[e-drug] HIV and ARVs in Cuba

[E-drug <e-drug@healthnet.org>]

E-drug: HIV and ARVs in Cuba
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[Susana Szava from Cuba alerted me to the BBC story of 17
February below. Thanks Susana. The one thing the article does not
talk about is the costs at which Cuba produces its ARVs. During a
recent visit to Cuba, I calculated that the Cubans produce first line
ARVs at some 10% of prices of CIPLA, while they could show me
acceptable bioequivalence tests. Admittedly, my calculations were at
the 'back-of-an-envelope' and maybe my price data were not optimal,
but still. My counterparts thought it was because of Cuba's low
wages, but India is not known for its high wages either. That put me
to think about the actual costs of (first line) ARV treatments and how
low they could go. Do E-druggers have ideas? Copied as fair use.
HH]


17 February, 2003
By Molly Bentley
BBC News Online

Few stories about HIV/Aids infection bring hope. But in the
Caribbean, where communism takes its last gasp, there is
encouragement in the fight against Aids. "Cuba has a lid on the
HIV/Aids problem," said Byron Barksdale, the director of the
American Cuban Aids Project, a non-profit organisation that provides
humanitarian aid to the island.

There has been no dramatic increase in HIV transmission in Cuba
since the beginning of the epidemic, said Dr Barksdale at the annual
meeting of the American Association for the Advancement of Science
in Denver. Cuba's infection rate is one of the lowest in the world.

In addition, certain forms of HIV transmission that plague the rest of
the globe are almost non-existent on the island. There is virtually no
transmission of the virus through intravenous drug use, blood
transfusion or to newborns at birth. 

Drugs available

The country now produces enough anti-retroviral medicines to supply
the country¿s patients. As a result, the 25% predicted mortality rates
for patients with Aids in 2002 were instead 7%. While mother-child
transmission is a huge problem in African countries, for example, in
Cuba, the government ensures that all HIV-positive mothers are
treated with prophylactic AZT therapy up to delivery and then the
babies are delivered by caesarean section.

No infants contract the virus through the birth canal, according to Dr
Barksdale, who added that Cuba's prevention measures are not likely
to be implemented in other countries. "It would be difficult to mandate
Caesarean sections on all HIV-positive mothers in the United States,"
he said. Cuba's low HIV infection rate is due largely to the country's
extraordinary response in early years of the epidemic.

Stigma

Cuba established the National Commission on Aids in 1983 to provide
education on the disease, a full two years before the first Cuban
national contracted the virus, and at a time when the word "Aids"
carried such stigma, US President Ronald Reagan refused to use it in
public speeches.

But in Cuba, said Dr Barksdale, people had lived under socialism long
enough to have "an idea of classlessness," which made educating the
public and providing medical attention fairly straightforward. Under
Cuba's socialised health care system, all HIV/Aids patients receive
medical care and drugs free of charge.

But some requirements of the programme pinch personal liberties. In
the late 1980s, Cuba implemented a classic public health measure
and began quarantining patients. The quarantine system includes
eight weeks of education and drug support, after which the patient is
free to leave - although, many choose to stay, according to Dr
Barksdale.
 
Surveillance

In addition, a national surveillance system tracks all infected people
and their partners. As a result, the government has an extensive
database on all HIV/Aids infections, including their source, whether
from overseas or within the country.

While the authoritative response helped contain the spread of the
virus, Cuba's political isolation initially prevented access to life-saving
anti-retroviral drugs. Then Cuba got innovative. Unable to afford the
expensive anti-retroviral medicines produced in developed countries,
Cuban chemists analysed the drugs' chemical components and set
about recreating their own. Cuba now produces sufficient quantities
of seven anti-viral medications for all its patients.

Because it is self-sufficient in drug production, said Dr Barksdale, the
country's next step is to export medication. He predicts that Cuba will
soon offer to sell the anti-retroviral drugs at cost to other countries. "I
suspect there will be countries in Latin America, the Caribbean basin,
and in Africa that will purchase these drugs directly from Cuba," he
said. 

In this, Cuba has set an example of political leadership in its response
to the AIDS crisis, according to Monica Ruiz, from the US National
Institute of Allergy and Infectious Diseases. "It's an example of what a
country can do on it's own shores," she said. "While each country will
provide a different response, this shows that political will has to be
there."

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