The Insatiable in Pursuit of the Uneatable

For all the blubbering Western powers, such as the EU and the US, do over aid and development, they show their true colours when it comes to trade. Western trade policies with developing countries are designed to increase their own markets, increase their supply of cheap raw materials and labour, destroy anything that may create even the smallest bit of competition and, in general, retain their position of dominance and exploitation.

The EU is currently trying to push India into signing a trade agreement that will threaten the supply of cheap and affordable antiretroviral (ARV) medications to developing countries. India is one of the few countries in a position to produce generic equivalents of branded versions that demand extortionate prices. The issue is, ostenibly, over whether India should be allowed continued access to the data they need to produce the drugs cheaply.

The EU is happy to spend enormous sums of money on this kind of pursuit, far more than they spend on 'aid'. And even though EU and US money is going towards the purchase of a lot of ARVs used in developing countries, they seem content to pay more for, presumably, a lot less of an identical product in the future. And this is at a time when all sorts of crazy policies are being discussed to increase the number of people on ARVs to several times present levels. (There is some discussion of these policies on my other blog, which deals with Pre-Exposure Prophylaxis and other technical 'fixes' for HIV.)

The apparent contradiction in vastly increasing the cost of products that their own funding will be used to purchase in ever increasing quantities is not really a contradiction at all. So called 'aid' money is mainly used as a subsidy for their own industries, especially the pharmaceutical industries. And compared to the amount of money that goes into promoting the interests of Big Pharma, aid money is little to write home about, anyway.

Despite claiming to have the interests of developing countries, including India, at heart, the EU seems intent on destroying the Indian generic drug industry. If developing countries, especially African countries, cease to be a market for these affordable drugs, there will be no other viable markets large enough to sustain the sector.

You might think that this would mean the EU is scoring an own goal but it is just what Big Pharma would like. They have never really wanted a supply of affordable generic drugs, why would they? They couldn't care less who buys their drugs as long as they pay a price that keeps their profit margins at levels they are accustomed to.

A few million Africans may die but that's just collateral damage to the pharmaceutical industry. And the thought of millions of Africans dying could make for a great publicity campaign to increase the amount of money the EU and the US are willing to pay for overpriced drugs. With competition out of the way, top prices are guaranteed. That's how the free market works, it appears.

Just in case you thought all that free market (for developing countries), anti-subsidy (except for wealthy countries) liberalism had been entirely discredited by recent global financial crises, think again. Those who gained from the policies of the past are doing very well, thank you, it's ordinary people who are, as always, paying the price. According to an article by War on Want, the deregulation that has caused so many problems is to continue. Clearly it didn't cause any problems for some people.

And talking of maintaining policies that have caused devastation up to now, the EU is busy pushing biofuels as a 'green' alternative to fossil fuels. Not only is biofuel production not a green alternative in any sense, production of biofuel in large quantities requires even greater exploitation of developing countries than is seen at present.

Vast tracts of land in developing are currently being used to produce food and raw materials for Westerners. But these tracts of land are nothing to what is being grabbed to supply Western cars with cheap fuel. The question of whether there will be land enough left over for developing countries to grow enough food to survive is not really being asked by the land grabbers. Water, in short supply in many countries, will become even scarcer in the pursuit of 'green' biofuels.

Production of biofuels will involve large scale destruction of environments to make way for factory production methods needed to produce 'cheap' fuel. The process of grabbing land is already underway, has been for several years. Perhaps the EU hopes that any increase in carbon emissions will occur in countries too poor to measure the pollution or to do anything about it.

The extent to which Western powers exploit developing countries should never be forgotten when the subject of 'charity beginning at home' comes up. Rich countries may be looking for ways to reduce spending but what they spend on development is a mere pittance, much of it never reaching the supposed recipients. The best thing rich countries could do is reduce their levels of exploitation. Then, whether they continue providing aid and how much they provide may cease to be relevant.

Will a New HIV Boss at WHO Make a Difference?

The World Health Organization (WHO) has a new head of HIV called Gottfried Hirnschall and he gave an interview recently to IRIN. Apparently he feels that, as a prevention message, abstinence is unrealistic. That's good, but not good enough. Abstinence didn't just fail because it's unrealistic. There's no reason why the option of choosing not to have sex under certain circumstances shouldn't be part of a comprehensive sex education program. It's just better if it's not called 'abstinence' and if it isn't the only trick in the box.

