Activists demand better access to antiretrovirals

A lobby group, the Kenya Coalition for Access to Essential Medicines, is demanding that the government provide affordable or free antiretrovirals (ARV) for Kenyans. "What we want to see is an expanded programme to treat as many people as possible," said Gitura Mwaura, Chairman of the coalition. "We believe the government has the resources, and can do something," he said. "Its priorities need to change." Of the some three million people living with HIV in Kenya, at least 10 percent are in urgent need of ARVs, while only between 7,000 and 10,000 are able to access them - mainly through mission hospitals, the private sector, or NGOs who sponsor the drugs. Buying imported generic ARVs costs up to 3,500 ksh (US $45) per month, which is way beyond the reach of the vast majority of Kenya's 32 million people, over half of whom live on less than a dollar a day. The government has committed itself to providing ARVS for 20 percent of those in need by 2005, but has no comprehensive national treatment plan in place, mapping out detailed procurement plans, supply chains, training for medical personnel and essential monitoring for all those in need of the drugs, says Mwaura. "Though they're [the government] talking about treatment, we don't seem to see much concrete action." Meanwhile, an estimated 700 people died of AIDS related illnesses every day in 2002, or over 200,000 people during the course of the year. Through the UN's Global Fund to Fight AIDS, Tuberculosis & Malaria the government plans to treat 3,000 people from December - namely TB patients, mothers and their families, ministry of health workers and emergency cases including rape. A further 6,000 will be able to access ARVs this year in 28 district hospitals around the country, at half of the purchase price or in some cases for free, the Director of Medical Services in the MoH, Dr Richard Muga, told IRIN. But this is just a drop in the ocean, say activists. Aside from the lack of a national strategy in place to treat and monitor all of those in need, the ministry of health's technical capacity has also been called into question. A pharmaceutical tender produced last month for 2004-2005, inviting suppliers to quote prices for drugs including ARVS, had "serious errors" in it, the coalition reported, despite readily available guidelines from the World Health Organisation and Kenya's own Essential Drugs Lists and Treatment Guidelines. The tender asked for a combination ARV pill that did not exist, the wrong dosage for another ARV regime, and left out other essential items - paediatric doses, ARVs for people with TB, for use after rape or immediately after infection, or second-line ARVs for use where initial drugs do not work. The coalition welcomed the fact that ARVs were on the tender list for the very first time, Mwaura said, but added "if that tender is anything to go by, then we certainly have a serious problem regarding the technical advice on offer to the ministry". "In a country faced with a massive co-epidemic of HIV and Tuberculosis, it is absolutely unacceptable for incorrect and non-existent drug combinations to be tendered for from the highest technical office of the Ministry of Health." Since 7 June the coalition has been trying unsuccessfully to meet the Kenyan minister of health, Charity Ngilu, to discuss a national treatment plan - which the government is reportedly working on - and to offer its expertise. To date it has not been granted a hearing. Meanwhile, the government is delaying in granting permission to a Nairobi firm, Cosmos, to start producing generic ARVs at home, which would push the monthly price down to 2,500 ksh (US $32). Dr Prakash Patel, managing director of Cosmos, told PlusNews that due to a "grey area" in international law he was waiting - for several months - to receive a letter from the Ministry of Health and the intellectual property office to allow him to begin large-scale production. "We are asking the Kenyan government to give us the go-ahead," he said. Government initiatives, or the absence thereof, have also been heavily criticised on other fronts. The National AIDS Control Council - which spent only 6 percent of its budget on programmes in 2000-2001, and a staggering 94 percent on overheads and salaries - has been under investigation for corruption and mismanagement this year, while the cabinet committee on AIDS had produced little by way of concrete results, said Mwaura. "We would like to see some more concrete action on the ground," he said. "We need some political will."