HIV drug shortages leading to gaps in treatment

A few weeks ago, a woman visited the downtown Athens offices of Thetiki Foni (Positive Voice), the association representing people with HIV in Greece. “I tried the Ippokrateio Hospital but they sent me here,” she said with hesitation as she took out from her purse an empty box of Eviplera, one of the drugs used to treat HIV. “I haven’t taken any since yesterday. I feel like I’m begging,” she said.

The hospital dispensary had informed her that they had run out of the drug and wouldn’t be getting any more for another 10 days. It was the first time she had faced such a problem in the 10 years since had been was diagnosed: running out of medicine. A Thetiki Foni representative called the hospital while Kathimerini was at the offices investigating the shortage. The employee at the other end of the line tried to explain the situation.

“I’m just an employee, sir. I don’t do the cost cutting. I’ve tried everything,” the hospital worker said. “The hospital doesn’t have any money. How’re we supposed to pay the suppliers?”

The 68-year-old woman finally got seven pills that the association’s representative managed to scrape together from other patients who had some to spare. “When you get another box from the hospital, you have to return the pills,” the representative said. “Can’t you make it 10?” the woman asked.

Shortages in antiretroviral drugs have been appearing in hospitals all around Greece for the past two years or so, prompting patients to resort to borrowing and lending drugs from and to one another in the time it takes for the Health Ministry to approve emergency funds for hospitals providing treatment. Every new approval solves the problem in the short term, but there are no guarantees as to when the next shortage will occur or when the money to pay for new supplies will come.

“Dozens of people have approached us for help over the past few months,” Giorgos Tsiakalakis, the press officer for Thetiki Foni, told Kathimerini.

“We doctors go to great pains to make our patients understand that they must be consistent, not miss any doses and stick to the dosage timetable,” said Marios Lazanas, the president of the Hellenic Society for the Study and Control of AIDS. “Everything that we’ve built is collapsing because of the shortages,” he added, explaining that going long periods without medicine can make the virus immune to treatment.

Hospitals are the only supply source for antiretroviral drugs in Greece. The state covers the entire cost of treatment for all HIV patients, whether they are insured, uninsured or certified as having limited financial means, and that cost is estimated at between 7,500 and 8,000 euros per year per patient. A large part of every hospital’s budget for medicine supplies goes toward these drugs.

As there is no functional cure for HIV or AIDS yet, the number of people infected keeps growing, while hospital resources dwindle as a result of cost cutting and in some cases mismanagement. According to the Center for Disease Prevention and Control (KEELPNO), by October 2015 there were 12,547 HIV positive individuals in Greece, a rise of 47 percent compared with 2010. Of these, 7,700 are receiving antiretroviral therapy (ART).

Thetiki Foni has conducted campaigns, organized protests and, on December 3, 2014, even filed an extrajudicial order against Attikon Hospital in an effort to put pressure on the administrators of the country’s hospitals to ensure that there are no interruptions in the supply of these lifesaving drugs. In the September-December period, shortages were noted at several hospitals in Athens, as well as the AHEPA Hospital in Thessaloniki. According to information obtained by Kathimerini, in the case of one of these hospitals, emergency funds approved for the purchase of additional antiretroviral drugs were used instead to cover other operational costs.

“No one could tell me when exactly they’d have the drugs. They kept telling me the problem would be solved ‘any day now,’” said Dimitris, aged 41. Like other HIV patients who spoke to Kathimerini, he asked that his surname not be published. “At the hospital I go to they told me to get in touch with patients’ associations to put pressure on the ministry. But I don’t like feeling that I’m being turned into a ping-pong ball.”

Dimitris ran out of his prescribed dose of antiretroviral drugs on November 30 and did not get any more medicine from the hospital until December 21. In the meantime, he reached out to other patients.

“I used my connections. But a lot of people don’t speak up because they feel stigmatized,” he said. He “borrowed” three pills from one acquaintance and four from another.

There are no figures from the official authorities or associations to indicate how many people with HIV may be going without treatment. Patients’ representatives told Kathimerini that the shortages in 2015 were unprecedented in scale. They added, however, that the Health Ministry has been open to communication, while Parliament’s permanent committee on social issues had its first ever discussion on the issue of HIV/AIDS on December 3, during which it was decided that expenditure for antiretroviral drugs should be kept separate from that for other medications so as not to affect the rest of the hospitals’ budgets.

The situation has improved since the last approved disbursement of emergency funds at most hospitals. People with HIV, however, are still concerned.

“It’s very stressful,” admitted 21-year-old Andreas. He stopped his treatment for two days, until he was provided with more drugs by people he knows. Andreas said that he wouldn’t rule out moving to another country in the European Union where he could work and receive treatment without interruption. “It’s an extreme solution, but I’ve thought about it,” he told Kathimerini.