There are probably many reasons why HIV prevention programs have failed in African countries but the one reason that WHO, UNAIDS, CDC and all the main HIV institutions refuse to countenance is that not all HIV is transmitted sexually. They go as far as admitting that a small amount is transmitted non-sexualy, but not enough for them to bother spending money or time on. And sure enough, Hirnschall mentions male circumcision and 'treatment as prevention'.

But what does treatment as prevention involve? Because HIV positive people who are responding to antiretroviral treatment (ART) eventually have a low viral load, they are very unlikely to transmit HIV to their partner. If it were possible to test every sexually active member of a population regularly, say once a year, anyone found HIV positive could be put on treatment.

There are just two small flaws. One is that persuading the majority of sexually active people to be tested even once, even to save their lives, has proved elusive. The second is that the majority of people who are currently in need of treatment are not yet receiving it. Much of the funding for HIV treatment that was so fothcoming in recent years has been cut or flatlined. Just as the WHO released new guidelines that would put more people on ART, there isn't even enough money to keep some people already on treatment in drugs.

People on ART need to take the drugs every day for the rest of their lives. If they miss their dose too many times, resistance builds up and they need to move to a different drug regime, a far more expensive one. It is very difficult to get credible figures on what percentage of people in African countries are adhering to ART. But numbers of people dying from Aids is suspiciously high in some countries. It would be one thing if those providing people with the drugs could afford the second or third line drugs for those who develop resistance. But some countries are in the position of not even being able to afford first line drugs.

Hirnschall is asked about the shortage of money and he mentions 'task shifting', things like training nurses to do what doctors have been doing up till now. For people who don't mind being seen by a doctor or who really don't need to see a doctor, that's fine. Most people in developing countries don't get to see doctors anyway, they are too scarce. But even nurses are scarce and they are pretty stretched already. Perhaps more nurses will be trained and these ones will not be poached by rich countries.

So much for treatment, though it's not very much. But will those advocating putting more people on treatment get around to preventing new infections? Ok, they like to say that treatment is also prevention, but from a practical point of view, this will not work. People are becoming infected faster than others can be put on treatment and if money for treatment becomes scarce, where will prevention be then?

First of all, not all HIV is transmitted sexually. It needs to be established how much is coming from non-sexual routes, such as unsafe healthcare and other things. And this needs to be dealt with because it sure as hell won't stop by handing out condoms, circumcising men and telling people how to run their sex lives. Hirnschall thinks that a HIV vaccine would be ideal. But what would be ideal would be to establish where most HIV infections are really coming from so that, even if there were a vaccine, we wouldn't need to waste so much money on it.

Second of all, if Hirnschall is worried about where all the money is going to come from if donors are thinking of pulling out he should get on to the issue of generic drugs. He talks about negotiating with big pharma. What's the point of negotiating with them? They want the highest price they can get, they know people in developing countries can't pay it but they think donors can. They will never reduce their prices to a reasonable level. The only way to ensure that drugs are made available at an affordable price is to open up the market to generic producers.

Of course, big pharma don't want that, they don't want to compete, they want to hide behind the protectionism of intellectual property 'rights'. There are companies well able to produce enough generics to supply everyone who needs ART, to scale up treatment and to continue treating people who go on to need second and third line drugs, as many people eventually will. This has to happen some time. It should have happened a long time ago. Will Hirnschall just drag his heels the way all the others are doing?

Is the WHO's new head of HIV just going to give us more of the same? Or is he going to question the behavioral paradigm that says that most HIV is transmitted sexually? And is he going to stop 'negotiating' with the blood suckers in big pharma and open up the drugs market to competition? If his aims are to reduce HIV transmission and eventually eradicate it, and to treat as many HIV positive people as possible, he will have to take both these steps.

Big Pharma Must Think We Are Idiots

A former British politician called Lynda Chalker who interferes with intellectual property (IP) issues in East Africa, says she is sure that East African IP legislation will not confuse generic and counterfeit drugs on the one hand and fake drugs on the other. But Kenya's Constitutional Court has already ruled that its own Anti-Counterfeit Act, only two years old, does confuse the three phenomena. And the court admits that this could result in people presently receiving affordable antiretroviral (ARV) therapy for HIV being denied the drugs the future. Chalker describes Kenya's decision as a 'drawback' to anti-counterfeiting efforts.

