Written by Aditya Wardhana.
Aditya is the Executive Director of the Indonesia AIDS Coalition (IAC), a national partner of the Make Medicines Affordable campaign.
First published by The Jakarta Post.
Indonesia has an increasing rate of new HIV infections, with approximately 46,000 people newly diagnosed per year. Fuelled by stigma and discrimination directed towards people living with HIV, the number of people living with the virus in the country is among the highest in the region.
According to a government survey, an estimated 640,000 people are living with HIV in Indonesia, but only 124,813 (19.49%) of them are receiving crucial antiretroviral (ARV) treatment.
This means that, alongside one of the highest rates of infection, Indonesia also has one of the lowest treatment coverage rates in South East Asia.
UNAIDS data shows that this significant treatment gap is resulting in 38,000 preventable deaths from HIV-related illnesses each year.
Since 2004, HIV treatment has been available free of charge for patients, with treatment fully subsidised by the government. However, due to the inefficiency of the procurement system, the price of ARV medicines paid by the government is among the highest in the world.
Annually, the government pays approximately $92 million (USD) (Rp 1.3 billion) to purchase medicine for approximately 180,000 people living with HIV. This leaves a large number of people with no access to life-saving treatment.
The treatment that most people in Indonesia are prescribed is tenofovir, lamivudine and efavirenz (TLE), combined in one pill, 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 around $28.5 (Rp 400,000) per bottle, roughly four times what is paid elsewhere for this kind of generic ARV combination.
In 2016, the Indonesia AIDS Coalition started to campaign on the issue. A price assessment was carried out, with the support of many partners, both nationally and internationally. The assessment found that the drugs were over-priced, and also calculated what a fair price would be.
The findings were published in a briefing paper which was circulated widely and referred to in meetings with the health minister, the House of Representatives and the Presidential Office. Several press conferences were also held and, as a result, more people came on board to demand that the government take action.
After three years of advocacy, the government has begun to reflect and act upon the community’s demands. The policy on ARV procurement has been revised, and a revised (maximum) price of Rp 210,000 per bottle has been set – 48% lower than the previous price.
Based on the number of people currently receiving TLE as their current treatment, this will amount to savings of around $8 million (Rp 114 billion) per year, which equates to an additional 45,482 people being able to receive life-saving HIV treatment.
The price reduction is a huge success which directly resulted from the patient group’s advocacy efforts. This bold action should trigger more government measures to lower the negotiated prices paid for other ARVs, and this can be replicated for other over-priced medicines. By taking this action, the government has shown great commitment to providing high-quality HIV health care, which ultimately will reduce the number of AIDS-related deaths.