Dessy Sagita – As someone living with HIV, Chacha said he was concerned by reports suggesting his much-needed antiretroviral medication may soon be harder to come by.

Chacha, not his real name, said he feared that potential changes to the supply of some patented antiretroviral drugs, which are provided free of charge or generously subsidized at many hospitals, would make them even more difficult to obtain.

"I've experienced it once before when stocks ran out at the hospital in Serang [in Banten province] where I usually get my ARVs," he said on Tuesday. "So I had to borrow the medicine from a friend."

Although people living with HIV/AIDS commonly borrow medicine from one another in Indonesia, Chacha said it was not something he wanted to do.

"If you borrow money from your friend and pay it back on time, they probably won't mind that much," he said. "But when it comes to ARVs, the other person needs the medicine as much as you do, so you can't afford to not repay them on time."

Chacha's concerns, and those of thousands of other Indonesians – UNAIDS estimates that there are 300,000 people living with HIV in Indonesia – stem from a report released on Monday by humanitarian aid group Medecins Sans Frontieres.

MSF reported that some major pharmaceutical companies had "abandoned HIV drug discount programs in middle-income countries," including Indonesia.

"Tibotec/Johnson & Johnson exclude all countries classified as 'middle-income' from their price reductions; Abbott excludes low-income and lower middle-income countries from discounts for one of its drugs; and ViiV (Pfizer GlaxoSmithKline) no longer offers reduced prices to middle-income countries," the group said in a press release on its Web site.

"In a reversal, Merck has now announced that it will no longer issue price discounts for 49 middle-income countries for its new drug raltegravir. This move leaves out countries with large numbers of people living with HIV/AIDS, such as India, Indonesia, Thailand, Vietnam, Ukraine, Colombia and Brazil.

"This development comes on the heels of a number of developing countries being excluded from last week's agreement between drug company Gilead and the new Medicines Patent Pool, which aims to increase access to affordable ARVs by negotiating licensing that can be used by generic manufacturers."

Rico Gustav, treatment and advocacy officer for the Bangkok-based Asia Pacific Network of People Living with HIV/AIDS (APN+), said a potential price increase would severely affect access to ARVs and put patients in an even worse predicament, especially in Indonesia, where many of those living with HIV/AIDS were underprivileged to begin with.

"We do appreciate the intellectual property concerns of these pharmaceutical companies, but ARV sustainability is a major public health issue, and interrupted supply could cost someone their life," he said.

Rico added that APN+ and other international HIV/AIDS advocacy groups would push the United Nations to take a stand to protect the stability of HIV drug prices. "We have to come up with a solution that will benefit the pharmaceutical companies without jeopardizing the lives of millions of people living with HIV/AIDS," he said.

Aditya Wardhana, a prominent HIV/AIDS activist, blamed the uncertainty over ARV supplies on the low domestic production of generic drugs.

"Why can't Kimia Farma produce the drugs in larger volumes for the whole country, so we don't have to depend on donors and imported drugs?" he said, referring to the country's largest state-owned pharmaceutical company. "If the major producers stop the discount programs, prices will skyrocket and the even stability of supplies will be uncertain."

He stressed that ensuring ARV sustainability was key to stopping the spread of HIV infections.

"People are so caught up in developing HIV/AIDS cures, but they overlook the fact that routine ARV treatment prevents new infections, even better than condoms." Sri Indrawati, the Health Ministry's director general for pharmaceuticals, said only, "There have been no holdups so far in the supply of ARVs, but we will see how it goes."

Chacha, meanwhile, said that if the new policy did result in a long-term shortage of free or subsidized ARVs, he would have no choice but to pay for more expensive patented ARVs.

"I'm only a social worker, I have a wife and a young daughter," he said. "I can't afford to spend millions of rupiah each month just for my medicine."