JP/Aman Rochman

Indonesia has an increasing HIV rate. Fueled by stigma and discrimination against the AIDS-affected population, the number of people living with human immunodeficiency virus (PLHIV) in the country is among the highest in the region. According to a government survey, roughly 640,000 people are living with HIV in Indonesia, with only 124,813 (19.49 percent) of them undergoing crucial antiretroviral (ARV) treatment.

Even as we commemorated World AIDS Day on Dec. 1, Indonesia was in an HIV/AIDS epidemic emergency.

The country has the lowest antiretroviral therapy (ART) coverage in the region, even though the treatment is most important to maintain and improve the quality of life for PLHIV. Moreover, successful ARV treatment will also stop the spread of the infection to others.

Data from the Joint United Nations Program on HIV and AIDS (UNAIDS) shows that the prevalence of HIV among adults is 0.4 percent with 46,000 new infections, and 38,000 people dying from illnesses related to acquired immunodeficiency syndrome (AIDS) yearly.

Since 2004, ARV treatment has been given for free since the government provided full subsidies for ARV medicine procurement. However, due to the inefficiency of the procurement system, the price of ARV medicines procured by the government is among the highest in the world.

Annually, the government needs to provide approximately US$92 million (Rp 1.3 billion) to purchase ARV medicine that is only sufficient for about 180.000 PLHIV. This leaves a large number of Indonesians untreated, with no access to this life-saving medicine.

The ARV combination that most PLHIV use in Indonesia is tenofovir, lamivudine and efavirenz (TLE), packed into one pill widely known as a “fixed-dose combination”. This combination of drugs is imported by two state-owned pharmaceutical companies: PT Kimia Farma and PT Indofarma. They are then sold to the government at about Rp 400,000 ($28.5) per bottle, roughly four times the international price for this kind of generic ARV combination.

The significant difference in pricing has led to resistance to the government’s ARV procurement system. In 2016, an NGO, consisting of PLHIV, called Indonesia AIDS Coalition started to campaign on the issue. A rational price structure assessment was started, supported by many partners both nationally and internationally, to assess the cause of this exorbitant price as well as to recalculate the rational price. The assessment found evidence of excessive prices driven by the private sector’s motive for profit.

These findings, compiled into a briefing paper, were circulated widely to stakeholders and raised in meetings with the health minister, the House of Representatives and the Presidential Office. Several press conferences were also conducted and more people demanded the government reduce the price of ARV drugs to enable access for more PLHIV.

After three years of effort, the government started to accommodate the community’s demand and sped up efforts to revise their policy on ARV medicine procurement. It was eventually decided that the government would purchase the ARV TLE combination at Rp 210,000 per bottle, 15 percent lower than the usual price.

With a total of 48,981 PLHIV consuming TLE so far, the government will have an estimated savings of Rp114 billion, about $8 million per year. These savings will be able to add 45,482 PLHIV to treatment using the same regimen.

The price reduction that resulted from the patient group’s advocacy efforts is a certifiable success. This bold action should trigger more government measures to lower other ARV regimens’ prices. This could be replicated with other medicines as well. With this action, the government has shown great commitment to providing high-quality HIV and AIDS health care, which ultimately will reduce AIDS-related deaths.

The question remains, will the government execute the ARV procurement as soon as possible since the ARV stock has almost run out across the country?

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