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

XIV International AIDS Conference

Abstracts ThOrE1423-ThOrE1455 531

under the auspices of the government and in India by the private sector. In Thailand, it has been shown that the access to antiretroviral drugs is feasible, affordable and cost-effective.
Lessons learned: In the context of South-South programmes collaboration, the
dialogue has been initiated between WHO/AFRO and Thailand in order to explore the possibilities for technology transfer to African countries to enable them
to produce locally antiretroviral drugs and drugs for opportunistic infections in the
context of the international law.
Recommendations: WHO/AFRO should provide support to countries of interest
for the implementation of technology transfer with special emphasis on institutional capacity building and technical assistance at country level.
Presenting author: Krisana Kraisintu, 75/1 Rama6 road, Rajthevi, Bangkok
10400, Thailand, Tel.: [phone], Fax: [phone], E-mail: krisana
@ mozart.inet.co.th
ThOrE1423 Chile's Informal Market for Antiretrovirals (ARV).
Features, Challenges and Lessons for Optimal
Regulation
C. Morales1, A. Brousselle2, and the Chilean Drug Access Initiative ANRS
Study Group3. 1Universite de Montreal, GRIS / CMIS, Hdpital Sainte-Justine /
Chilean Drug Access Initiative ANRS Study Group, Montreal, QC, Canada,
Canada; 2Universite de Montreal, GRIS / Chilean Drug Access Initiative ANRS
Study Group, Montreal, Canada; 3ANRS, Santiago, Chile
Background: The informal market (IM) for ARV in Chile is perceived as a growing
phenomenon, poorly documented and that constitutes major public health challenges. First, clients are exposed to several risks: ARV from doubtful sources may
be of sub-optimal quality, discontinuity of supply may cause virus resistances,
patients don't receive adequate counseling and are exposed to stress. Second,
vendors selling their own ARV drastically undermine their health and may also
develop resistances.
Methods: The research was conducted in 09-12/1999 and in 06/2001 in the context of the evaluation of the UNAIDS/CONASIDA Drug Access Initiative in Chile.
Direct observation and semi-directed interviews were performed with about 90
actors (NGOs, CONASIDA, health centers, pharmaceutical companies, patients).
Results: The IM has several expressions. On the supply side: individuals buy
ARV outside the country to sell them in Chile, patients that benefit from public
therapies sell them to cover for more pressing needs (clothing, housing, feeding), and foreign NGO's and solidarity groups provide ARV to informal patient
networks. On the demand side: privately insured patients (PIP) prefer to buy on
the IM instead of disclosing their HIV status to their insurance company, patients
enrolled in the public system (PS) with no access to ARV and no financial resources to buy on the official market, and occasional buyers that need short term
emergency supply.
Conclusion: The fact that patients of the PS receive free ARV but PIP have to pay
for their drugs, creates a double price system that encourages the existence of
an IM. Thus, universal coverage for ARV is recommended. Meanwhile, increasing
ARV access only for PS patients may increase the IM because there will be more
patients tempted to sell their ARV. Finally, closer follow-up and widen access to
viral load measures may help to better appraise the problem and to develop more
counseling initiatives.
Presenting author: Cristian Morales, 7411-B St-Denis, Montreal (QC), CANADA,
H2R-2E5, Canada, Tel.: [phone], Fax: [phone], E-mail:
moralesc@ magellan.umontreal.ca
ThOrE1424 The impact of national production of ARV drugs on
the cost of the ARV therapy in Brazil, 1997-2000
C.L. Szwarcwald. FundaBo Oswaldo Cruz, FIOCRUZICICT Av Brasil, 4365, RJ
21045-900, Rio de Janeiro, Brazil
Background: Brazil is the unique low-income country to provide universal access
to ARV therapy. Highly positive related effects have been evidenced, such as the
substantial reduction of AIDS mortality. However, the cost of newly released ARV
medicines has challenged the Brazilian Program in maintaining universal access
to ARV treatment. Locally production of generics was the main adopted strategy.
Methodology: A mathematical analysis of the annual total cost of the ARV therapy, in the period 1997-2000, is presented. Firstly, the average cost of individual
therapy using two drugs was calculated. Similar calculations were performed for
the average cost of individual triple ARV therapy, using either NNRTI or PI medications. The average cost of individual ARV treatment was estimated as a weighted
mean of the different therapeutic scheme average costs. The economic impact of
the local production of generics was estimated as the reduction in the annual cost
of the ARV therapy, provided by the replacement of imported drugs by national
products, in the period 1997-2000.
Results: Reductions of 72% in the average individual cost of the two-medicine
therapy and of 64% in the triple therapy individual cost were evidenced in the

