Recommendations on Rational Pharmacotherapy for State-Budget-Covered Antiretroviral Medicines for HIV Infection call for revision
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04.01.2010
Brussels, 14 Dec 2009
EU HIV/AIDS Civil Society Forum Open Letter to The Commission on Social and Employment Issues in the Latvian Parliament, The Latvian Ministry of Health, The Centre of Health Economics in Latvia, The Latvian Infectology Center, The Latvian Prison Administration, The Latvian National Coordination Commission on Limitation Spread of HIV, STI and TB
Recommendations on Rational Pharmacotherapy for State-Budget-Covered Antiretroviral Medicines for HIV Infection call for revision
Distinguished representatives of the Latvian Health Authorities,
We, the signatories below, a group of people living with HIV and AIDS activists, were appalled by the discriminatory postulates of the Recommendations on Rational Pharmacotherapy for State-Budget-Covered Antiretroviral Medicines for HIV Infection issued in August 2009 towards injecting drug users and by the other provisions that seek to reduce the number of people who are eligible for life-saving HIV medicines. We were glad to see the withdrawal of the recommendations in October 2009.
We recognise that the current economic crisis in Latvia is leading to a substantial reduction of the expenditure on health care, a reduction imposed by the IMF, but treating those in need is essential for good public health practice and a protection of basic human rights.
The only way to control the growing HIV epidemic in Latvia is to have effective harm reduction programmes in place for injecting drug users and to provide antiretroviral treatment for those with HIV, according to the internationally accepted treatment guidelines.
Given the current less than adequate coverage of antiretroviral treatment in Latvia, we call for the continuation of the process of revising the recommendations to ensure that they follow good medical practice, international guidelines, human rights principles and Latvias health commitments to its people.
We urge that:
the document be reviewed by experts of the World Health Organisation and the European AIDS Clinical Society;
that the conclusions drawn by the World Health Organisation and the European AIDS Clinical Society should serve as the basis for the change of the Recommendations;
that the Centre of Health Economics proactively works on reducing the cost of antiretrovirals in Latvia by asking for differentiated pricing in accordance with the Bremen initiative or by using flexibilities of the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement of the World Trade Organization to issue compulsory licenses in line with its national legislation to invite producers of WHO-prequalified generic versions of antiretrovirals to compete to supply drugs. As recommended by the joint WHO and UNODC mission, lowering prices and using more efficient strategies will enable Latvia to reduce the expenditure on HIV medicines instead of reducing the number of patients receiving them or lowering quality of care.
In particular, we already suggest the following changes to the present document:
1. HIV is a chronic infection that requires life-long treatment. Ensuring continuity and sustainability of the treatment must follow international guidelines (WHO/EACS).
2. The treatment criteria for initiating HIV treatment should clearly recommend initiation when CD4 count reaches 350 cells/mm3 following WHO recommendations and recent guidelines of the European AIDS Clinical Society (EACS)[5].
3. A plan to establish treatment adherence mechanisms in line with the WHO and UNODC mission recommendations should be developed and implemented.
4. The Recommendations should include provisions concerning maintenance therapy for IDUs.
5. Special provisions should be made regarding HIV treatment and care for people with restricted freedom.
6. The Recommendations should include a comprehensive and integrated approach for the in treatment and care of people living with HIV which addresses their different health related needs, including the management of HIV/hepatitis co-infections, TB co-infection, the management of opportunistic infections, palliative care, reproductive health, and immunisation.
We urge you to ensure that all people in need for treatment are eligible to receive it in equitable, ethical and non-discriminatory way.
In partnership with the Latvian Health Authorities and the community of people living with HIV in the country, we commit ourselves to advocate for adequate financial and technical support at the international and EU level to address the HIV epidemic in Latvia.
We would appreciate if further communication would be sent to Nicole Heine, Policy Adviser, European AIDS Treatment Group (Nicole.Heine@eatg.org).
Respectfully,
Anna Zakowicz, Chair, European AIDS Treatment Group (EATG)
Shona Schonning, Program Director, Eurasian Harm Reduction Network (EHRN)
Nikos Dedes, Co-chair, EU HIV/AIDS Civil Society Forum
Yusef Azad, Co-chair, EU HIV/AIDS Civil Society Forum
Martine de Schutter, Executive Coordinator on behalf of AIDS Action Europe (AAE)
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