E-drug: AIDS Medications: The New "Black Market" in Central America
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San Jos�, Costa Rica
April 21st, 2000
Anti-retroviral Medication Therapy Pricing Creates New kind of "Black
Market" in Central America
By Richard Stern
Lorena, a 37 year old woman from Nicaragua, is a new kind of drug
trafficker. Lorena rides the buses of Central America looking for places
to
buy AIDS medications in the black market that has sprung up here as a
result of the crisis surrounding medications for people with AIDS.
Lorena was in Costa Rica early in April, where she contacts People with
AIDS who might have an extra supply of a medication they have discontinued,
or simply be willing to sell their own medications for cash. I met with
her
in a restaurant in downtown San Jos� where we shared a lunch of rice,
tortillas, and black beans. Lorena was totally candid with me, and
wanted
to know if I knew of anybody who might have some Crixivan, Videx, or AZT,
anti-retroviral medications which are on her
shopping list this trip. Lorena is a short, but corpulent woman who
speaks
in a very soft voice, articulating her words carefully. But the softness
of
her voice and her seeming humility belie the hardness of her real life
experience, and her determination to survive.
She fills me in on her story. Her husband, a grocery store worker, was
diagnosed with HIV seven years ago. He hasn't worked since 1997. She was
a
housewife and had never heard of AIDS until he told her his diagnosis when
he began to get sick. She was tested and is positive, and has had some
AIDS
related illnesses but their two children, both teen-agers, are HIV
negative. Her husband goes off and on anti-retrovirals depending on their
availability and she knows this isn't good. Neither of them knows their
CD4 count or Viral Load.
Later this month, after to returning to Managua, Nicaragua's poverty
stricken capital, to distribute those medications that she could purchase
in Costa Rica, she was heading for Guatemala, an eighteen hour bus ride
to the North. In Guatemala, the two tiered system of health care has
created a lucrative black market in anti-retroviral medications, which are
sold openly outside the AIDS clinic of the country's Instituto
Guatemalteco de Seguro (IGS). About 400 of Guatemala's 3000 AIDS sufferers
who are affiliated with the IGS receive their medications free through
the
Institute. But some of these 400 may have other sources of medications
and
are willing to sell duplicate pills for needed cash to people desperate to
obtain them at the Black market prices. Others simply weigh the pros and
cons of life saving medication, or having income for other needs viewed to
be equally as urgent.
Lorena makes a living and also is able to obtain medications for herself
and her husband by making these arduous journeys across Central American
borders. She collects money from a small group of Nicaraguans who are
desperate to obtain anti-retrovirals, and then negotiates with sellers that
she finds through her extensive network of contacts with People with AIDS
throughout the region.
"None of us can afford to buy from the pharmaceutical companies," she says,
"but if we can buy from other patients we pay less than half of what the
companies are charging."
Lorena spends about half her time in Managua and the other half in her
travels, staying in $2 per night hotels along the bus routes.
Does Lorena feel she is doing something wrong as she carries medications
for which she has no prescriptions across borders? "How can I feel bad
about what I do," she says. "This is our only option to live. There is a
proverb, "judge not, lest yee be judged. 'Let the drug company owners (sic)
be judged before they judge me,' she adds, her voice quivering with
bitterness. "We have two children. If we die, they are going to be in the
street."
Guatemalans with AIDS are worried about the growing black market in their
country. "This has to be stopped. People are always calling me trying
to
sell medications," one NGO Director told me, during my own visit to
Guatemala City last February. But he recognizes that a black market is
likely to continue as long as some people have access to expensive
medications and others are left completely out of the health care system.
In Guatemala, per capita income is $250 per month and an anti-retroviral
cocktail would cost between $650 and $800 monthly.
In Costa Rica the "two tiered" system of attention to people with AIDS is
less of an issue as nearly 100 percent of the population is covered by
government sponsored Health Care insurance that pays for medications. But
in Guatemala as well as Panama, and several other Latin American
countries,
only certain portions of the populations, generally between 15 and 40
percent, are covered by the Health Care system, which creates the natural
tendency for a black market to occur.
Costa Rican AIDS activist Guillermo Murillo is one of the first People with
AIDS to have come out publicly in Central America. "The cost of these
medications is disastrous for the poor people in Central America," he says
"Even in Costa Rica, the costs of triple therapy puts us in a position
where we really don't have access to changing our treatment if a particular
combination of drugs doesn't work. But for people like Lorena, its a
nightmare." The Costa Rican government is currently spending about
seven
million dollars yearly to supply 900 patients with ARV therapy. But
mortality from AIDS has dropped over 70 percent since the therapy was
started late in 1997.
(Richard Stern, Ph.D. is Director of the Agua Buena Human Rights
Association. The Association is supported entirely by private donations.)
rastern@sol.racsa.co.cr
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