Opinion: Second-line ARVs in India; PEPFAR funding

The successful scale-up of services for people living with HIV (PLHIV) in India "is now at risk," write Loon Gangte, president of the Delhi Network of Positive People, and Leena Menghaney, projects manager in India for Medecins Sans Frontieres' Campaign for Access to Essential Medicines, in a livemint.com editorial.

Although "[t]he need for access to newer combinations of ARVs has been evident from the beginning of the government treatment programme," the authors write that "the government held back from introducing second-line ARVs in the national AIDS treatment programme on concerns about the spiralling prices of second-line ARVs." While ten ARV centers have begun to administer second-line ARVs, there are restrictions on who can access the drugs.

"The refusal to treat spells immense hardship for PLHIV and their families, who are forced to purchase second-line ARVs themselves from pharmacies at prices significantly higher than those obtained by the government through bulk purchases directly from the generics producers," say the authors, adding, "Many will not be able to sustain this expensive treatment, leading inevitably to further drug resistance, continuous ill health, AIDS, and death."

The authors conclude, "The battle to start providing ARV therapy in India has been won. The battle to provide lifelong treatment to all is just beginning" (Gangte/Menghaney, livemint.com, 6/8).

Obama's PEPFAR Funding Level, 'Unwise,' But 'Understandable' Choice

"Though President Obama's trip to Africa [last week] focused on the Muslim world, by looking South from Egypt across the Sahara to the rest of the continent he could have seen the dramatic impact" of former President George W. Bush's HIV/AIDS policies in Africa, columnists Cokie Roberts and Steven Roberts write in a Billings Gazette opinion piece. PEPFAR's "efforts to deal with HIV/AIDS in Africa have saved more than a million lives; Obama needs, even in these tough times, to continue them." 

PEPFAR's investments are "impressive" throughout the "15 focus countries of the program, where more than 2 million people have received lifesaving antiviral drugs free of charge," according to the authors. But the "bad news is that the number of infections has not decreased and there are still millions of children who have been either orphaned or made vulnerable to a life of desperate deprivation due to HIV/AIDS," according to Roberts and Roberts.

The opinion piece includes details about Cokie Roberts' recent Africa trip to see how Save the Children, where she is a trustee, uses PEPFAR money. One of the group's projects focuses on improving "the lives of [children's] caretakers" by working with local charities to teach women how to save money, according to the authors. They also describe a youth center where young boys talk about "how much they like coming to a place where adults pay attention to them and try to teach them how to make good choices."

According to Roberts and Roberts, these are some of the "best way[s] to reduce the incidence of AIDS in the long run." They conclude that although Obama's budget proposal decreases PEPFAR somewhat, it's "an understandable choice in recessionary times, but an unwise one given the success of the program" (Roberts/Roberts, Billings Gazette, 6/5).