World AIDS Day 2023: India Must Focus on Addressing Drug Shortages – But How?

Drug shortages jeopardise many lives and reflect the structural issues in healthcare access.

Image used for representation.

(Photo: FIT)

India has found itself in a situation where we are facing a shortage of HIV/AIDS testing kits and drugs at intervals in various states. This also comes at a time when the country is still grappling from the effects left by the COVID-19 pandemic.

The shortage of essential life saving medicines and testing kits jeopardises the lives of those directly affected and is a reflection of the structural issues in healthcare access.

In Delhi, protests erupted at the National AIDS Control Organisation (NACO) office in 2022. During the same time, SOS messages were shared on social media platform X (formerly Twitter).

HIV and AIDS have been impacting lives for more than two decades globally, and India is no exception in witnessing the epidemic. The shortage of antiretroviral drugs (ARVs), essential for managing the condition, can cause further concerns by developing drug-resistant strains of the infection and hampering the progress of viral load suppression.

Demanding Drugs & Dignity

Back in 2019, the Delhi Network of Positive People (DNP) and National Coalition of People Living with HIV in India (NCPI) protested due to pan-India drug shortages, with some places facing a total drug stock out.

The protests weren’t just to demand the medicines but to demand dignity, access, and Universal Health Coverage (UHC).

Prior to the protests, leaders from state networks of people living with HIV wrote to the administration, informing them and asking for solutions. But to their dismay, there was no urgent action that took place. The administration denied drug shortages initially and the state networks provided evidence for it as well.

Later, NACO pointed out issues with tenders (including a blacklisted company getting the tender) which led to the shortage. All of this led to the community going in ‘action mode’, by organising a protest at the NACO office that lasted 42 days and nights.

If someone doesn’t get their medicines regularly, the viral load will not be suppressed. The impact of the medicines loses progress against viral suppression.

But There's Still Much More That Needs To Change...

Access to medicines still remains a concern for many – even today. In 2023 in Delhi, when one needs to get a HIV/AIDS test done free-of-cost, there's a whole lot that happens.

• It takes two days to book the tests. The elisa test kits are still not available in plenty in the state.

• It takes another two days to get the result back, if it’s negative. If the test result is positive, it takes 15-30 days to get the report due to confirmation and reconfirmation.

• The treatment doesn’t get started immediately.

Drug shortages are also frequent due to an intricate web of issues surrounding the pharmaceutical industry – including supply chain disruptions, regulatory challenges, sharing of intellectual property, and financial constraints imposed by state government health budgets.

The financing has taken a blow from COVID-19, and the overworked yet under trained healthcare staff has taken too much on themselves, for a long time.

The diversion of resources, both human and financial, to combat the pandemic has inadvertently affected the ongoing fight against HIV/AIDS and pushed us further away from the 2030 goals.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria emerges as a beacon of hope. This multilateral health financing organisation has been a stalwart ally in the global battle against these infectious diseases since 2002.

India, being one of the largest recipients of Global Fund aid, has benefited significantly from its contributions.

India Must Focus On How To Avoid Drug Shortages

Addressing the HIV/AIDS medicine shortage in India demands a multi-faceted approach that combines immediate interventions with long-term systemic changes.

• First and foremost, there must be a swift and coordinated effort to streamline the supply chain of antiretroviral drugs. This involves collaboration between pharmaceutical manufacturers, regulatory bodies, and healthcare providers to identify and eliminate bottlenecks.

• Increased investments in research and development are essential to identify alternative and more resilient production methods. This includes exploring partnerships with the private sector, incentivising innovation, and leveraging technology to optimise the manufacturing and distribution processes.

• A diversified and adaptable approach will fortify the healthcare system against future shocks. Global collaboration remains paramount in this endeavour.

The international community, including organisations like the Global Fund, must continue to pool resources, share knowledge, and foster partnerships to ensure that no one is left behind in the fight against HIV/AIDS. This includes ongoing efforts to address the broader determinants of health, such as poverty, climate change, restrictive laws, stigma, and discrimination, which contribute to the vulnerability of key populations.

'Strengthen Your Community Health Systems'

The other important task will be to strengthen community health systems and make them resilient.

Community Health Workers (CHWs) are the ones who are directly involved with people living with HIV. They ensure the drugs are being taken regularly and that patients have access to drugs.

The CHWs need to be trained and paid well to incentivise their efforts in ending AIDS and intimating the authorities as soon as they see they don’t have buffer stock for two months.

CHWs are trusted members of the community, thus, a lot of times young people would approach CHWs to know about testing – if the CHWs do not have readily available test kits, young people might not get tested.

The shortage of HIV/AIDS medicines in India demands sustained efforts. By addressing the root causes, leveraging international support, and implementing long-term solutions, we can not only overcome the current challenges but also build a more resilient healthcare system that can withstand future crises.

The fight against HIV/AIDS is not just a medical battle, it is a testament to our commitment to human dignity and the universal right to health. Why should we wait for another stock out to talk about it?

(Hari Shankar Singh is an HIV activist and member of the Delhi Network of Positive People (DNP+), Anukriti S is a Youth Advocate and Communications and Media Officer at Global Fund Advocates Network AsiaPacific (GFAN AP). This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)