Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 42254-42320 837

It is retrogressive to argue that the availability of essential drugs must be
improved before proceeding to antiretroviral therapy. The time to prepare for
antiretroviral therapy is now, so the phasing in can start!
S42316 Access to treatment for people living with HIV/AIDS in
Colombia
Henry Ardila. Avenida 32 #14-46 Bogota, Colombia, Colombia
Issue: In Colombia, there are 8433 AIDS cases and more than 10,000 people
living with HIV. They have little or no access to anti-retroviral treatment until 1996.
Reforms in the Social Security System and AIDS legislation, attained through
the political activism of communty groups, have make changes so that now all
Colombians have the right to these treatments.
Project: The Colombian League for the fight against AIDS worked in cooperation with the community and other sectors to develop different strategies which
resulted in the modification of the approved list of medications which are covered
by the Social Security System (Agreement 53 of 1997). Members of the political
sector such as the First Lady, Ministry of Health and Pan-American Health organization were lobbied to collaborate in the effort to improve access to treatment.
In June, 1997, new legislation was approved (Law 1543) which requires that the
Social Security System to give Anti-retroviral treatment, Protease Inhibitors, and
comprehensive outpatient care to pwa in Colombia. Advocacy and cooperation
with the mass media proved to be an effective means to improve access to
treatment
Lessons Learned: 1. Strategies to gain access to treatement to medications
for pwa must be based within the context of Human Rights. 2. An Inter-sectorial
approach is fundamental to implement actions, generate political will. 3. The
mobilization of people, groups, and organizations in society is strengthened by
the participation of the mass media by enabling more people to learn about their
rights.
S42317 1Impact of the use of protease inhibitors in newly
diagnosed AIDS-related infections in Brazil
Valeria Saraceni1, E.E.M. Cortes2, M. Perez3, S. Abbud3, C.G.L. Neves3,
B. Durovni4. Rua Cupertino Durao 219/B/404, Rio de Janeiro, RJ, 22441-030;
2Hospital Da Lagoa, Rio de Janeiro; 3Hospital Rocha Maia, Riod de Janeiro;
4Transmissible Diseases Department, Rio de Janeiro, Brazil
Objectives: To document the impact of the introduction of the antiretroviral
combined therapy and the consequent delay in newly diagnosed opportunistic
infections (01), according to the trends seen in the developed world.
Methods: We reviewed retrospectively the charts of the patients that were
referred for the administration either of ganciclovir or amphoterycin B, in order to
treat their first episode of Cytomegalovirus (CMV)-related disease or Cryptococcosis, in a public hospital-based AIDS Day Clinic. We divided them in two groups,
before and after the protease inhibitors (PI) became available, as those drugs
are government provided in Brazil. The first group came to us from November
1st, 1995 to October 31st, 1996. The second from November 1st, 1996 to October
31st, 1997. The distribution of PI started on November, 1996. The patients that
were using PI at their own expenses before that date were excluded from the
second group.
Results: We received or made the diagnosis of 32 cases of CMV-related
disease and 15 cases of Cryptococcosis in the first group, and 18 cases of CMV
and 7 cases of Cryptococcosis were detected in the second group.
Conclusion: We have seen a decline in the referral or diagnosis of new
cases of Cryptococcosis and CMV-disease of 53.33% and 43.75%, respectively,
showing that PI must be influencing the outcome of HIV-related infections.
42318 Antiretroviral (ARV) use in general practice in urban
Zambia: problems and successes
Jennifer Chisanga1, R. Baggaley2, A. Canada3, D. Kasonde4, E. Van Praag5.
'Corp Med Medical Services, Lusaka; 5ASH WHO, Geneva; 4Mutti Medical
Centre, Lusaka, Zambia; 2ASD/WHO, Geneva, Switzerland; 3Global AIDS Rx,
Raleigh NC, USA
Background: The optimistic and extensive publicity given to ARVs in the popular
press has lead to an overwhelming and largely unmet demand in developing
countries. We set up a system of obtaining ARVs as cheaply as commercial
possible through a mail order company and attempted to care for our patients
who could afford or obtain them. ARVs were seen as part of a comprehensive
package with counselling and social support being an integral part.
Design: Descriptive study
Methods: The progress of 25 consecutive patients who were taking ARVs was
reviewed. Follow up for a median of 13 months. Variables looked at: CD4 counts
and clinical picture on starting ARVs, method of obtaining ARVs and short term
follow up.
Results: 22 people starting ARVs were already symptomatic and 16 had CD4

counts below 50. Although follow up is, as yet, very limited 19 showed some
symptomatic improvement, but improvement in CD4 counts, particularly for those
who were severely imunocompromised, was disappointing. Four deteriorated on
ARV treatment and two died. No major side effects from the ARVs were noted.
Three patients were unable to continue with treatment because of financial constraints and five moved to industrialised countries in order to obtaining drugs from
public services. All, except one, were able to share their HIV status with their

partner or a close friend or relative who all took an active part in supporting them
in their ARV therapy.
Financial source of ARVs by sex

