Eating the air on promise of supply

The supply chain for antiretroviral drugs (ARVs) in Indonesia is a real mess. Almost every month, at least one hospital runs out of one or more of the drugs. And about every three months, the country runs out. The problems vary from orders not placed, no money, poor inventory control and reporting in the hospitals, lost reports at the centre, and on and on.

I've talked before of the reluctance to start therapy by those who really need it. Not surprisingly, one common reason is that they are scared about sustainability of supply. They've been told that if they miss doses, they'll become resistant, and they wonder what they'll do when the supply line suddenly becomes empty.

Naturally, there's a wider fear that the government will lose interest in fully subsidizing ARVs, particularly as the numbers grow. There is no long-term guarantee; not only is the government budget only valid for a year, the actual funds are usually only released six months or so into the financial year, and have to be spent before the end of the year. Impossible to manage.

Of course the alternative to starting, albeit riskily, is clear: fall sick and die. AIDS is not forgiving! When ARVs first became available, we tired to guarantee supply for 12 months; they could at least they would survive for another year. But that's really not acceptable.

The price of ARVs will drop. The last information I had was that the government is paying Kimia Farma around $500 per year for the basic triple-drug regimen. This is now available on the international market through the Clinton Foundation for only $100. That's less than most of our friends spend on cigarettes in a year. Is that a reasonable comparison?

Would we be better without subsidy, but controlling the supply ourselves?

Babé