After Pich Sophea heard he had contracted the virus that causes AIDS, he went to a pharmacy and spent all his money on a drug made in France.
People told him it could help keep him alive, but it was too expensive and he was too poor. After a month or two, the former soldier’s money ran out.
“I paid a lot of money, about $200,” said Pich Sophea, who checked into the AIDS unit at Preah Bat Norodom Sihanouk Hospital two months ago.
Most Cambodians who contract HIV, the virus that causes AIDS, are like Pich Sophea. They will likely die from the disease, even though in many Western countries they could expect a chronic medical condition—rather than certain death—thanks to expensive drug therapies that can suppress the disease, but not cure it.
But for some of the estimated 200,000 Cambodians carrying HIV, this could change in the next few months. Generic versions of the high-priced drugs are headed to Cambodia, and some people may get them for free.
The normal cost of these drug treatments in the US and Europe ranges from $10,000 to $15,000 a year. In Cambodia, those who can afford it pay about $6,000 a year.
“A general or a minister can buy drugs every month if they get HIV,” said Dr Chhin Sanya, who heads the Department of Infectious Diseases at Sihanouk Hospital. “But the middle class or the poor can only buy for maybe four or five months until they are finished with their money.”
In February, an Indian pharmaceutical company announced it will make triple-therapy drug “cocktails” available at cut-rate prices to 10 developing nations, including Cambodia.
The Bombay-based Cipla says the antiretroviral drugs will be offered to Medecins Sans Frontieres at a special humanitarian price of $350 a year per patient or to governments for $600 a year per patient, according to a company statement. MSF will then offer the treatment for free to AIDS patients.
Catherine Quillet, chief of mission in Cambodia for MSF France, cautions that before the drug therapy can be offered here, several things must happen.
First, all three drugs must be approved by Ministry of Health officials.
Lamivudine is already registered, according to Sandeep Majumdar of the Healol Pharmaceutical Import Export Co, Ltd, the exclusive importer of Cipla drugs in Cambodia. Nevirapine is ready to be approved, he said, but stavudine may take awhile.
“Normally, it takes two or three months to register a drug with the Ministry of Health,” Majumdar said. “There is different criteria that needs to be met. Laboratory tests have to be performed. But maybe we can get this faster, because it is life-saving.”
Majumdar said he plans to meet soon with ministry officials about registering the drugs. He also needs an import license before he can bring the drugs in from India.
Also, the National AIDS Authority must approve the treatment, Quillet said. And the cost Cipla announced may not be the same low price in Cambodia.
“I have import costs. I have duty fees. So I still have to work out the costs,” Majumdar said.
Finally, there’s Cambodia’s weak but unclear patent regulations.
Currently, there is no law in Cambodia banning the sale of drugs that are patented by multinational drug companies. The antiretroviral drugs that Cipla wants to bring to Cambodia are “generic” drugs, copied from anti-AIDS drugs made in Western countries.
Pharmaceutical companies in Brazil and Thailand have been producing anti-AIDS drugs similar or identical to drugs made by companies in Europe and North America. These “generic” drugs are then sold for low prices, angering Western companies who hold patents on the drugs in the US and many other countries.
In these countries, US company Bristol-Myers Squibb is the patent holder for stavudine. Glaxo-Wellcome of Britain owns the patent on lamivudine and German company Boerhinger Ingelheim holds the patent for nevirapine.
Cipla’s proposed daily therapy is two tablets of 40 mg of stavudine, two tablets of 150 mg of lamivudine and two tablets of 200 mg of nevirapine.
MSF, which won the Nobel Peace Prize in 1999 for working in war-torn and impoverished areas, has made aggressive efforts in the last two years to get multinationals to reduce their prices on life-saving drugs for the poor.
“There is such a huge lobbying effort throughout the world to urge pharmaceutical companies to make drugs available,” that multinational companies will be forced to reduce their prices, said Dr Oscar Barreneche, who works on HIV/AIDS issues for the World Health Organization in Cambodia.
One example, he said, is the recent announcement by Glaxo-Wellcome that they will cut prices on their anti-AIDS drug by 90 percent for humanitarian organizations working in developing countries.
And last May, five multinational drug companies, backed by the WHO and other UN agencies, offered to sell drugs to poor nations at low prices.
In Cambodia, where 3.5 percent of the population is infected with the disease, not everyone will be able to get the treatment, Quillet said. Unlike Western countries—where most people who have contracted HIV get antiretroviral drugs—MSF in Cambodia will start by only treating adults who have developed AIDS, she said.
It’s not clear how patients will be selected for the treatment, she said. Perhaps patients at Sihanouk Hospital will receive the drugs. MSF now works there helping Chhin Sanya treat AIDS patients for opportunistic diseases like tuberculosis that can kill people with weakened immune systems.
“We don’t have antiretroviral drugs,” Chhin Sanya said. “We need it. We lose so many patients every year. Last year, 260 people died at the hospital.”
If everything goes well, Quillet said, treatment for some AIDS patients could begin in April. But it is unclear how many would benefit, she said.
“It’s a very difficult treatment,” Quillet warned. There are side effects and years of treatment, she said.
Majumdar met with MSF earlier this week. He said he also has a list of NGOs he will call once the drugs are registered and imported.
“We want to contact everyone once we actually have it here,” he said. “I know it will be in very great demand.”