“For people living with HIV, the huge impact is not just the positive test, but the many changes they have to incorporate in their daily life because of the medication. Some medications are exhausting – and this is why some people stop treatment.”

“My name is Violeta Ross, I am an anthropologist, a rape survivor and a woman openly living with HIV since 2000. I am from Bolivia and, currently, I serve as the President of the Bolivian Network of People Living with HIV. I led the advocacy for access to antiretroviral (ARV) medication in Bolivia, the elaboration and approval of the HIV law, and I currently lead the political incidence for the full sustainability of HIV prevention and care programmes in Bolivia.

“Bolivia has incorporated dolutegravir (DTG) in its national guidelines and this regimen together with tenofovir and lamivudine is being made available from April 2019.

“A huge challenge for people living with HIV is the full exclusion of women between ages of 15-59 years old. We consider this situation a great loss given the effectiveness of DTG in comparison with efavirenz (EFV) and the cost benefit.

“Currently, Bolivia purchases TLE (tenofovir/lamivudine/efavirenz) at the price of 77 $US/patient/year. TLD (tenofovir/lamivudine/dolutegravir) will be available cheaper.

“I recommend DTG. The reduction of side effects, the effectiveness in controlling the viral load and, therefore, reducing the possibility of resistance are just two powerful reasons. I have been taking TLE since 2005 and I begin to see other side effects and consider this is already too much of the same medication. Following the outcomes of DTG introduction in some African countries, with the support of Unitaid, I fully recommend DTG. We, as people living with HIV, have the right to the best treatment available. EFV was such a treatment in its time, but nowadays I believe there are better options.

“DTG’s fewer side effects and the immediate improvement in the quality of life, being able to wake up not feeling dizzy and therefore being able to work normally, stopping being tired all the time, are just some things many people with HIV do not want ever again. In comparison, EFV is a very difficult drug to take; I refer to EFV because TLE is the only regimen available as first line treatment option in Bolivia. As I mentioned earlier, the price is just another good reason in terms of public health investments and outcomes in health.

“In the HIV advocacy world, we continue to say HIV is a chronic disease and manageable. We tell people their lives can continue just as before they learned they are HIV positive, but for many people, the huge impact is not just the HIV positive test, but also the many changes they have to incorporate in their daily life because of the medication. Some medications are so exhausting, and that is why some people decide to stop the treatment.

“Regarding the challenges ahead for broader access to DTG in my region… it is the inclusion of women between the ages of 15-59 and the transitioning of people who are already receiving treatment (precisely the ones with more side effects). The HIV guidelines in Bolivia say that treatment naïve patients will access DTG first, but we think the already-treated patients, especially those on EFV, should access DTG first, because they are physically and psychologically exhausted with EFV.

“I participated with other advocates around the world in the elaboration of a DTG Advocacy Brief and the literal interpretation of the WHO recommendations seems to be a major issue, it reflects the distrust in women’s choices and the lack of integration of sexual reproductive services with HIV services.”

From January 2012 to December 2018, MPP generic manufacturing partners have supplied 7,000 patient-years of DTG and TLD treatment in Bolivia.

 

Notes:

In 2016, the Plurinational State of Bolivia had 1100 new HIV infections and <1000 AIDS-related deaths. The UNAIDS country statistics for Bolivia can be accessed here

 

 

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