Interview: the road to affordable HIV medicine in Indonesia

Interview: the road to affordable HIV medicine in Indonesia

Over the past decade, there has been a significant increase in access to lifesaving medicines for diseases like HIV in low- and middle-income countries, mainly due to increased generic competition. Unfortunately, the situation has changed in the past years and the progress achieved is under threat. New medicines are provided with a monopoly through a patent for countries to comply with international obligations as members of the World Trade Organization. As a result, generic competition is restricted, and new medicines enter the market at very high prices, impeding the accessibility of these lifesaving medicines. In countries like Indonesia, this is blocking many people from receiving crucial HIV treatment. Of the estimated 640,000 people living with HIV (PLHIV), only 20% received the crucial antiretroviral (ARV) medication in 2017. This significant treatment gap is resulting in 38,000 preventable deaths from HIV-related illnesses each year (source: UNAIDS). To make a change, our partner Indonesia AIDS Coalition (IAC) has successfully advocated for accessible treatment for all. In this interview, we spoke to Aditya Wardhana, the Executive Director of IAC, to dive into the progress made around affordable HIV medication in Indonesia.

What have you been focused on and why is it important?

“One of our organisation's missions is to ensure the fulfilment of the rights of people living with HIV (PLHIV). In doing so, accessible and affordable medicines are highly important. Improving the affordability of medicines means that an increased number of PLHIV can be treated. This could significantly reduce AIDS-related deaths caused by a lack of access to treatment.

IAC protesting at a Regional Comprehensive Economic Partnership negotiation in Indonesia

Our advocacy efforts reduced the price of Tenofovir Lamivudine Efavirenz (TLE), which is one of the most used medicines, by 52%. We went through a very long process, actively involving the community, other organisations, governments and the general public. We engaged the media, to ensure that it was widely known that ARV prices are very high compared to regional prices. This created awareness about the situation of HIV treatment in Indonesia. This particularly opened the eyes of PLHIV who did receive treatment, because they were getting the medication for free. They became more aware that their treatment was being provided through government subsidies with money from taxpayers. This way, the media reports encouraged the community and the wider public alike to push for a price reduction of the drug.

Beyond that, we have pushed for a safer and friendly regimen for PLHIV. As a result, the Tenofovir Lamivudine Dolutegravir (TLD) regimen, which is a recommended regimen by the WHO, has been introduced and recognised across Indonesia.”

Looking back at your efforts, what are you most proud of?

“We work closely in collaboration with two coalitions, Economic Justice Society and Affordable Medicine Coalition, which consist of patient groups from other diseases. Together with the Economic Justice Society, we joined several free trade agreement (FTA) negotiations. At these negotiations, we managed to speak with the European Free Trade Association (EFTA)-Indonesia Comprehensive Economic Partnership Agreement (CEPA) and Regional Comprehensive Economic Partnership (RCEP) negotiators. Through these engagements, we ensured that Trade-Related Intellectual Property Rights (TRIPs) Plus provisions -which would further hamper the production of generics- were not included in the two FTAs.

IAC protesting at a Regional Comprehensive Economic Partnership negotiation in Indonesia

We also managed to establish a close relationship with policy-makers, such as with the Presidential Staff Office and the Minister of Health. The former is very supportive of our advocacy work around access to affordable medicine, such as supporting the promotion of a PLHIV-friendly TLD regimen. Through our relationship with the Minister of Health, we advocated for access to COVID-19 vaccines, and to become a co-sponsor of the TRIPS Waiver, which would increase the access to COVID-19 vaccines. We inform the Minister of Health on the situation of the HIV prevention program to accelerate the progress of the three zero’s (Zero new HIV infection, Zero Stigma and Discrimination, Zero Death related to AIDS).”

When did you hear about the price reduction of the ARV medication and how did it make you feel?

“When we focus on saving the lives of PLHIV and protecting the lives of many other people, the price reduction is of the utmost importance. The news significantly increased our motivation as well as the hope for a better HIV program. Being able to improve access to ARV treatment will result in increased viral load suppression among PLHIV. A very important step towards ending HIV and AIDS!”

 

Want to know more about how we increase access to treatment for people living with HIV?

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