But Chalker herself simply makes the same confusion. She says that 'an anti-counterfeit law is essential in Uganda and east Africa as a whole; one only has to look at the number of deaths arising from counterfeit pharmaceutical products, electronic goods and auto spare parts'. If a drug or produce is causing death or injury, that is a health and safety problem. Branded goods can cause death and injury. Putting a brand name on a product illegally doesn't make it harmful, nor does doing so legally make it safe. The harm comes when the goods are substandard or when drugs are fake, not real drugs at all.

The distinction seems basic enough, but Chalker and the people who put together the original Kenyan bill appear unable to comprehend it. Worse still, Uganda and several other countries seem keen to follow Kenya's lead, despite the Kenyan's change of mind. Chalker and others who follow this tendency to conflate counterfeits, generics and fakes then go on to deny that their stance could jeopardize availability of affordable generic drugs, such as ARVs. But their denial sounds hollow when they go to so much trouble to confuse generics with counterfeits and fakes.

Someone who has been taken in by this deception pontificates about 'fake' drugs (and doctors) in Uganda in another article. Eleven Ugandan 'legislators' are querying the quality of drugs from India, which is the source of most of Uganda's affordable generic drugs. They note that the price of the same drugs from the UK is higher and wonder why. Perhaps that's a question for Chalker. But usually a huge difference in the price of drugs indicates that the expensive ones are branded versions and the cheap ones are generic versions.

Of course, there may also be counterfeit drugs and fake drugs in circulation. When drugs are priced so that no one in developing countries can afford them, in the hope that aid money will be used to purchase them, it's not surprising that some people will try to cash in on the market for cheap drugs. If the pharmaceutical industry is concerned about the fact that it is quite easy to make a good profit from counterfeit and fake drugs, they need to sort out their own pricing policies, perhaps by taking a look at what the 'market' can tolerate. Otherwise they might be accused of depending on subsidies and of rigging the market, which would be quite intolerable.

Chalker expresses her concern at the 'extra burden counterfeiting places on health services in developing countries'. If she is worried about health services being burdened, it is branded goods she should target. If she thinks that health services will be unable to afford the growing need for ARVs, she needs to champion the cause of those producing affordable generic versions of the grossly overpriced branded drugs that her friends in the pharmaceutical industry produce.

Chalker says that IP laws should be 'well-drafted', which, presumably, all laws should. But well-drafted for whom? Intellectual property is for the benefit of industries like big pharma, not for the benefit of poor people who are sick and dying. IP laws are not, as Chalker seems to think, to protect people from harm, and I don't think anyone who knows about IP would claim something so stupid. That's why human rights activists had to fight for international law to protect people from IP laws and allow poor countries access to affordable generics. I don't believe Chalker is stupid, though. She just thinks that everyone else is.

Fake Aid to be Cut: Recipients May Benefit

It isn't often that government departments admit that they got something wrong but it's no less welcome when they do. The two Kenyan departments responsible for health (two because of the power sharing government) agree that they were wrong to pass the anti-counterfeiting bill in a form that failed to distinguish between counterfeit and fake. They accept that this could lead to people being unable to purchase affordable versions of vital drugs, including HIV drugs. India was particularly worried as they supply most of the generic drugs that Kenya and other African countries purchase.

The Kenyan health departments claim that the law in question was pushed by the Ministry for Industry, who didn't realise the implications of the wording of the law. Both these claims sound suspect and the whole issue of a bill which was so stacked in favour of the pharmaceutical industry and against the generic drug industry smelled of industry lobbying and arm twisting. And in practice, even without this law, enormous amounts of money are spent on non-generic, branded products, despite the availability of generics that cost a fraction of the brand price.

Most money spent on health in Sub-Saharan African countries comes from donors. This is one of the reasons that unnecessary amounts of money are spent on overpriced branded drugs. African countries certainly couldn't have afforded them. Some even suspect that a lot of foreign donor money is specifically made available for branded drugs in order to destroy the generic market. After all, branding, intellectual property, is a particularly egregious form of market protection. And there are few who like to protect their markets more than the pharmaceutical industry, regardless of how many people suffer or die from treatable and preventable illnesses as a result.

But this is not the end of the matter. The European Union, that bastion of free market talk and protectionist action, wants India to sign up to a 'Free Trade' Agreement which will effectively restrict the country's ability to produce generics and sell them to poor countries. Médecins Sans Frontières (MSF) is campaigning against this appalling threat to the health and lives of so many people, but most international health institutions are remaining silent.

