient to take the drugs as required is already an uphill task. This makes a very difficult process even more difficult. We are likely to see more people falling out of the treatment,'' he says.

Some patients can afford to switch to another anti-retroviral drug, which is more readily available. But this choice is also risky. Wasongo says these patients will have a higher chance of developing drug-resistant strains of HIV, reducing their future therapy options.

''So far there are only 16 ARV molecules that the world can use. And in Kenya some of these are not yet even in the market. So we have a very limited range of drugs and we must always strive to preserve future therapy options for those patients who may develop resistance.

''So we will not experiment and start somebody on three different drugs, then tomorrow we change it because of shortages to another one. That is playing with people lives.

''We are going to end up with serious resistance and two years from today we might have no ARVs that we can use,'' he warns.

Liza Kimbo of the Kenya Coalition for Access to Essential Medicines says the problem of drug shortages started last year when the five major drug companies lowered the prices of their AIDS drugs for Africa by between 50 to 98 percent. ''It's the big five. It's the companies that have provided these drugs at the beneficial prices are the ones that are then affected with the shortages. We also do not find a similar pattern with all the other drugs that they supply begging the question -- why is it that these particular drugs which have been promised to us at reduced prices are the ones that are suffering shortages but not the other drugs?'' she asks.

Kimbo says the Kenyan government should end the branded drug companies' monopoly. If generic versions of the drugs were available in Kenya, increased competition would encourage the big five to ensure that stocks do not run out. ''We are urging the government to provide a competitive environment and improve access by allowing a provision of generic drugs. The more supplies there are in the market, then the less tendency we'll find to have shortages of critical drugs,'' she says.

Theoretically, Kimbo's wishes should be granted on May 1 when the Industrial Property Act, passed last June, comes into effect. This will allow parallel importation - where a licensed importer can shop around the world for the cheapest generic medicines regardless of patent rights. The Act also strengthens compulsory licensing - empowering the government to licence local drug manufacturers to produce generic versions of patented medicines.

But this is full of hurdles as Robert Lettington, an independent legal consultant, explains.

''The problem that we have is the government still hasn't issued the regulations to accompany the Act,'' he says. To get a compulsory licence, companies must apply for one from the government. Three Kenyan companies had already applied for a licence to manufacture generic ARVs - Laboratory and Allied, one of the country's largest pharmaceutical companies, Cosmos and Universal Pharmacy - by January.

Generic imports also have to be licensed and checked by the government. This registration process, carried out by the Pharmacy and Poisons Board, normally takes two to three years. With an estimated 700 Kenyans dying of AIDS-related diseases every week and less than 10 percent of Wasongo's patients able to afford ARVs at the prevailing market prices, many believe this period is far too long. Campaigners are wary because the Ministry of Health has already let Kenyans down by failing to conclude negotiations with the German firm Boeringer Ingeilheim for free supplies of Nevirapine to the country's estimated 280,000 HIV-positive women who get pregnant each year.

The women need the drug to stop mother to child transmission. The government failed to meet two conditions - to carry out HIV tests for all the women to be put under the drug, and put in place security mechanisms that ensure that donated Nevirapine is not stolen and sold on the black market.

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