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AFRO-NETS> Kaiser Daily HIV/AIDS Report-June 12th 2001

Kaiser Daily HIV/AIDS Report-June 12th 2001

*South African Hospitals 'Overwhelmed' by AIDS Patients
*GlaxoSmithKline to Offer Discounts on HIV Drugs Ziagen, Trizivir and 
  to Developing World

  *South African Hospitals 'Overwhelmed' by AIDS Patients

Hospitals in KwaZulu-Natal province, South Africa, are "overwhelmed" by an in-
flux of AIDS patients, which has some hospitals operating above maximum bed ca-
pacity, and the problem may only get worse as the number of infected South Af-
ricans is expected to climb from 4.7 million to seven million by the end of 
decade, Reuters reports. A South African Medical Journal survey of 
hospitals in
the nation's "most AIDS-ravaged province" found hospitals in some areas devote
80% of their beds to HIV-positive patients (Swindells, Reuters, 6/7). And in
some rural areas, hospitals are operating at 120% over capacity. Dr. Paul
Kocheleff, clinic chief at the Grey's and Edendale Hospital HIV/AIDS clinic,
said that based on HIV's six-year incubation period, the "tide of sick people"
represents the 1994-1995 HIV prevalence figures of 15%-20%. Currently, 36% of
those in the province are estimated to be infected, Smith said, adding "[Y]ou
don't need much imagination to picture the hospitals in another six or seven
years -- the exponential increase will be huge." Admissions for HIV-positive
patients at King Edward Hospital "jumped" from 39% in 1997 to 53% in 1998. Dr.
Sean Drysdale, principal medical officer at Hlabisa District Hospital, said
"[N]obody seems to be planning for the AIDS epidemic which hasn't hit us yet.
In five years time this place will collapse -- it's crumbling as we speak. 
a catastrophe waiting to happen."

*A 'Downward Spiral'

         If the numbers of HIV-positive patients continue to increase, the 
of care for inpatients will "continu[e] to spiral downwards," the study 
Dr. Jim Muller, acting head of medicine for Edendale, Grey's and Northdale Hos-
pitals said, "[P]eople are dying prematurely because we are so stretched. Medi-
cal patients who don't have HIV/AIDS are being severely compromised because we
have to discharge them prematurely -- everybody is being compromised -- the
system just can't cope." The survey found that HIV/AIDS patients are being re-
routed to other wards, elective surgeries "fall by the wayside" and patients
are receiving "inappropriately skilled" nursing care because the demand is so
great. Doctors also face the "ethical nightmare" of determining "who lives and
who dies." Muller said that the doctors "assess each case on its merits" 
and if
it appears that they are going to "pull the plug" on a patient, they try to en-
sure that it is a "consensus decision." The survey found that "[n]early all"
physicians complained about a "lack of clear provincial and national protocols
to guide them through the new ethical minefield." Kocheleff said, "If we can
draw a distinction between those near death and those for whom quality of life
and life expectancy can be improved, we can make headway with a more holistic
approach." However, those guidelines do not appear forthcoming, though the
health department has pledged to increase staffing levels. Ronnie Green-
Thompson, the provinces director-general of health, said that "purveying an at-
titude of doom and gloom and scare tactics won't help the guys on the ground"
but added that if he was "dealing with patients every day I'd be seeing it the
same way" (Bateman, South African Medical Journal, 5/2001).

  DRUG ACCESS GlaxoSmithKline to Offer Discounts on HIV Drugs Ziagen, Trizivir
and Agenerase to Developing World

         GlaxoSmithKline will announce today "another round" of price 
on anti-AIDS drugs for developing nations, moving to sell the antiretrovirals
Ziagen, Trizivir and Agenerase at cost to 63 of the world's poorest countries,
the Wall Street Journal reports. Under the new preferential pricing plan,
Ziagen, which is sold in a standard two-pill treatment for $10.68 per day in
the United States, will be offered for $3.80 per day; triple-drug combination
pill Trizivir will be reduced from $27.92 to $6.60 per day; and Agenerase, a
protease inhibitor, will be sold at $8.70 per day for 16 pills rather than the
U.S. price of $18.50. Furthermore, GlaxoSmithKline will drop the price of a
"full course" of its 12-pill malaria regimen Malarone from $52.71 in the U.S.
to $19.20 in poorer nations. It will also continue to offer the combination
therapy Combivir to governments, charity groups and nongovernmental organiza-
tions in the "least-developed nations" for $2 per day and says it is negotiat-
ing drug discounts with several large African employers.

*Still Too Costly

         However, Glaxo CEO Jean-Pierre Garnier acknowledged that even with 
discounts the medicines would still be too costly for most patients in the de-
veloping world. He said, "We're not naive about the fact that compared to the
means in these countries, everything is overpriced, even the generics." He
added that he expects the drugs may be subsidized by international purchasing
funds such as the new Global AIDS and Health Fund proposed by U.N. Secretary-
General Kofi Annan. Garnier also noted that the drug maker is "not surprised"
that previous discount offers on anti-AIDS drugs for developing countries have
been "slow to get to patients." He explained, "You can't simply use those 
in an open environment because there are a whole lot of practical issues to
overcome," including creating distribution channels and ensuring patient com-
pliance with complex drug regimens. To this end, Glaxo said it intends to es-
tablish a new corporate social-responsibility committee to examine the firm's
policies in poor countries, and plans to begin a series of pilot programs to
determine the impact of preferentially priced anti-infectives, deworming and
diarrheal drugs (Zimmerman, Wall Street Journal, 6/11). The new discount 
come just two months after an April statement in which GlaxoSmithKline said it
would not cut the price of AIDS medications for developing countries any more
than the 90% it already had offered. At the time, a GSK spokesperson said, "A
90% reduction is a significant offer ... a huge reduction. We are not going to
go further because we would get into a ridiculous situation" (Kaiser Daily
HIV/AIDS Report, 4/9).

The Kaiser Daily HIV/AIDS Report is published for, a free
service of The Henry J. Kaiser Family Foundation, by National Journal Group
Inc.c 2001 by National Journal Group Inc. and Kaiser Family Foundation. All
rights reserved.

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