Many other African countries followed Kenya's unwise decision to pass intellectual property law that only benefited pharmaceutical multinationals, so maybe some of them will reconsider this now. Perhaps they will also get behind MSF and any other organisations involved in campaigning for fair economic conditions for developing countries. Tanzania and others are wondering how they will fare now that so much donor funding has been cut, with the global economic crisis being used as an excuse. They will do a lot better when they exercise their right to purchase generic drugs, rather than wasting the ample HIV funding on extortionately priced brands.

Multinationals and other pushers are constantly bleating about how people in developing are suffering and all rich country governments need to do is pay for their products for things to be ok. But there just isn't enough money to buy branded products, nor is there any necessity to do so. Much of the current HIV transmission in developing countries is preventable, especially transmission from mother to child. But despite the relevant drugs being available for many years, an estimated 43,000 babies were infected by their mothers in Tanzania in 2008 alone. Of the 217,704 new infections, many more would have been the result of lack of proper equipment for ensuring proper levels of medical safety. Tanzania need to find affordable drugs and medical equipment so that they can get by with less money.

The issue of intellectual property protectionism goes far beyond essential drugs and medications. Most household product markets in Kenya and other African countries are dominated by one single brand or a handful of brands, for example, soap, sanitary pads, diapers, cleaning materials, etc. These brands are unnecessarily expensive but one disinfectant soap manufacturer even claims that using their soap makes you and your children 100% healthier. Such claims, leading people to believe that they are harming their families if they don't use these products, are widely advertised. That is where much of the money made by multinationals is spent; it's spent on marketing and advertising, not on research, as they would like us to believe.

Let multinationals do their own dirty work, they should not be entitled to donor money that is supposed to be spent on needy people. If these organisations are bothered by competition from generics, let them put their prices down and learn how to compete, for a change. They love talking about competition but they usually operate in completely protected environments. And if they think those producing fakes are worth fighting, they could just lower their prices enough so that it is no longer worth while producing fakes. Fakes are only economic when the cost of making the goods is low but the price charged is high. Multinationals should start abiding by some of the principles they seem to think are so important. They have priced themselves out of the market that they have worked so hard to rig in their favour.

Countries like Kenya and Tanzania are right to be worried about reduced funding but there are two things that may work in their favour. Firstly, if they are less dependent on donor funding, they may be better able to shop around for affordable drugs and other vital goods. At present, donors usually decide which drugs and goods to purchase and they favour their own markets. That's what being a donor is all about, isn't it! Secondly, they may find ways of achieving even more with less money once they are freed of all the restrictions that foreign loans and donations often carry. This is not an argument for reducing funding, which I think should be increased. But it is an argument for funding to become more transparent, more democratic, more like genuine funding than merely a tool for benefiting the donor far more than the recipient, as it appears now.

The Odds Are Not Stacked Enough in Our Favour, Say Big Pharma

The 'Counterfeit Act' signed by the Kenyan government last year is being challenged as unconstitutional, violating the right to health. This act was not really necessary because it was already an offense to make and distribute fake goods and there are already officials whose job it is to enforce existing laws.

In fact, the act seems to have been cobbled together and rushed through parliament at the behest of big industry, especially big pharma. The last thing they would want is competition, except where the odds are well stacked in their favour. So they whinged to the government (a process called lobbying in some countries) about how things were so unfair and the government kindly came up with a piece of legislation that fails to distinguish between fake goods and generic goods.

As a result, generic versions of drugs destined for Kenya have been held up in various countries on the grounds that they may not be legally distributed in Kenya. This is great for big pharma, they never wanted generic versions of drugs to be produced unless they themselves produced them, at inflated prices. But they were forced to reduce their prices when producers won the right to produce generics and big pharma have been fighting them ever since.

GlaxoSmithKline has come up with the expedient of reducing a few well known products, such as some of their antibiotics, to try to undercut generic versions. However, they don't seem to understand the concept of undercutting: their prices need to be lower. They have reduced their prices, sure, but they are still far more expensive than generic versions. What they are offering are hardly loss leaders, rather some kind of token gesture, to which journalists give the expected publicity and praise. And it's still not even certain if the reductions will be passed on to consumers.

