Ellen Campbell Grizzle - Pharmacy Today HE TOLD the pharmacist that he chose to pay school fees and feed his children instead of buying the new group of Antiretrovirals (ARVs) prescribed to manage his full blown AIDS. Robert Jackson (not his real name) confessed that he had started medication stretching in the last 12 weeks so that he could pay some of his other bills. He was the father of two young children and lived with a "baby mother" who did not work..
Maxine Brown (not her real name) has never been seen by her pharmacist. For the past two years, she has sent her friend to fill her prescription but called almost daily to talk about the side effects of her ARVs, a constant feeling of distress and the expense of medication and proper nutrition. Maxine threatened many times to stop taking her medication. She has not called her pharmacist for a while. Concerned pharmacists in Jamaica and across the Caribbean are worried about the fate of the increasing number of persons who are unable to purchase their HIV/AIDS medication. Lower cost brand name drugs and generics have helped to soften the blow but the long term adherence patterns needed, stigma and expense are "real killers". A 2001 Knowledge, Attitude Behaviour and Practice (KABP) commissioned by the Caribbean Association of Pharmacists revealed that uncoordinated efforts to assist their patients include:-
Offering low cost brand or generic alternatives
Convincing patients that ARVs save lives
Payment plans and discounts
Encouraging patients to return to institutional care setting, when necessary, despite fear of stigma
Referral to physicians, nutritionists, hospices and other relevant places of care
Hours of telephone counseling
On-line prayer
Networking with contacts in the industry for support in critical cases
Volunteering in AIDS support group.
Many respondents felt that their present efforts were not substantial and that they would like to do more. Subsequent focus group discussions within the Caribbean fraternity have led to the identification of several action steps to ease the challenges to access.
They include:-
Build on the increasing trust of patients who are now seeking help from pharmacists
Expansion of the use of counselling booths so that no signals of discrimination can be sent regarding persons seeking medication and counselling
Help clients to manage the side effects of ARVs through small adherence clinics
Lobbying for formal arrangements between the pharmaceutical marketing companies and Caribbean pharmacists that would directly benefit the special population of persons living with HIV/AIDS
Continuing Professional Development in issues related to HIV/AIDS
Carmen Bent (not her real name) is a community pharmacist. She collects samples of ARVs so that she can help to fill prescriptions for desperately ill and indigent patients. Three months ago she chose to help Lisa and not Peter. Three days ago Lisa came to visit her to say thanks. Pharmacist Bent is still pondering Peter's fate. ARVs of good quality are excellent drugs. They continue to expand the life chances of persons living with HIV and AIDS. Effective use requires disciplined adherence to therapy, change in lifestyle and proper nutritional and social support. There are many global initiatives that aim to enhance availability, access and encourage adherence to treatment. However, in the immediate circumstances many Jamaican pharmacists and patients describe a "rocky road". If you need someone to point you in the right direction to accessing HIV/AIDS medication, ask your pharmacist, you have the right to know!
Ellen Campbell Grizzle is the President of the Caribbean Association of Pharmacists (CAP), Director, Information & Research, National Council on Drug Abuse (NCDA), Kingston, Jamaica.
