Costs of ARVs spiral

A rise of more than 100 percent in the price of antiretroviral drugs is likely to put the life-prolonging medication beyond the reach of hundreds of thousands of Zimbabweans living with HIV.

Pharmacists in Zimbabwe's second city of Bulawayo increased the price of a monthly course of ARVs from an average of Z$30,000 (US$120 at the official exchange rate) to between Z$80,000 (US$320) and Z$100,000 (US$400), telling IRIN/PlusNews the price hike was an inevitable response to the country's economic woes, which has seen inflation surge to 1,281 percent, and foreign currency become a scarce item.

"People think the price increase is severe and unnecessary, but all we are doing is passing on the costs of procurement to keep the supply chain running. We are aware of the public outcry but there is nothing we can do. We import these products, so we need to keep the prices at a level where we can supply the country and remain viable at the same time," said a Bulawayo pharmacist, who declined to be identified.

She said the sharp hike in the price of the life-prolonging medication was a consequence of the high cost of procuring the raw materials, as all the ingredients for manufacturing the medications were imported. Because foreign currency was unavailable on the formal market, manufacturers had turned to the parallel market, where there was an abundance of foreign currency, but the exchange rate was astronomical.

On the parallel market one US dollar fetches as much as Z$6,000, as opposed to the official exchange rate, which is pegged at Z$250 to one US dollar.

"We understand the importance of ARVs to the country, but we cannot sell them at prices that may lead us to close shop. The government needs to do something to ensure that ARV manufacturers are given priority in sharing the little foreign currency that comes in. We can only reduce prices if our suppliers reduce theirs. At the moment that is highly unlikely, so we either increase the prices in line with them or just close shop," said Edmos Moyo, a pharmacy manager in the city.

More than 300,000 Zimbabweans require antiretroviral therapy, but the government ARV rollout programme has only reached 50,000 people - the remainder either have to buy the medication from private pharmacies or rely on handouts from nongovernmental organisations distributing ARVs in private and public hospitals.

The government intends to make ARVs available to 160,000 people, but a government minister conceded this month that the programme was lagging far behind schedule. UNAIDS estimates that about 20.1 percent of adults in Zimbabwe are infected with HIV/AIDS.

"Many of our people cannot afford the treatment at such cost. I foresee a situation where many people will just drop out of treatment and wait to die in silence," Emmanuel Masuke, of the Zimbabwe National Network of People Living with HIV/AIDS (ZNNP+) in Bulawayo, told IRIN/PlusNews.

"The pharmacists are the only reliable source of the drugs, since government has failed to provide ARVs to those who need them. The few NGOs that are helping out will not be able to meet the growing demand, as they are also struggling to keep up steady supplies to patients who are already on their programmes."

Deputy minister Edwin Muguti told IRIN/PlusNews that the planned rollout was still on the cards, but the programme had been hamstrung by shortages. "The government still intends to go ahead with the rollout of ARVs, but we are short of money to buy the drugs. In some cases we have a shortage of personnel because of the ongoing problem of brain drain. We have prepared the facilities, but we are still losing staff to other countries."

Muguti condemned the ARV price increase, which coincides with government's increase of hospital fees by up to 100 percent, and said pharmacists should realise the importance of antiretroviral drugs to the nation's health.

However, pharmacists said the government should stop accusing them of putting "the health of the nation" at risk and address the lack of foreign currency and hyperinflation, which were the main drivers of the price increases.

Pharmacists predicted that the imminent gazetting of the statutory instrument 263/2006, which will introduce fixed fees for the registration of medicines, licences and permits under the Medicines and Allied Substances Control Act, would further increase the price of ARVs and other drugs.

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