“How was your family before the diagnosis?” With these seven words and a black microphone in front of her, Soyla Marina Pérez, from the Sintana Quetzal Community in Guatemala, burst into tears before the international Court. This question, that spilled nostalgia down her cheeks, came up in one of the most important trials in the history of the worst Guatemalan public health epidemic the Guatemalan Ministry of Public Health and Social Assistance (MSPAS) had ever dealt with, the AIDS epidemic.
Soyla found out she was HIV-positive the same day she heard about the disease existence. None of her children could complete beyond sixth grade, all of them had to drop out school as they needed to support their parents. Her husband, also infected and in worse health conditions, could not face the catastrophe alone. Soyla’s case is one more in the long list of people who live with HIV and whose life depend on an appropriate, transparent and humane contracting system. This pandemic thrives in countries where medicine is scarce.
In this exercise, we have looked at all the purchases made between 2011 and 2018 by the Guatemalan Ministry of Public Health and Social Assistance (MSPAS), including purchases by the Global Fund, the Pan American Health Organization (PAHO) and those complementary purchases made by private laboratories in order to satisfy specific demands.
In total, there are 297 antiretroviral procurement contracts corresponding to more than 167 million quetzales. If the shortage problem is not solved in the short-term, the amount required by the country to solve this issue will raise significantly, as more people will be infected by then.
Medicine purchases are made by the MSPAS using five contract types, which does not always provide the ideal conditions for fair competition between companies. The highest number of procurements in Guatemala are done through international agreements, and the lowest are done under the Low Amount Purchases mode (little market stock).
Therapy is aimed at the greatest number of HIV-positive people: young men from 20 to 25 years old who have been mostly diagnosed in Guatemala City. Illiteracy also represents a big factor of risk, as 1,846 cases come from people who cannot read or write. Lastly, the most recent AIDS Epidemiological Surveillance Report released by the MSPAS states that at the moment it was published, there were 949 people with an advanced stage of viral load: 243 women and 706 men.
MSPAS has an agreement signed with the PAHO since 2017, and from 2011 to 2016 had another agreement with the Global Fund. These two organizations totally controlled the sales of antiretrovirals in Guatemala.
Purchases were made through this mechanism for a value of 86 million quetzales. The rest of acquisitions are divided between private individuals. The companies that were awarded the most contracts were Solmedica S.A, Amicelo S.A, Importer and Marketer RR S.A and Advanced Medicines. In total, these four managed to sell 5,752,414 quetzales in 33 contracts.