People Living with HIV (PLHIV) are facing an acute shortage of life-saving drugs, say protesters who who have been camping outside the National AIDS Control Organisation (NACO) office in the capital for over 15 days now. They allege rationing of medicines, arbitrary change in drug regimen and even complete deprivation of vital paediatric drugs for children living with HIV. They fear if the situation continues, many will be pushed towards treatment interruption, drug resistance, and imminent death due to AIDS.
NACO, functioning under the Ministry of Health and Family Welfare, is a nodal agency responsible for overlooking and coordinating activities of the National AIDS Control Program (NACP).
The protesters noted that NACO in its public communication had claimed that 95% of PLHIV have not faced any shortages. “Going by the same figure, 5% of 14.5 lakh is 72,500 people, who are being affected by the current shortage and stockouts. The impact of the shortage on PLHIV community is severe and far-reaching,’’ they say.
According to the protesters, in December 2021, PLHIV networks across the country started witnessing shortage of certain Antiretroviral (ARV) drugs in AntiRetroviral Therapy (ART) centres.
Anticipating a large-scale shortage, the PLHIV network started reaching out to the authorities with numerous letters and emails, including an urgent representation to the Secretary-Health, and NACO on February 16, 2022, raising concerns and requesting prompt action to address them.
“A fresh tender for procurement was floated in March 2022 but the new tender, and contracts were not awarded in time to ensure the resumption of supply, leading to a stockout of HIV drugs such as Dolutegravir 50 mg, Lopinavir/Ritonavir (adult and child doses), and Abacavir in the States of Assam, Bihar, Uttarakhand, Haryana, Delhi, Punjab, Gujarat, Punjab, Himachal Pradesh, Jharkhand, Uttar Pradesh, Mizoram, Manipur, etc.,” said the protesters, who didn’t want individuals to be named or identified.
They added that NACO, in its communication dated May 30, 2022 sent to all State AIDS Control Societies (SACS), requested a change in existing treatment regimens for PLHIV as an interim measure to deal with the countywide stockout. However, it was an arbitrary request, and did not take into consideration existing treatment protocols of PLHIV, rued one of the demonstrators.
"Whether an HIV-positive person has suppressed viral load or not, or if they had used any other regimen before the current regimen, with regards to what previous Nucleoside Reverse Transcriptase Inhibitor (NRTI) or Protease inhibitors (PI) was used, was not considered," said a protester.
They added that the response to the crisis in States like UP, Maharashtra and Himachal Pradesh had been alarming as the tenders came too late and the shortage has already started impacting PLHIV.
“As an interim measure, certain State AIDS Control Societies also procured small quantities of the drugs locally. But a quality test revealed that some drugs did not meet the quality standards prescribed by the Drugs and Cosmetics Act and Rules, raising concerns around substandard drugs entering the supply chain,’’ warned one of the protesters.
“The PLHIV community seeks streamlining of central procurement of HIV medicines and an uninterrupted supply of life-saving medicines, thereby safeguarding the right to life of millions of PLHIV in the country, who are at risk of being pushed close of death due to the disease,’’ they said.
Meanwhile, the Health Ministry has responded to the on-going protest and said that there is no stockout of drugs and there are no instances of disruptions or non-availability of treatment services or anti-retroviral (ARV) medicines at the national and State levels.
“NACO has reviewed the entire situation and held a series of meetings with the protesters. The issue of providing a month’s supply of ARV drugs was discussed in detail. ARV drugs are being provided for a duration of less than one month currently, but at no point in time has there been any shortage of drugs for any of the PLHIV. The ARV stock status is monitored strictly and closely by NACO,’’ it said.
Further it said that at times, if there is anticipated ARV shortage at ART centres, various proactive steps are undertaken to ensure uninterrupted supply, through immediate relocation from nearby ART centres or from other States in consultation with the concerned SACS. Also, State/District AIDS Control Societies are authorised to do emergency local procurement of ARV medicine (as per requirement) from their budgeted grant-in-aid provided by Government of India under NACP.
“The information under circulation in various fora that there was shortage of syrup Nevirapine (which is given as prophylaxis to infants born to positive women) and near-expiry medicines were being dispensed is not correct, as most SACS have got fresh supply of this medicine before its expiry date,’’ said the Ministry.