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Svetlana, 33, is awaiting September with a mixture of anticipation and dread. The St. Petersburg resident is looking forward to her daughter's 17th birthday -- the age when she herself married and started work selling cosmetics. She is also wondering where she will get the medication that keeps her alive. In 2000, Svetlana learned she was HIV-positive, the result of an intravenous drug habit she kicked the same year. Last August, she began treatment with anti-retrovirals, the drugs that a decade ago turned HIV from a death sentence into a chronic but manageable disease. At first she received the drugs from the city's AIDS center, where, by law, they should be available free of charge. "For the first three months, I got all three medicines with no problem. Since then, there is always something missing," said Svetlana, who now works for an AIDS advocacy organization. She was not comfortable having her last name published. "Sometimes for five days, sometimes for a week, sometimes for a whole month there are no drugs at all." The parliament passed a federal law on AIDS in 1995 that guaranteed
free treatment to all. The legislation seemed particularly farsighted,
given that at that time, fewer than 900 Russians had tested HIV positive,
and only 160 had died of AIDS-related ailments. But today, that guarantee remains for many an empty promise. The Federal AIDS Center estimates that 1 million people are infected with HIV. As many as 60,000 of them urgently need treatment, but only about 2,000 receive it, according to World Health Organization estimates. Breaks in treatment such as those that have threatened Svetlana present an additional danger. The virus' ability to mutate means that when treatment resumes after a break, it may no longer be effective, requiring a switch to more costly and burdensome therapies. Friends have helped provide Svetlana with her monthly supply by purchasing drugs privately -- at enormous expense. While a reliance on generic drugs and local manufacturing has lowered anti-retroviral drug costs in countries like India and Brazil to $300 or $400 per person per year, equivalent treatment in Russia can cost $8,000. "The cost is unreal," she said. "It's possible to buy one drug once every few months, for example, but to do so constantly is impossible."
The high price of anti-retroviral drugs in Russia is a constant preoccupation of activists and health organizations, and one of the central obstacles to universal treatment. The federal law on the monetization of social benefits, which went into effect on Jan. 1, compounded the problem by mandating that the funding for the drugs come from already-strapped regional budgets. "The regions have been left to fend for themselves," said Sergei Avdeyev, director of the Chelyabinsk AIDS Center. "There are richer regions that can take care of their needs, but there are also those that are, in an economic sense, helpless." Avdeyev requested 30 million rubles ($1 million) from the regional budget for 2005 but received only 6 million rubles. Of the 159 people in the region requiring immediate treatment with anti-retroviral drugs, only 40 receive it. This is just a shadow of the shortfall to come, Avdeyev said. The rate of the disease's progress varies widely, but it can take 10 years or more from the time of infection to the time when treatment becomes crucial. Because the epidemic is still in an early stage in Russia -- 99 percent of registered HIV cases have appeared in the last five years -- only 1 percent of the 16,000 Chelyabinsk region residents registered HIV positive currently require treatment. "In five years, we expect that 10 to 15 percent will require treatment," Avdeyev said. "If this problem isn't addressed immediately, our hospitals will be overflowing with AIDS cases."
A host of factors are keeping prices beyond the reach of regional budgets and private individuals alike. The first is that nearly all of the anti-retroviral drugs in Russia are produced by international pharmaceutical companies such as GlaxoSmithKline and Roche. While some countries have negotiated sharp price reductions with these companies, Russia's end-consumer prices continue to be comparable to those in Western Europe and the United States. Michael Crow, general director for GlaxoSmithKline in Russia, disputed the idea that Russia could not afford the higher price for the drugs, known as ARVs. "I do not believe Russia, as a member of the G8, should receive the same prices as the developing world, as this is not a poor country," he said. "In fact, in June 2003, Russia actually endorsed a memorandum with the other G8 countries not to benchmark ARV prices to those in the developing world." The pharmaceutical companies argue that wealthy countries have a responsibility to pay the higher prices to help fund the development of future generations of anti-AIDS drugs. The shortage of anti-retroviral drugs in Russia, Crow said, "is really a question of budget." For a country with Russia's industrial capacity, one potential medium-term solution would be to domestically manufacture generic ARVs, as India and Brazil have done with "great success," said Akram Eltom, who is Russia director of a WHO initiative to provide 3 million HIV sufferers worldwide with the drugs by the end of 2005. Local production can lower drug prices by cutting shipping costs, tariffs, duties and markups by importers -- all of which, Eltom said, contribute to the high price of anti-retroviral drugs in Russia. But local production is no cure-all. It can take years for manufacturers to scale up their facilities, and without competition from cheaper imports, prices can remain high. Currently, only a single domestic pharmaceutical manufacturer makes an anti-retroviral drug recognized by the WHO, and it costs nearly as much as brand-name versions. David Melik-Guseinov of Pharmexpert, an agency that analyzes the pharmaceuticals market, said he did not expect this situation to change. "I think that the anti-AIDS drug segment is not attractive for local manufacturers," he said. He cited the relatively small market for the drugs and the lack of existing production capacity. One bright spot on the horizon is the imminent dispersal of two grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is set to begin in September. The grants will provide Russia with $209 million over five years, largely to supply anti-retroviral drugs to regions and populations thus far deprived of them. As a condition of receiving the grants, the Health and Social Development Ministry concluded an agreement with major manufacturers in which it would buy their drugs with the Global Fund's money at a dramatically reduced price. The initial cost will be $1,700 per person per year, and the grant stipulates that the cost be brought down to $600 by the end of the five-year period. Still, activists warn that this money will cover only a fraction of the ultimate demand, especially as the epidemic progresses. "In the long term, it is the government budget that will have to pay for this kind of health care," Eltom said. It is important to raise the level of internal political will, since no amount of foreign aid will be able to contain the epidemic, he said. "We keep saying Russia can achieve a lot given its health sector capacity, and like many G8 countries, it can live up to its aspirations to contain major public health threats such as HIV/AIDS," Eltom said. "There is still a chance it will choose to do so." Источник: The Moscow Times |
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