E-drug: UN session tackling African pandemic (cont'd)
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In response to the question of Dr Frighi why less than 1% of
HIV-infected pregnant women in heavily infected countries receive
treatment to prevent transmission of the virus to their children, though
the drug is free:
The question is spot on - and not asked by enough people. You are
certainly not ignorant! I lived in Uganda for the past few years making
family planning and then nevirapine more available, and have recently
written a paper on how pharmaceutical companies make drugs
available in developing countries. The issues are complex. A few
reasons that I would give as to why people might NOT get nevirapine
at childbirth are:
- The availability of testing: Most antenatal clinics are not set up to do
HIV testing. Certainly not rural clinics, but even many urban sites are
not equipped. As you know, it takes time to train counsellors and
establish correct testing protocols. It's starting, but will take time.
- The stigma of testing: If you are pregnant in many African countries,
the last thing you want is for your husband to find out you are HIV+.
Violence and abandonment can result. In many cultures, the person
who first tests positive is thought to have brought the virus into the
relationship. In Uganda, where the study on the effectiveness of
nevirapine was conducted, many women were declining testing for
this very reason.
- Most births happen at home - in Uganda it was about 60%. The
drug needs to be administered to mom during labour and to baby
within a few days after birth. There are a lot of questions about how to
do this effectively. One issue that you note is the logistics of getting
drugs to rural areas. Another is that self-administration could lead to
other family members thinking they should take the drug as an AIDS
treatment.
- Not sure which countries are included in "heavily infected countries"
but I'd guess that political will also enters in. For instance, South
Africa and Zimbabwe have not distributed nevirapine due to
commitment and infrastructure issues.
- Boehringer Ingelheim, the donator of nevirapine, also is cautious
about how the drug is distributed. They have an application process
that requires a site to demonstrate that they will use the drug correctly
etc. Although this adds some time to the procurement side of the
equation, I think we'd all agree that some degree of control is a
worthwhile time investment.
I am sure there are many more reasons, but those are the ones that I
find most challenging to overcome. Hard to say which should be
tackled first.
Elizabeth Gardiner
Sloan Fellow
London Business School
tel: +44(0)7766760133
email: egardiner.sln2003@london.edu
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