Reveka Papadoupolou is MSF's program manager in Geneva, Switzerland, for the Honduras program. She explains how the supplies of antiretroviral drugs ran out yet again. A statistical picture of HIV-AIDS treatment in Honduras HIV patients in Honduras began receiving antiretroviral drugs in 2002, with MSF's active involvement. The country has received funding from the Global Fund for five years, including the current period. According to medical authorities in Honduras, the AIDS virus affects 70,000 people. Of that number, 7,000 are believed to be in urgent need of ARV treatment. Some 3,500 currently take those medications. MSF set up an AIDS treatment project in Tela and 300 patients are receiving ARVs. Responsibility for their treatment was transferred officially to national health authorities in September 2005.
"The Honduran government was working with the Global Fund To Fight AIDS, Tuberculosis, and Malaria to finance the purchase of ARVs for AIDS patients, who currently number 3,500. Despite its pledge, the ministry did not submit its drug order to manufacturers until early January, so it was inevitable that supplies would run out."
What are the reasons for this delay?
"It is not our role to search for those reasons and we are not in a position to know exactly what they are - whether economic or political. However, we do have a responsibility to express our concern publicly for those patients who will be the victims, sound the alarm once again and, finally, take action to ensure that they continue to receive treatment.
"We do know that this delay is different than the one that occurred in September 2005. That was the direct result of a last-minute announcement by GlaxoSmithKline, which was maneuvering to protect its business interests and not honor the order for the ARV, CombivirÃ?®. MSF had to provide an emergency supply while waiting for the Indian company, Cipla, to make a replacement delivery of generic drugs approved by the World Health Organization. I should, nonetheless, point out that the Global Fund and the U.N. Development Fund placed that order."
Where are we today?
"Following actions taken locally by our teams and other organizations, the Ministry announced that it had found ways to resolve the problem; specifically, by submitting the orders. In fact, even if the orders had been submitted, which remains unclear, 2,450 patients would be without one of the key generic ARVs for a minimum of three weeks. We could not accept that. The authorities already acknowledged that a minimum of 500 new patients would remain on the waiting list for treatment because of this crisis.
"MSF had just handed over the responsibility for treating some 300 patients in Tela to the Honduran authorities. We could not leave them without treatment. When medicines ran out last time in September, MSF took action to make sure that ARV supplies would continue. We lent medications from our Guatemala projects so that patients would not be without treatment.
"It is even more unacceptable to be facing this problem again, especially because the major donors — particularly the Global Fund — have already provided more than half the financing required to place these orders."
What are the possible consequences for patients of halting treatment?
"Stopping ARVs has immediate impacts on the health status of patients, whose condition will worsen quickly. Furthermore, if patients do not take these treatments regularly, they can become resistant to the drugs, which renders them ineffective. Not only that, but patients run the risk of developing opportunistic infections again. They then would have to take more medicine, which is both expensive and difficult to tolerate."
What has MSF done?
"We are taking action to provide drugs on an emergency basis so that no patient—whether an MSF patient or not—will suffer from this lack of medication. Our top priority remains patients' continued survival.
"Furthermore, by addressing the problem with other Honduran civil society groups, which have organized widely, we want to push authorities to set up drug procurement mechanisms that operate effectively, regardless of which team is in place in the Ministry. We have to do everything possible to strengthen the notion that the government — not medical humanitarian organizations — must ensure that these mechanisms work properly, including during emergencies. We are talking about patients' lives here and nothing can justify this kind of dysfunction."