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The Price of Life

Sun 18 Jan 2004 In: HIV

How much is your life worth? An increasing number of HIV patients in New Zealand are being faced with just that question, while the gay community at large faces a potential return to the dark days of weekly funerals. Matt Whyte is one among the hundreds of people living with HIV/AIDS in our country. His daily routine revolves around the consumption of numerous pills to keep his viral load down, and dealing with the side effects that produces, in order to save his life. But like increasing numbers of HIV patients, Matt's treatment options have run out. His drugs are no longer working and he could be dead within a year. Making that all the more difficult to deal with is the knowledge that if he were residing in Australia or the UK, he could have another 10 years of healthy living. Why? New Zealand is lagging behind its nearest neighbour in making the latest HIV treatments available. There are currently four antiretroviral drugs available in Australia that cannot be prescribed here. The New Zealand AIDS Foundation says that Matt needs access to these drugs in order to stave off death - and sadly, he's far from alone. "We could be facing a return to the grief of losing our loved ones in increasing numbers," says Kevin Baker, the Foundation's Positive Health Manager. The NZAF estimate on the number of HIV patients here that have no treatment options left stands at 34, but Bruce Kilmister of Body Positive - a peer support group for people living with HIV/AIDS - believes this is a conservative figure. "The number of HIV+ people needing new drugs is under-reported. The media figure of 34 is more like 55 people now teetering on the edge," he says. "We are about to enter a new phase of deaths which is all too reminiscent of the weekly funerals we went to 10 years ago and thought we had left far behind, but death seems to have caught up with the assistance of a non-caring New Zealand health regime." Specialists have advised the NZAF that without access to these new drugs the number of those facing death is likely to rise to over 100 by World AIDS Day in December this year. So why is Pharmac, the government's pharmaceutical management agency, dragging its feet on getting these drugs approved for use? Unfortunately, they say, it all comes down to a limited pool of funding, necessitating the use of a term which is chilling when taken in the context of human life - "cost benefit". "[With HIV/AIDS] we spend some $6.4 million a year on therapy for about 400 people," says Pharmac's medical director Dr Peter Moodie. "Treatments for HIV/AIDS are expensive, but this is in line with the trends we see in other dynamic areas where new treatments are emerging. For example, spending on multiple sclerosis is $4.4 million for about 300 patients, and for hepatitis C $1 million for about 500 patients." But if we're just going to crunch numbers, wouldn't New Zealanders be faced with an even larger bill once these people get sick? "It cost the tax payer over $20,000 for a recent hospitalisation for Matt earlier this year [in 2003]," says Kevin Baker. "One year's supply of Kaletra would cost less than half this amount per year and he could be working, paying taxes and contributing to society - it is hard to see the sense in this." Desperate times call for desperate measures, and Bruce Kilmister says that it has encouraged the secret smuggling of HIV drugs into New Zealand. "The so-called 'long term survivors' have used up all the drug options available here in New Zealand," he says. "To keep well they need to travel to the HIV clinics in Australia to be able to access new medications." Kilmister blames the increasing greed of drug companies as well as Pharmac's failure to subsidise the new treatments for putting people in desperation. This failure is all the more perplexing when faced with the knowledge that one of the four needed drugs was approved by Pharmac as high priority in 2002, yet twelve months later it still isn't available. What is going on? "The reality in New Zealand is that pharmaceutical spending takes place within a fixed budget. This is where New Zealand differs from Australia," says Dr Moodie. "Sometimes this means there is limited opportunity to make new investments in pharmaceuticals - a situation we faced in the 2002-03 year. "That process has to ensure that the drug is actually going to do something more than existing therapies that are available. AIDS drugs go through just such a process and there are currently two in the system. The question to consider here is, is there an additional benefit that justifies potentially higher cost?" While the NZAF says it appreciates the pressure Pharmac is under, their focus on the bottom line does not hold water with them. "Saving costs is one consideration, but saving lives is another," says Baker. One thing is certain - with new HIV infections in New Zealand approaching record levels, Pharmac's words are serious food for thought in the gay male community. Antiretrovirals never were the miracle cure that some saw them as, but if you become infected with HIV today, your options for living could well have shrunk to zero. There may be nothing your doctor can do for you unless you've saved up one hell of a lot of air points. Chris Banks - 18th January 2004    

Credit: Chris Banks

First published: Sunday, 18th January 2004 - 12:00pm

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