The result of Kenya's self-serving piece of legislation is that there is widespread confusion about pharmaceutical products. People really have no way of knowing what is fake and what is not. The fact that something has a well known manufacturer's name on it does not guarantee that it is not fake. But if it is genuine, you are still robbed of the extra cost that going for the branded product involves.

People are just not able to afford many of the branded products. Slight reductions here and there, or even substantial reductions, miss this point. What is never so clear is what people have to sacrifice if they do go for the expensive branded product. But that's of little interest to organisations like GlaxoSmithKline or to the journalists who flock to report on whatever titillating rubbish is being reported on by all other journalists.

I'm glad to hear this despicable act is being challenged and hope those opposing it succeed. Because other countries, such as Uganda, are considering similar acts, no doubt in response to lobbyists for big pharma and other industry interests.

Don't Wait for Big Pharma to Respect Human Rights

The Science and Development Network has an article commending the Brazilian government on its strategy for tackling HIV and AIDS. The country approached pharmaceutical companies in 2000, which is some time ago, and tried to put pressure on them to lower their prices. They made it clear that they could issue compulsory licences for Brazilian companies to produce generic versions of antiretroviral drugs that were still under patent.

This worked very well and the prices of drugs came down considerably. Brazil produced and imported some of the generic versions of drugs they needed. This is why the country was able to roll out antiretroviral therapy (ART) for everyone who needed it. Campaigners may have been fighting for the rights of people with HIV and AIDS but the real clincher seems to have been a threat to big pharma's ability to screw as much money out of people as possible.

Kenya is not as wealthy as Brazil and most of their money for ART comes from donors. However, far from producing or importing generic ART drugs, Kenya has passed a bill that makes it unlikely that generic drugs can be imported because the law is now fuzzy enough not to distinguish between generics and fakes. It would seem that the Kenyan government did this for the benefit of pharmaceutical companies rather than for the benefit of Kenyans.

I am surprised that donors are content to pay for overpriced drugs rather than putting some of the money into giving Kenya the capacity to produce generic versions of the drugs they need. In the long run, large scale rollout of ART will not be sustainable unless the price paid for the drugs comes down. If Kenya were to produce their own, that would go a long way towards making rollout sustainable and even feasible.

Around 30% of people requiring ART are currently receiving treatment. The plan is to have 100% of people on treatment by 2010. The number of people becoming infected with HIV continues to exceed the number of people being put on treatment. There are also plans to put people on treatment earlier, which will further raise the costs of the national treatment effort.

It's not that there isn't enough money, it's just that too much money is being charged for pharmaceutical products. This is a political and human rights battle and at present, Kenya is on the side of big multinational pharmaceutical companies, fighting for commercial interests and opposing Kenyan people's human rights.

Always Buy Generics Where Possible

Or rather, think about what you may be paying for when you buy a branded product.

Three Kenyans on antiretroviral treatment (ART) for AIDS are challenging the recently passed anti-counterfeiting Act as unconstitutional because it could be used to deny them access to generic versions of their life saving medicines.

The bill's definitions are ambiguous enough to be interpreted in a way that makes generics indistinguishable from fakes. This could result in generics not being allowed into the country. As generics can be up to 90% cheaper than the branded versions, this could result in people being unable to afford to continue treatment.

Representatives of pharmaceutical companies and pharmaceutical companies themselves deny that the anti-counterfeiting act would have such a result and deny that they will try to block generics from coming into the country. However, generic medicines have already been held up in European ports and this Kenyan act will only make it more likely that delays will occur.

It is not in the interest of most pharmaceutical companies to have cheap generic versions of drugs being used instead of their expensive, branded versions. Of course, some of them could, and probably do, produce their own generics. But these companies are answerable to their shareholders and anything that threatens profits, regardless of the cost, is not likely to be too popular.

Besides, the pharmaceutical industry is very good at persuading powerful people to promote their interests. In the US, the industry spends several hundred million dollars a year on lobbying. This figure doesn't include other costs, such as advertising and research. These companies know they can make a profit from generics. but they know that the profit is many times higher if they can kill as much trade in generics as possible.

The anti-counterfeiting legislation relies on people associating generics with fakes. Fake goods blight the everyday lives of Kenyans, some even threaten their health. But ironically, it is the extortionately high prices of branded goods that makes the fake goods industry so profitable!

Generics are not fakes. In fact, the very existence of generic versions of ART drugs will make it feasible for most, or even all, HIV positive people to be able to avail of treatment when they need it.

