The Jakarta Post
Indonesia Positive Women Association (IPPI) national coordinator Baby Rivola’s cell phone has been buzzing day and night over the past two weeks.
Women, mostly mothers with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) from across the archipelago, have been telling her about their concerns after they heard that the nation was running out of a fixed-dose combination (FDC) antiretroviral drug (ARV), a tablet containing tenofovir, lamivudine and efavirenz (TLE).
“Most of them have used FDC for years. But they said hospitals in their respective regions had ran out of FDC months ago and they had to start using single doses of those three drugs instead of the FDC,” Baby said on Thursday.
The women were worried about their condition without the drug. They were also wondering about their treatment.
“It is important for the mothers to take the pill regularly not only to save their lives but also to prevent the virus from infecting others,” she said.
Taking TLE regularly is deemed the most effective treatment to reduce the HIV viral load in the body to an undetectable level.
However, the tender to procure the drug recently fell through after the government and state-owned pharmaceutical companies PT Kimia Farma and PT Indofarma, the authorized producers of the drug in the country, disagreed on the pricing.
TLE is the most used drug among people with HIV/AIDS in Indonesia. Around 48,000 people, or 42 percent of people with HIV/AIDS, rely on TLE.
Aditya Wardhana, the executive director of the Indonesia AIDS Coalition (IAC), said even though the government had made an emergency procurement financed by the Global Fund to Fight AIDS, the current supply of TLE would only last until April at most.
“Honestly, we can die in less than a year if we do not take the drug. Our lives are at stake. What should I say to my children, because I really don’t know whether I’ll still be around them by the end of the year,” she said.
The nation has pledged to reach the 90-90-90 target in 2027; 90 percent of people with HIV/AIDS will be aware of their HIV status, 90 percent of them get ARV treatment, and 90 percent of them have their viral load suppressed.
The budget allocated for ARV treatment has also increased every year. In 2017, the Health Ministry allocated Rp 1.19 billion (US$84,673) to fund ARV treatment for 112,054 people with HIV. The allocation increased from Rp 243 million in 2015, and is predicted to reach 1.8 trillion by 2020.
HIV/AIDS treatment currently has the second biggest budget allocation from the ministry, after the allocation for vaccine procurement.
While lauding the government’s commitment to HIV/AIDS treatment, Aditya of the IAC said the nation “should not spend that much money on ARV treatment” because based on the coalition’s survey, the drugs could be purchased almost 400 hundred percent cheaper outside Indonesia.
“Compared to other countries in the world, ARV in Indonesia is the most expensive one,” Aditya said, adding that he hoped Kimia Farma and Indofarma, as state-owned pharmaceutical companies, were not only seeking profit.
“Even for a reasonable profit they could sell it for Rp 175,000 but instead they sell it at around Rp 400,000 per bottle. It is too expensive. One bottle only lasts for a month, so imagine how much money must be spent for that in a year for every person,” he said.
The coalition also encouraged President Joko “Jokowi” Widodo to immediately call on related ministries to help with the negotiation.
When asked about the IAC’s view on the price of ARV, Kimia Farma president director, Honesti Basyir, said he “never heard about that statement and do not know how did the IAC compared the price with other countries”.
“We always make our best effort to support the government program, as long as we are able to do it [..] since 2005, Kimia Farma has provided ARV for people living with HIV, even though the population of people taking ARV remains very small,” he said.
The ministry’s director general for pharmacy and medical equipment, Engko Sosialine Magdalene, admitted that the tender had failed and explained that the price of locally produced ARV was higher in Indonesia as a result of the additional costs to produce the medicine.
“We have to consider many costs, such as the import tax as well as cargo and transportation fees. When they [IAC] calculate the price, they should add these costs into their calculation as well,” Engko told The Jakarta Post on Thursday.
Engko also said the country had enough ARV supplies for the next 10 months.
According to Engko, people with HIV/AIDS can still take fixed-dose drugs until this April and continue their medication with a single-tablet regimen as an alternative.
Data from the Health Ministry show that over 2 million Indonesians have taken an HIV test. Of those, 314,143 were declared positive, with 212,240 having started ARV therapy since 2018.
This article was originally published in The Jakarta Post's print edition on Jan. 12, 2019, with the title "People with HIV/AIDS at risk after drug tender falls through".