A lack of anti-retroviral medication is putting lives at risk. If a person with HIV/AIDS does not take the meds as prescribed, it can cause HIV to become resistant to the drugs and the patient will not have treatment options. This week, we have been following reports that there is an acute shortage at the public health facilities because the supplier, an Indian company, has not been able to deliver on orders for the medication. News Five’s Hipolito Novelo looks into the shortage and its effects.
Hipolito Novelo, Reporting
The June 2019, the 2017 HIV Statistical Report was published and figures show that of the thirty-seven thousand HIV tests conducted that year there were two-hundred and twenty-three new cases of HIV in Belize. At December 2017, a total of one thousand three hundred and eighty five persons living with HIV were on antiretroviral treatment, taking generic medication such as Lopinavir/Ritonavir to suppress the viral load and prevent transmission. Twenty-six-year-old Javier Paz was diagnosed with HIV in August and has joined the antiretroviral treatment programme.
Javier Paz, Living with HIV
“I am literally very new to the whole treatment and everything. I haven’t really learned much about it but I know enough to know that this is the easier step for me to take.”
But that step has gotten difficult and life threatening because the country has run out of the much needed medication.
“The issues that I am having is that I cannot restock on it right now. Apparently there is none in any of the free facilities within the country. What I have left is only eleven of them excluding the one that I will take tonight.”
“So eleven pill, eleven days; what happens after the eleventh day?”
“Well, I’ve been trying to reach out to organizations that I heard off to see if they can help me in getting access to medication but I mean, it was just today that I found out that. So I haven’t heard back from them. I tried reaching out to friends in the states who work in pharmaceutical companies that deal with these types of diseases that bring down your immune system but they don’t carry this specific type of medication either. At this point I cannot say what will happen.
In May of this year, the Government of Belize made payments to the tune of two hundred and forty one thousand dollars to an Indian pharmaceutical supplier for a total of four thousand three hundred bottles as part of its annual and usual procurement process. The company has failed to deliver the stock, putting the lives of many at risk. Director of Health Services, Doctor Marvin Manzanero says that the Indian company is experiencing multiple issues with production and distribution.
Dr. Marvin Manzanero, Director of Health Services, M.O.H.
“We started procuring generic medications from 2006 directly from Indian companies, making us one of the countries procuring at one of the lower prices of the entire region. What has happened now is that companies in India with which we used to do business some of them have started downscaling their production of anti-retrovirals and some of them have shifted to other medications that are more lucrative as a business. So we did our procurement to find out one particular anti-retroviral from April of this year we did payment in May. We were suppose to have gotten that product in June but because there is a downscaling in production, there is bigger markets that are actually buying more. I mean South Africa for example buys maybe a million bottles when our procurement s three thousand six hundred. So you are not going to be first in the list even though you have paid for it.”
But even so, just last week the Government paid a further two hundred and sixty thousand dollars for other key anti-retrovirals that should be delivered within a few weeks.
Dr. Marvin Manzanero
“We’re understanding that the companies were having difficulty in accessing raw materials. You noticed that earlier in the year there was a notion that some of the anti-hypertensive medication had cancer agents that were tainting the raw materials. So they were trying to safeguard that. Mine you that is not an excuse.”
In June, the Ministry of Health realized that the anti-retroviral would not be delivered according to schedule and looked to its neighbours for assistance.
Dr. Marvin Manzanero
“Reaching out to countries who could loan us or donate to us. We managed to get a loan from Costa Rica. That loan is still owed. But the countries in the region are also facing the same situation. So I think it is one medication that I know that we are at zero stock which is Lopinavir/Ritonavir and that is the generic name. I am aware that one other medication that is triple combination where people would take one single pill. I think we have stock out of that. My understanding, however, is that you are not going to be able to get that one single pill but the other ingredients are available as separate tablets so patients are perhaps going to be getting two-three tablets instead of taking the one pill. I am not sure as to status as is in terms of when that particular product will arrive. In terms of the ones we have stocked out the company has told us that it is going to be here in the next two-three weeks.”
But persons like Paz do not have three weeks. Adverse effects can be experienced by persons living with HIV if they go long enough without taking their medication. They begin developing resistance to the meds.
Diego Grajalez, Director, CNET+
“Your body could develop some sort of resistance to the medication which means when you start again eventually you will notice that it is not working with you. There would no way to prove that because within the country we don’t have resistant testing for HIV. In this country we have first and second line medication. Once you surpass that medication there is nothing else you which is why a lot of people are concern about this issue. One day is already too much without this medication.”
The stock of anti-retrovirals puts Belize’s commitment to the UN 90-90-90 goal which in part seeks to have ninety percent of people living with HIV with an undetectable viral load.
Enrique Romero, Executive Director, N.A.C.
“We at the National Aids Commission are very concerned. We find the situation unacceptable as well because we are dealing with people’s lives. As a country we have subscribed to the United Nations Gen programme to HIV/AIDs to the ninety-ninety-ninety goals which looks at testing ninety percent of persons living with HIV and Aids and having them know their status, getting ninety percent of those on link to care and anti retrovirals. The third goal is having ninety percent of those on anti-retroviral having a viral load suppression.”
“We are striving to reach for people living with HIV as a national response to have an undetectable viral load which means that a person living with HIV, not that the virus isn’t there but is so minute in your system, controlled by the medication that you cannot even transmit HIV. It’s controlled. It put also that at risk. If a person is undetectable and it out of medication allows the virus to replicate because the idea of the medication is to suppress the virus in order for the virus not to reproduce within the body.”
“So if we cannot effectively address pillars two and three adherence if we are constantly having stock out of medication.”
If the Indian companies was to halt production of anti-retrovirals to which company or country would the government turn to then? That is what the Ministry of Health is contemplating at the moment. Reporting for News Five, I am Hipolito Novelo.