Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

254 Abstracts WePeF6675-WePeF6679

XIV International AIDS Conference

WePeF6675I Turning empathy into action: A survey of
medication recycling projects
M. Buitron1, J.C. Rodriguez2. 1Harbor-UCLA Research & Education Institute,
1068 minerva park, long beach, ca, 90813, United States; 2CSULB Center for
Behavioral Research & Services, Long Beach, United States
Issues: There are programs that collect unused HIV medications and send them
to those who cannot afford them in other countries. While these efforts have been
shown to help some, lack of monitoring, interruptions in treatment, issues of accountability, and lack of coordination with other projects have kept these efforts
from being their most effective.
Description: This paper presents information about projects that collect HIV
medications in the United States and send them to individuals and organizations
in other countries. Issues around funding, collecting procedures, record keeping,
and distribution are compared. Problems with customs, surplus medications and
logistics are presented along with solutions devised by some of these organizations. Criteria for individuals and organizations who receive these medications
along with monitoring procedures show that less rigorous procedures for accountability can sabotage the best of intentions. This paper is based on personal experience in sending medications to South America along with open-ended telephone
interviews conducted with staff from other recycling projects.
Lessons Learned: The proliferation of medicine recycling has kept a number
of people alive who would otherwise not have access to anti-retroviral therapy.
Some projects are able to incorporate capacity building and political action into
their recycling work. Some projects however, lack the resources or will to monitor
the health of individuals being sent these medications, thus are not able to ensure
that medications are being used by the intended recipients.
Recommendations: This presentation recommends the active collaboration with
agencies on the receiving end, accurate record keeping and monitoring, and the
pre-establishment of criteria for the receipt of medications.
Presenting author: michael buitron, 1068 minerva park, long beach, ca, 90813,
United States, Tel.: [phone], Fax: [phone], E-mail: michaelbuitron
@earthlink.net
WePeF6676 The impact of the Diflucan partnership program
training of health care workers on the number of
patients treated
S. Conway1, P. Connelly1, J. Wright2. 1IAPAC, suite 244, postnet killarney,
private bag X2600, houghton 2146, South Africa; 2KZN DoH, Pietermaritzburg,
South Africa
Issue: The impact of a HIV training program on the number of patients being
treated for HIV related Cryptococcal Menningitis and Oesophageal Candidiasis
within public health facilities in the Kwazulu-Natal (KZN) Province of South Africa
through the Diflucan Partnership Program (a treatment access program for fluconozole).
Description: The Diflucan Partnership Program (DPP), a collaborative effort of
the Pfizer Corporation, the South African National Department of Health and
the International Association of Physicians in AIDS Care (IAPAC), offered "Best
Practices" seminars to promote adherence to DoH guidelines and training for
the proper diagnosis and treatment of HIV related Cryptococcal Menningitis and
Oesophageal Candidiasis with Diflucan. Diflucan was made available for free beginning in May 2001 by Pfizer for patients reporting to South African public health
facilities. Best Practices seminars began in October as part of the Kwazulu-Natal
HIV/AIDS Training Program.
Statistics were maintained by KZN Department of Health on the number of health
care workers participating in the Best Practices Seminars and on how many patients were being treated with Diflucan in each district.
Lessons learned: The number of patients treated with Diflucan in all districts of
KZN increased with the introduction of training by 57% from September to October. The three prior month to month increases averaged 13%. In contrast, the
Ulundi District of KZN was the only district that did not receive training in October
and experienced a decline of 26% in patients treated from September to October.
The October increase in patients treated was maintained with a 1% increase in
November.
Recommendations: Training promotes treatment access to drug access initiatives for HIV/AIDS and should be considered a vital component of all such care
initiatives.
Presenting author: shaun conway, suite 244, postnet killarney, private bag
X2600, houghton 2146, South Africa, Tel.: [phone], Fax: [phone]
5990, E-mail: [email protected]
WePeF6677 Initiating a demonstration project of antiretroviral
treatment in a resource constrained urban setting
in South Africa

D. Dayal, G. Gray, J. McIntyre, A. Violari, M. Chersich. Perinatal HIV Research
Unit, 8 Cowie Road, Forest Town, Johannesburg, 2193, South Africa
Background: South Africa has the fastest growing HIV-1 epidemic with 5 million
infected individuals. 120,000 AIDS related deaths have occurred and is expected
to increase to 450,000 by 2005. While HAART has impacted on AIDS morbidity
and mortality in the USA, these therapies are largely unaffordable to people in
developing countries. We initiated a demonstration project in collaboration with