At present, a small percentage of people who need ART are receiving it. That percentage may get smaller as the present economic climate gets worse. But if generics are pushed out of the market there will never be enough money made available to provide ART for all who need it.

The European Community is already investigating the pharmaceutical industry for anti-competitive practices that affect access to generic drugs in Europe. But there needs to be opposition to the practices of pharmaceutical companies in developing countries, where the majority of HIV positive people live and where millions of people need ART but cannot afford it.

The industry is very rich and will continue delaying and blocking things indefinitely as they continue to extort enormous amounts of money from sick and dying people. I hope the people in Kenya succeed in their challenge to the anti-counterfeit legislation, for their benefit, for the benefit of Kenyans and for the benefit of citizens of other developing countries who are also being pushed by the pharmaceutical industry to pass self-serving laws.

Generic Drugs are Counterfeit, Say Kenyan Government

When pharmaceutical products first became available to treat HIV, they were far too expensive for most people to afford, especially in developing countries. Yet, the majority of people in need of treatment for HIV live in developing countries. So, how could pharmaceutical companies fix a price that would allow them a staggeringly high profit margin but also a large volume of sales?

HIV treatment (antiretroviral treatment or ART) is still very expensive, and that's just the drugs. It's still unaffordable to most people, but pharmaceutical companies have successfully lobbied donor governments to pay for the drugs. That gets rid of one problem, how to maximise profits for pharmaceutical companies.

But then there was another problem. Some countries who had the capacity to do the requisite research and planning and production are now producing generic equivalents of HIV drugs. These are much more affordable but this is a terrible headache for pharmaceutical companies. Of course, they are not too worried, most aid money for HIV goes to buying the branded, expensive drugs. Very little is allowed go to generics.

In Kenya, the pharmaceutical companies don't seem to have had much problem. The government produced a piece of legislation that doesn't distinguish between counterfeit products and generic equivalents. Perhaps the Kenyan government thought it was better to buy products that are tens or even hundreds of times more expensive. After all, they are not paying for them. Or perhaps someone nobbled the Kenyan government, it's hard to know. But the legislation makes sure that generics from any country can be considered counterfeit and this is very useful to the pharmaceutical companies.

There are hundreds of thousands of Kenyans in need of ART in order to stay alive and raise their families. Many of them are not on ART because the business of rolling out the drugs is slow. And because so little money is being spent on preventing new infections, the number of people requiring ART continues to increase. In fact, most of the money being spent on HIV prevention goes to programmes that have little influence on transmission of HIV or any other sexually transmitted infection.

I agree that treatment is part of prevention; people who are on treatment are less likely to transmit HIV if the treatment is working properly. But it's not good enough to spend, say, 50% of the 15 billion dollar President's Emergency Fund for Aids Relief (PEPFAR) on treatment when only 20% is going on prevention, especially as many prevention programmes have fairly dubious benefits.

It wouldn't be so bad if some of that 50% is going on something other than drugs. People on ART need more than just drugs, they need a lot of palliative care, a lot of monitoring, good health care, economic and moral support, good levels of nutrition, etc. Perhaps if pharmaceutical companies were to provide these things, donor money would be spent on them. As it is, many people get the free drugs but little else.

Those on ART who are not taking the drugs in the prescribed way, or who are not responding to the treatment for some reason, may turn out to be like the 80% of Kenyan's who don't know they are HIV positive; they could be continuing to have sex, not knowing that they are may be as infectious as people not on ART. Even worse, they may be spreading a resistant strain of HIV.

Resistance is most worrying in Kenya because it could take some time to identify people who are carrying resistant strains. Health and social facilities are not strong enough to monitor people adequately. Many get the drugs and disappear, for some reason or other. Others struggle to get the treatment they need but they don't know if they are or are not responding to the treatment until they become ill. By this time, their life and the life of their partner may already be at risk.

Resistance is a good thing, though, if you are a pharmaceutical company. People who are resistant to 'first line' drugs are usually put on 'second line' treatment. This is far more expensive, meaning higher profits. So if people fail to take their ART drugs properly, that could help the pharmaceutical companies greatly.

The Indian government is protesting because similar legislation is planned in other African countries, one of their biggest markets. And it's not just HIV drugs that are threatened, also cholera, malaria, hepatitis and malnutrition. This is not what Kenya or any other African country needs.