Drug supply
Self financing
Relative/friend paying
cost-sharing with employer
"Donations" from abroad

Male n = 22 Female n = 3
8 0
5 3
4 0

Conclusions: Embarking on ARV therapy in developing countries often imposes great logistic and financial burdens. It remains a treatment which is far
beyond the means of the vast majority of people with HIV in Zambia. There is
however a growing demand and some people go to enormous lengths to obtain
ARVs often at great cost to themselves and their families. In our experience very
few women were able to obtain ARVs and many people embarked on therapy at
a late stage in their disease.
42319 Important reduction in the number of deaths among
patients of an AIDS referral center in Sao Paulo, Brazil
Artur O. Kalichman1, D.L. Estevam2, R.A. Souza2, J.M. Caraciolo2,
Z.M. Xavier2. 1Street Antonio Carlos 122 Sao Paulo; 2STD AIDS Reference
Center, Sao Paulo, Brazil
Issues: In November/96 the Ministry of Health and the Government of Sao Paulo
State started the free of charge distribution of the new nucleoside inhibitors of
reverse transcriptase and protease inhibitors to AIDS patients, following a national criteria including: CD4 count, clinical status, progression of disease despite
double therapy use and more recently viral load. The STD/AIDS Reference and
Training Center is a public service of the State Health Department and the Head
of the STD/AIDS State Program. More than 20.000 HIV/AIDS patients were registered at the Center since 1988 and more than 2500 patients are currently being
followed, 60% of them symptomatic.
Project: To evaluate the impact of the availability of the new combination of
drugs in the absolute number of deaths among the patients followed in a public
service of a developing country. We compareed the absolute number of deaths
in the first semester of 1996 and 1997. It is important to say that there were no
important changes in the total number of patients registered or followed in the
service and in the sources of information on deaths in this period of time.
Results: In the first semester of 1996 there were 350 deaths and in the same
period of 1997 these figures reached 169, representing a proportional reduction
of 44%.
Lessons Learned: The availability of the new combinations of drugs seems to
have a dramatic impact in the reduction of the mortality of AIDS patients followed
in a public service of a developing country. The free of charge distribution of these
drugs represents an important public policy to improve the quality of life and the
survival of HIV/AIDS patients.
S42320 A global AIDS related biotechnology transfer protocol
(GARBTTP) to facilitate access to AIDS prophylactics in
developing countries
Joe Thomas. AIDS Advocacy Alliance C/o 17B, Block F 3, Lok Man Road, Chai
Wan, Hong Kong
Issue: Further efforts in facilitating Access to AIDS treatment in developing
countries
Project: A plea to UNAIDS to initiate a process by which existing AIDS related
bio-technological knowledge, facilities or capabilities are rapidly utilised to fulfil
the needs in developing countries. This process involves, identifying all the currently available AIDS related bio- technical resources, identifying potential users
in developing countries (e.g., government labs and bio-technology companies in
developing countries), and a UNAIDS mediated bio technology transfer protocol
to interface the two. Collaboration should also be sought from World Intellectual
Property Organisation (WIPO) and World Trade Organisation (WTO).
Guiding principles: Acknowledging the global inter dependence, all AIDS
related medical and biotechnological advances are to be considered as a global
heritage.
The goals and services: The primary goal of GARBTTP is to expedite the
transfer of technology from the numerous laboratories throughout the world to
the end-users. The services provided by GARBTTP will fall into four major categories: Business & Operations Management services to assist in identifying
policies related to intellectual property rights, global trade agreements, management, production and general operations problems that hinder AIDS related bio
technology transfer. Research, Planning & Development services focusing on
all phases of technology development leading to new products and processes
in various countries and by partner agencies. This includes identifying state-ofthe-art technologies to be considered to be included in GARBTTP. Commercial
services to assist clients in getting technology and/or products to the commercial
marketplace at and developing mechanisms to make it affordable. This also
might involve a global fund to compensate to acquire advance technology to be
transferred Education & Training services designed to expand knowledge about
treatment options, the types and status of technology available for transfer and
the mechanisms for promoting this process.
Conclusion: A UNAIDS sponsored global AIDS related biotechnology transfer initiative is essential to facilitate greater access to AIDS prophylactics in
developing countries.