period 1997- 2000. Despite of the increasingly number of patients, the total annual therapy cost decreased 8% from 1999 to 2000, and did not exceed the limit
budget of 300 million US dollars. Further, if the average cost per patient/day had
remained the same as in 1997, Brazil would had spent 220 million US dollars
more in the period 1998-2000.
Conclusions: As a result of the national production of generics, the cost of ARV
treatment has not escalated in recent years, making possible to maintain univer
sal access to ARV therapy. The Brazilian model offers important lessons learned
to developing countries, as it shows that universal anti-AIDS therapy is an achievable goal, even in a low-income country context.
Presenting author: Celia Szwarcwald, FIOCRUZ/CICT, Av. Brasil, 4365,
RJ 21045-900, Rio de Janeiro, Brazil, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThOrE1l425 Litigating AIDS: background, strategies and
outcomes of the Treatment Action Campaign's
(TAC) case to prevent mother to child HIV
transmission in South Africa
M.J. Heywood. AIDS Law Project, AIDS Law Project, CALS, Private Bag 3,
University of the Witwatersrand, Johannesburg, South Africa
Issues: Annually over 70 000 infants are born with HIV in South Africa. However,
despite the growing body of medical evidence/opinion on the efficacy and benefits of interventions to reduce mother-to-child HIV transmission, the South African
government's response is characterised by obfuscation and delay. This causes
confusion and loss of life. Consequently, in August 2002, the Treatment Action
Campaign together with a group of paediatricans launched a legal challenge,
based on human rights entrenched in the South African Constitution, to seek a
court order that would compel the government to make Nevirapine available, and
to develop a reasonable national plan to prevent infant infections.
Description: The paper describes how the TAC was able to construct a legal
strategy that deployed scientific evidence, medical opinion, economic research,
and descriptions of the impact of MTCT in a court application founded on the assertion of legal duties linked to human rights. It describes how the court papers
compose a body of evidence and testimony that capture the history of a conflict
between health advocates and health authorities caused by political inertia and
interference around the HIV/AIDS epidemic. It analyses the relationship between
advocacy and law, critically debating the merits of legal contest around social and
health issues.
Lessons learned: The legal challenge will only be concluded in mid-2002 as
a result of an appeal by the government to SA's Constitutional Court. The final judgement will have profound implications for a mother-to-child HIV transmission programme as well as for access to treatment and government responsibilities concerning allocation of resources for health. Linking advocacy and law had
quantitative and qualitative benefits.
Recommendation: Human rights law, combined with advocacy and supported by
quality scientific evidence, is a way to claim rights, improve health, and overcome
political barriers to HIV prevention and treatment.
Presenting author: Mark Heywood, AIDS Law Project, CALS, Private Bag 3,
University of the Witwatersrand, Johannesburg, South Africa, Tel.: [phone]
8634, Fax: [phone], E-mail: [email protected]
ThOrE1455 Cultural weapons in the AIDS struggle
Z. Mashinini. Gauteng Health Department, Private Bag X 085, Marshalltown,
2107, Johannesburg, 2000, South Africa
Issues: Cultural interventions to overcome denial ensure an appropriate context
for communication and facilitate a response to social factors driving the HIV epedemic. Work is done in contemporary and traditional cultural contexts.
Description: Cultural interventions are used in a range of contexts:
- Traditional song and dance with migrant workers
- Contemporary music with urban youth
- Gospel artists with the religious sector
- Drama in schools.Youth led drama groups reached 560 000 youth in schools in
the first year.
The hostel programme in 41 hostels has broken through denial. Gospel artists
gained the support of Africanist Churches. Working with musicians, artists on radio, millions of youth have been reached. The media is responsive to AIDS issues.
This cultural intervention draws on strong local traditions of song and dance and
community solidarity. It has powerful meaning for most of the population. In addition ours is a verbal culture, relying largely on face-to-face communication. The
AIDS programme has supported both song and dance and modern youth culture.
The approach is key in our social environment.
Lessons learned: 1.Cultural activities need to be integrated into mobilisation,
communication and educational programmes.
2.Cultural work adds value in mobilising for change.
3.Indigenous African culture, both tradional and modern, has special strengths
we can mobilize. It builds humanism and social values in the face of degredation
produced by poverty combined with materialism.
4.Cultural work is under-utilised because it is poorly understood, especially in the
field of public health.
Recommendations: 1.Cultural interventions should be integrated into AIDS programmes.

2.Skills in the field of cultural interventions need to be developed.
3.Sustainability of cultural interventions should be insured.
4.Cultural interventions are a key factor in unleashing capacity for change.
Presenting author: Zanele Mashinini, Private Bag X 085, Marshalltown, 2107,
Johannesburg, 2000, South Africa, Tel.: [phone]/3254, Fax: [phone]
3399, E-mail: [email protected]