Inter Press Service - June 22, 2001
Judith Achieng'

Unlike many women in Kenya who have little knowledge of the disease, she has acquired skills on managing the HIV virus and gets a constant supply of drugs at a low cost from a hospital programme funded by the French charity, Medicins Sans Frontieres (MSF), which also has employed her as a counsellor for other women infected by the virus.

Most of her patients come from the overpopulated Kibera slums in Nairobi, where few women are literate and can hardly afford treatment for even minor fungal and bacterial infections.

Unfortunately, the programme only distributes drugs to fight opportunistic infections, such as tuberculosis and cryptococal meningitis, responsible for the majority of deaths of HIV patients.

MSF is unable to provide anti-retroviral combination therapies used in treating the virus itself, due to their prohibitive cost and tight importation rules. "Knowing that there are legal barriers to access drugs is a depressing fact," Ochieng' says.

"The only thing I can do is treat each infection as soon as it comes. But without anti retrovirals, I will also go one of these days."

Patricia's story could be told by each of the 2.5 million adults in Kenya living with HIV. About 500 die daily of Aids related infections, according to official figures.

This high number of deaths is largely attributed to lack of access to essential medicines and anti retroviral therapies, making what has become a chronic disease in Europe and America, where HIV/AIDS mortality has been reduced by 75 percent, a deadly plague in African countries.

In Kenya, according to MSF, which is spearheading campaigns to easier access to drugs, anti-retroviral cocktails are only made available to urban hospitals and pharmacies already with sophisticated infrastructure and expertise to administer and monitor their use, cutting off the rural population.

The pharmaceutical industry has argued that ARVs are highly toxic and costly to develop drugs, which if used badly, not only risk the patient's life but also could cause the HIV virus to develop resistance to the drugs.

In May this year, the cheapest price negotiated by certain hospitals in Kenya came to 1, 620 dollars (US), per patient per year, making it affordable to only about 2,000 out of the 2.5 million infected Kenyan adults.

Generic companies, like India's Cipla have been selling ARV combinations to governments like Cameroon and Nigeria, for as little as 350 dollars per patient per year, but Kenya is yet to enter into such arrangement.

The biggest challenge in accessing drugs in Kenya, according to MSF regional pharmacist Sofie Marie Scouflaire is to get information on where, in the big towns, the cheapest drugs are sold. "It is difficult for everybody to know where to get the cheapest medicines. People can only get good treatment from the private sector."

For women, already marginalised by socio-economic factors, access to anti retroviral drugs and essential medicines is further out of reach, although they need more special reproductive care than men. "Many of them suffer quietly and don't know that they need to go for treatment," Ochieng' says.

Although few studies have been conducted on the specific problems faced by women in accessing the costly anti-retrovirals, it is believed that they are more disadvantaged since majority of them are poor.

"Women are margnalised in policy development. They are the majority of the unemployed. When they get sick, society still demands that they continue with their role of providing care to their families," says Eunice Odongo, head of Women Fighting Aids in Kenya (WOFAK).

Women also in many cases, says MSF lawyer and campaigner Indra Van Girbergen, are left with little or nothing to buy drugs with, when men sell family property to treat themselves without telling their wives.

The problem of access goes deeper than the cost of anti- retrovirals. It is a package that involves access to medicines used in treating opportunistic infectious, and also availability of testing equipment, a major requirement in the HIV treatment plan.

Even with a reduction in the price of the anti-retrovirals, a coalition of 15 NGOs fighting for better access to Aids drugs, argue that HIV virus will continue to be a major killer in Kenya is if the cost of other essential medicines remains high.

Also testing for viral load and the CD4 count, which must be carried out before treatment begins, is only available in major towns, cutting off majority of the population based in rural areas, which are worst hit by the epidemic.

Hospitals charge as much as Shillings 10, 000 viral load testing and Sh.. 3, 000 for while CD4 counting, both which must be done twice a year. ( 1 dollars US is 77 Shillings).

In the villages, where a majority die due to lack of testing and treatment infections like malaria and typhoid, the cost of testing for HIV treatment is too prohibitive.

To improve access and information to women in rural areas, organisations like WOFAK are now targeting traditional healers for training on how to administer the anti retrovirals, particularly to expectant mothers.

"However much the cost of anti-retrovirals isreduced, they will still remain inaccessible, if we do not out where the women are," Odongo adds.

The Kenya parliament is about to pass the Industrial Property Bill to ensure that Kenya respects patent laws that protect drug companies from competition by generic manufacturers.

An NGO coalition is asking the parliament to take advantage of the World Trade Organisationhealth safeguards which permit poor countries to override patent rules in cases of national emergencyto save lives.

Kenyan parliamentarians "must not miss this opportunity to include life-saving WTO/TRIPS safeguards such as parallel importation and compulsory licensing in the Bill," echoes Chris Ouma, a doctor with the British charity Actionaid and a leading crusader for access to Aids drugs. (END/IPS/HE/ja/cr/01)

* Editors Advisory. This is one in a series of IPS features previewing the United Nations Special Session on AIDS, to be held in New York June 25-27.. It is the first-ever Special Session devoted to a single disease.

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