Second Class Citizens: Brian West on why we must stop dumping
old drugs in Africa
Brian West argues that we must stop dumping second hand drugs in Africa and on the world’s poor
as anyone heard of the drugs Triviro or Triomune? Or the manufacturers who produce these drugs, Cipla and Ranbaxy? Probably not if you live in the UK. Our drugs have names like Truvada and Kivexa, and companies like Gilead and GlaxoSmthKlein make them. But who cares about the name, or the company that makes them– it’s what’s in the drug that counts. And that’s where we have a problem. We have sat back and watched as drugs become commonly used in poorer countries that we wouldn’t touch with a bargepole ourselves. We have made people in Africa and Asia second-class citizens by handing them out second hand drugs.
The big problem with Triviro and Triomune is that they all contain the drug Stavudine. We used to know it as D4T or Zerit. We also know what comes along with taking this drug - wasted looking faces and limbs. Lipodystrophy as it’s called. That’s why we hardly use the drug Stavudine now. It’s not that it doesn’t work against HIV. We know it does. But we also know the nasty side effects associated with this drug. (As well as the very physical ones already mentioned, it has some other serious side-effects such as peripheral neuropathy and lactic acidosis.) It is now only used here in Britain when there is no better alternative. Even the company that originally manufactured it in, Bristol Myers Squibb, would admit to “not promoting it” in Europe anymore.
The problems associated with this drug are beginning to show up in resource poor countries now. So much so that in May this year the World Health Organisation, (WHO) issued new guidelines on its’ use, suggesting that Stavudine drug doses be reduced. That’s not so straightforward when they come in easy to take fixed dose combinations. Earlier this year, during a discussion session at the14th Conference on Retroviruses and Opportunistic Infections, Charlie Gilks of WHO’s HIV Department discussed the increasing degree of complications being experienced due to the use of drugs like Stavudine in resource-limited settings. Think of the thousands that were affected by the drug here in Britain, then multiply it one hundred times over for the larger numbers affected in Africa.
Why are people living with HIV still starting off on this drug? Because it’s cheap is probably one easy answer. Because it was one of the first drugs to be made by a generic manufacturer in India is another. There is now we know a problem with the drugs known as nucleoside anologues, which is why most people in Britain would start off their treatment regimes containing something “kinder,” and “cleaner,” like Truvada or Kivexa. Why are those drugs not commonly available right now in poorer countries at the right price?
And why has the supposedly “vocal” HIV community been so quiet about this? Maybe it’s because we have had our eyes focussed on just getting anti HIV drugs into countries where there was none. We worked on campaigns like, “Treat 3 million people by 2005,” (we didn’t reach that target of course!) More recently we’ve been focussed on “AIDS Treatment for All by 2010.” At the rate we are going at the moment, we won’t meet that target either!
In fairness, when we were first pressing for ARV’s for poorer countries, we were ourselves still using Stavudine. But we have moved on, and we haven’t brought the vast majority of the people living with HIV with us. We’ve been concentrating our activism on the numbers game - that we aren’t winning anyway – and we’ve taken our eyes off the quality.
We need to be battling now on two fronts in countries where people still have poor access to ARV’s. We need to be saying not just, “AIDS treatment for All,” but “Good AIDS Treatment for All.” We need to be putting pressure on providers of health care, governments, the UN, and pharmaceutical companies to get all the good new drugs into the countries where they are needed – at the right price. We need to be phasing out the old therapies that we have stopped using that we know are just storing up problems for people living with HIV in the future.
And that is where we really need to start to be honest. Because the second-class citizens of the world taking the second hand drugs that we don’t want anymore are predominantly poor and live in Africa. We should make sure that the mistakes we made with some of the earlier drug treatments for HIV are not repeated on an even larger scale in poor populations. Sitting back and accepting it because, “at least they have drugs now,” has a vile racist odour. We certainly wouldn’t accept this treatment for the predominantly white population of Europe. We should get the bad old drugs out of Africa now, and the good new ones in. +
Brian West is Development Officer, Healthy Gay Scotland