the International Solidarity Fund to assess the feasibility of delivering HAART in
a resource- poor setting.
Methods: This demonstration project aims to provide treatment to a 100 individuals (70% adults), with CD4 counts<200 cells/ml and who are committed to
participating in a therapeutic program run by nurses and doctors. The primary
goals are maximal and sustained suppression of viral load, restoration of immune
status, decreasing hospital admissions and ensuring that participants are healthy
enough to sustain and care for their families.
Results: 53 adults (43 women: 10 men), mean age of 31.7 years are on treatment (3 individuals have fallen out of the study). Mean baseline CD4 count and
viral load were 97 cells/ml and 281,454 copies/ml respectively 10 patients have
completed 12 weeks of therapy and all have viral loads below 400 copies/ml.
There was no statistically significant improvement from their baseline weight (tTest: P=0.187; 95%CI). Nineteen children (11 boys: 8 girls), mean age of 7.3
years remain on treatment, mean CD4 count and percentage is 362 cell/ml and
10%, the mean baseline and 12 week post-treatment viral load decreased from
352,871 to 2611 copies/mi. One patient died from severe PCP and 1 patient (CD4
count 35 cells/ml; viral load 146,000) reported a grade 3 peripheral neuropathy.
Conclusion: Patient and family participation contributed to the 98% compliance
rate. Initiating HAART in this setting has positive impacts on the clinical course of
HIV infection and on the lives of people living with AIDS.
Presenting author: Dinesh Dayal, 8 Cowie Road, Forest Town, Johannesburg,
2193, South Africa, Tel.: [phone], Fax: [phone], E-mail: dinesh
@ hiv.co.za
WePeF6678I Smoke and mirrors: Assessing pharmaceutical
industry commitments to making HIV drugs
affordable and accessible
S. Lynch1, A. Russell2, B. Baker3. 1Health GAP Coalition, 511 E 5th Street Apt
4A, NYC, NY 10009, United States; 2ACT UP/Philadelphia, Philadelphia, United
States; 3 Health GAP Coalition, Boston, United States
Issues: The demand for HIV treatment, including antiretrovirals (ARVs), in resource poor settings (RPS) has burgeoned since the XII AIDS Conference in
Durban, South Africa in July 2000. These demands have increasingly focused on
the price of patented ARVs a major and crucial barrier to accessing life saving
care.
In response to greater focus on drug prices related to patent protection, and attempts to utilize World Trade Organization permitted safeguards such as compulsory licensing and parallel importing, the patent-based pharmaceutical industry
has made a number of well-publicized announcements of significant price drops
and medicine donation programs, for developing countries
Description: Pharmaceutical companies are evaluated in terms of their actions
to help or hinder access to ARVs and other AIDS medications in RPS. Limitations of these company-led strategies will be discussed. These limitations include
slow implementation, geographic and economic eligibility restrictions, lack of -
transparency, and the exclusion of the private health care sector.
Lessons learned: Pharmaceutical industry offers have not lead to widespread
price drops of a sufficient magnitude to make a difference to many PLWHA, and
have been structured in such a way to be of limited effectiveness and divert public
attention from other, more sustainable interventions. In order to realize the right
to health care and medicine, poor countries require prices that are as close to
marginal cost of production of a medication as possible. Fostering generic competition will help ensure reduction to the lowest possible price and will facilitate
continuous decreases in price over time.
Recommendations: Concessionary offers must be critically examined against
the need for sustainable solutions to expand access to AIDS treatment. Activists
have an important role in publicizing the limitations of these touted programs and
egregious efforts by pharmaceutical companies to block access.
Presenting author: Sharonann Lynch, 511 E. 5th Street Apt 4A, NYC, NY 10009,
United States, Tel.: [phone], Fax: [phone], E-mail: salynchoo00
@earthlink.net
WePeF6679 Side effects and adherence to antiretrovirals by
HIV-positive Mexican women
T. Kendall1, H. Perez-Vasquez2, A. Luna3. 1Red Mexicana de Personas que
Viven con VIH/SIDA, Astronomos 38-5 Col. Escandon, Mexico, DF Mexico,
11800, Mexico; 2Colectivo Sol, Mexico City, Mexico; 3, Astronomos 38-5 Col.
Escandon, Mexico, DF Mexico, 11800
Issues: Adherence determines to a large degree the success of life-saving antiretroviral treatment. Side effects of antiretroviral medications are common and
may discourage HIV-positive individuals from adhering to treatment. The objective
of this study was to explore the relationship between side effects, receiving adequate treatment information, and adherence in a sample of HIV-positive Mexican
women.

Description: 6 focus groups in 5 Mexican states that included a total of 30 HIVpositive women were conducted. Women also completed a questionnaire that
included information on side effects and treatment history.
Lessons learned: Of the 19 women who had taken antiretroviral therapy, 18
(95%) experienced negative effects from their medication, including alterations in
body shape consistent with lipodystrophy syndrome. Women reported stopping
and re-starting therapy and abandoning treatment in response to side effects.