Re: Global Fund on the need for 2nd line ARV drugs in India

[Guest guest]

Dear Mr. Rahman,

Thank you very much for taking the time to send me this letter explaining your

point of view about the Global Fund project in India.

At this moment, the situation regarding the unwillingness of the Indian

government to provide second line medications is critical, yet as you yourself

have stated * " the government of India has not decided yet to introduce second

line medications " *

I would like to raise some points and ask a couple of questions, based on

information I obtained during my recent visit to India. Questions specifically

directed for you appear in *bold face and are underlined* below.

1) I believe that the Global Fund was created to save lives*. Does it

really make sense to start PLWA on treatment, and then for those who develop

resistance, simply allow them to die one or two years later for lack of second

line treatment**? * This seems contradictory to all of the basic principals of

the Fund.

2) *You yourself have speculated in your letter that " the first year

alone would cost over $3 million….and in later years it would cost

approximately $70 million or more "

*Where is the concrete evidence for these estimates? * Until a tender is issued

and people come forward for treatment, no one knows exactly what the prices will

be, and how many people need treatment.

Figures such as $70 million can appear very scary to decision makers, but I know

of no hard evidence to support this, I must request that you explain this

figure.* $70 million when and for how many

and based on what evidence ? *

3)India at this moment has local generic production and distribution

of all second line medications that would be necessary at the present time for

PLWA, through companies with reputations for assured quality such as Ranbaxy

and CIPLA.

This differentiates India from any other country in the world. " List prices "

are still perhaps high for these medications, but all

Indian generic companies have indicated that dramatic price reductions would

occur if the government would issue a tender to actually purchase the

medications.

4) *It is very significant that you make no reference in your letter

to funds available at this moment in existing Global Fund grants

specifically designated for purchase of anti-retroviral medications,

information that is clearly available on the Global Fund website in the India

section. (www.theglobalfund.org)

In the Round 4 grant, approved in 2004 and signed in 2005, $77 million is

available over 5 years clearly designated for ARV purchase, yet, in your

letter, you have not specifically referred to these funds or whether or not

these funds have been disbursed.

You refer to a recent disbursement to the of $17 million, but it

is not at all clear that these funds have been disbursed for ARV purchase, as

the 4th round grant project also includes an additional $70 million in

components other than purchase of ARVs.

*Could you please indicate very specifically how much of the $77 million

available for ARV purchase has been disbursed to NACO, since the grant agreement

was signed? *

Also in the Round six grant for India, which could be available as early as

March of 2007 an addition $85 million is specifically designated for purchase of

ARVs. This grant runs through 2012, thereby assuring sustainability of available

funding for five more years.

5) PLWA who need the medications NOW are told to wait " a few more

months, " as you state, until the government can establish a policy.

*Why would the government not begin second line ARV treatment for those who

need them, while policies are being determined if it is a question of a few more

months?**

* Those who need second line treatment now, many of whom I met on my recent

visit, may be dead by the time these medications become available.

6) Given the fact that it is the Country Coordinating Mechanism (CCM) that

needs to also make decisions that affect the issues being discussed above, I

feel that the Indian CCM needs to prioritize the need for comprehensive care and

treatment, which includes second line medications.

The CCM has the option of insisting that these funds be disbursed in a timely

fashion given the needs which exist NOW. The CCM can also request a

" restructuring " of existing grants in order to meet emerging needs, but there is

no evidence that this restructuring is even needed in order to request that

funds for second line medications be disbursed now.

7) Unfortunately your letter gives the impression of an " exclusive "

dialogue between the Global Fund and the government of India, but excludes

reference to the role of Civil Society in this process through the CCM.

All of the Civil Society people I met during my five weeks in India (several

hundred in fact) were strongly in favor of utilizing some existing funds NOW for

second line medications, but their voice seems silent in your letter.

*Could you please comment on this. *

8) The Indian government continues to make the distinction between

first and second line drugs, as if they must choose either one or the other, in

terms of meeting the needs of PLWA.

No other country, even those nations that are poorer than India, makes this

distinction. Second line treatment is part of the continuum of comprehensive

care that is recommended by all of the International Agencies of ation.

Granted that there may be limits in some countries, but India at this moment

*has more Global Fund money (specifically designated for treatment access)

sitting in the bank than any other country in the world. In my opinion this is

unacceptable.*

Dr. Rahman, I think this debate is critical to the lives of many people in India

who need second line treatment. I appreciate the advances that have occurred

in the past two years in terms of the overall panorama related to ARV access in

India, which are significant.

But I would still hope that you would respond to the issues I am raising above,

and I would also hope that Indian CCM would issue a statement in relation to

these issues.

Sincerely,

Stern, Ph.D

Director,

Agua Buena Human Rights Association

San , Costa Rica

Telephone: 506-280-3548

Fax: 506-280-3548

e-mail- rastern@...

www.aguabuena.org

----------

Eugene Schiff

Caribbean Region Coordinator

Agua Buena Human Rights Association

1-312-731-6652

www.aguabuena.org

eugene.schiff@...

[Guest guest]

Dear Forum

This has ref to Stern's letter dt 22 dec on Global Fund on the need for

2nd line ARV drugs in India.

It has long troubled me as to the thinking of policy makers on providing 1st

line ARV'S while declining 2nd line treatment.

Thank God there are some people who have a greater insight on such matters as

reflected in the above mentioned mail. For some one who has just started 1st

line treatment the rising stress has already begun thinking that all I can hope

for as of on today is help for another few yrs: what then??? If so be the case

why not just let me go as of today; by giving me a few more yrs of life, if

policy makers think they have done some thing great for me, I really beg to

differ.

I wish I could share with you the names of my experience with two key NGO's who

allegedly claim to have helped me with diagnosis and initial treatment. To put

it mildly, I was walked through the entire process like a man 'blindfolded'.

Both touched the subject of reducing stress, however they kept me in elevated

states of stress because of their complete lack of 'simple' management skills. I

fell out with the first one when they stopped responding to testing needs and

the second one was never able to get me the ARV's on time.

As ungrateful as this may sound to some, I will say to policy makers to please

stop this short sightedness. For all the millions/cores allocated to HIV work,

if you are going to bag ¾ of it in management, how do you hope to ever really

help people like me.

I simply do not understand that in a country like ours where there are allegedly

5.3 (or 5.7) million people infected, from what I gather there has been a 100

times more money that has been put into this crisis. Then why and how are we

short of cash?

Can some one please explain this to me?

Regards

Kumar

e-mail: <kumar.captretd@...>