ACCESS TO HIV/AIDS TREATMENT IN RESOURCE-POOR SETTINGS

1. THE CASE OF ANSS/BURUNDI By: Jeanne Gapiya Niyonzima ANSS Legal Representative ACCESS TO HIV/AIDS TREATMENT IN RESOURCE-POOR SETTINGS

2. HIV/AIDS in Burundi • Total population: estimated at 6.5 millions • Prevalence: 18.6 urban, 7.5 rural, first cases in 83, 11% in 89, 20% in 2000 (urban) • 390.000 persons living with HIV/AIDS (2001) • More than 70% of hospital beds occupied by AIDS patients

3. ANSS: history and background • Founded in 1993 by PLWHA • Mission: to promote full enjoyment of human rights by PLWHA, to give the epidemic a human face and voice, to prevent new infections through VCT • 1995: VCT starts in an office rented with the support of Aides Federation Nationale, a French NGO (FF 26000)

4. ANSS (cont’d) • Increase in the demand for VCT as a result of our sensitization campaigns: 35 people in Dec. 95, 489 Jan.-Nov. 96, 747 Jan.-Mar 99 • Development of peer psychosocial support for those who get positive results • 1996: started treatment through drugs donations with volunteer and part time physicians from public hospitals; started a nutrition program for 25 poor families

5. ANSS (cont’d) • 1996: started an informal support network of PLWHA using ARVs • 1998: ANSS negotiates with one private pharmacy to make ARVs available and one private clinic to make CD4 count equipment available. Before that, people had to travel to Uganda or Kenya for over BIF 500,000 . The cost came down to BIF 10,000 • ANSS reaches agreement with Glaxo SK on reducing prices for AZT and 3TC (about $ 350/mo

6. Strategies for political commitment • ANSS lobbied government on the basis of prior achievements (reduced prices of ARVs, available CD4 count) and led it: • to waive customs duties on ARVs and drugs for opportunistic infections (40%) • to set up a national therapeutic fund with an annual gov. contribution of USD 150.000 (now built into the national annual budget)

7. Political commitment (cont’d) • The leadership and commitment of ANSS members contributed to government involvement in the response in general and in care and treatment in particular • Continued PLWHA advocacy led gov. to accept them as stakeholders and to include them in decision making bodies: National AIDS Commission, Theme Group (GIPA in action)

8. Professionalizing care and treatment: Centre TURIHO • 1999: with the support of Ensemble Contre le SIDA, a French NGO, ANSS opened Centre “TURIHO”, a center for VCT, care and support. In Kirundi, the local language, the word Turiho is a statement in itself. It means “we [PLWHA] are alive. We are here!”

9. TURIHO • Turiho is now the second VCT center in the country after the national blood transfusion center (747 people tested in 99, 2176 in 2000, 2949 in 2001). Counseling is done by PLWHA • A total of 7 doctors see patients at the center. Two of them are employed and paid by the association, the other five are volunteers

10. TURIHO (CONT’D) • Center Turiho provides psychosocial support through counseling, food aid with the support of WFP (25 households in 96, 156 in 2002 ) and training in nutrition(2 workshops per month) • Turiho has now become a reference center for HIV/AIDS in general and for antiretroviral therapy in particular

11. TURIHO (CONT’D) • 8980 visits have been registered by the reception desk in 2001. Of these 6266 were medical visits. 6687 prescriptions (essential medicines) have been served by the pharmacy of the Center. 700 patients were under cotrimoxazole prophylaxis • The Center has a three-bed ward where patients can stay a few hours (e.g. injections for cryptococcal meningitis) • A little lab performs simple investigations

12. TURIHO (CONT’D) • In 2000, ANSS obtained funding to purchase CD4 count and VL dosage equipment and placed them in public hospitals. It also started training programs for physicians on the management of ARVs • In 2001, the gov. signed an agreement with 5 pharmaceutical companies on the reduction of ARV prices with the support of UNAIDS

13. Partnerships for care • In collaboration with MSF and the government, ANSS negotiated with the generic manufacturer CIPLA for the provision of generic ARVs. As a result, the price of a monthly triple therapy combination which ranged from $ 112 and $ 215 was reduced to $ 30-$ 60.

14. TURIHO • Out of the estimated 1000 patients using ARVs throughout the country, 400 get them through the Center • 5 persons from the poorest and 10 ANSS staff members receive ARVs from ECS

15. Conclusion • This experience demonstrates the feasibility of access to treatment in general and to ARVs in particular in poor countries. For ANSS to achieve this, it took vision, guts, determination and leadership from PLWHA. This is indeed one example that they are not part of the HIV/AIDS problem but part of the solution.

16. Conclusion • Undoubtedly, a number of challenges remain: making treatment available and accessible to all those in need; building the capacity of health professionals to deal with treatment issues; decentralizing care services, managing resistance. • As encouraging as it can be, we need to recognize that this is small. It needs to be scaled up. Further drugs price reductions are needed, increased resources for care are needed (GFATM, governments, private sector, donors, etc)

17. Conclusion • If a little association of PLWHA in a small, very poor country torn apart by 9 years of conflict can make some progress in access to HIV/AIDS treatment, then there is every reason to say that everyone else should do a hundred times better. All it takes is commitment, organization and, off course, resources. THANKS FOR LISTENING!