The Link Between Poverty, Counterfeit Drug Use and Level of ARV Adherence in The Global South


Introduction:
The developing world or global South has frequent drug shortages, does not have the staff, technology, political or social wherewithal to eradicate counterfeiters. Scholars and reports on counterfeiting have shown that the business of prescription medicine is an over $ 900 billion industry with 85% of the market in the global South. 30% of all counterfeits do not contain any active ingredient. There is a connection between knowledge,  demand for this industry, economic power, privilege and access to quality HIV-related services in different domestic countries. In the global South,  national-scale policy helps influence social relations and HIV prevalence reductions. This has involved policy change in many areas including import substitution and generic drug manufacture. This study looked into despite state-led domestic industrialization policies that allow for instance, drug manufacturing and other programming initiatives, there is a proliferation of counterfeit medications on markets. 

Method:
A qualitative analysis of 72 articles on counterfeit ARVs, ARV side effects, ARV elite users, ARV naive users, Drug fatigue, Household incomes, PLWHIV, Combination/Comprehensive HIV care covering 8 Global South countries (3 in Africa; 2 in Asia; 3 in Latin America). All 72 articles were eligible for inclusion. Primary descriptive analysis, literature review and a critical social theories to explain grounded struggles was done. Marxian political-economy analyses were used as lenses to figure out how an HIV+ve diagnosis plays out in structures and systems enabling or disabling capital accumulation and those impacting social relations of class, the role of the state, production systems and inherent coercive processes of HIV prevention.

Findings:
The need for food, support networks, how to ensure one has medication, housing or necessary means for food supply has an impact on life seeking practices.The fate of a person living with HIV in relation to ARV and other forms of support is impacted by different factors. The factors include identity, subjectivity, knowledge and power which constitute a political ecology in which an HIV +ve person is situated. Secondly, there is a contextual aspect of HIV prevention, e.g., clinical aspects surrounding adherence, switching between ART regimens or given country policy toward support to People Living With HIV. In countries with poorly managed HIV care services, the priorities to access the right medicines or even food shifted power for HIV +ve persons when weighed against housing and nutrition for single people living with HIV. Households with children, priorities to access the right medicines was relegated by needs of children. 

Conclusion:
There is a relationship between location, social groups, cultures, spheres of production and consumption to uptake of life promoting medication or services. Supply of ARVs and an HIV+ve diagnosis affect the connections to knowledge, power, its practice, material manifestation (property ownership and use) and life preserving practices (food supply, drug refills, nutrition support and eating habits) of those living with HIV. Further study into housing, nutrition and subsistence money for travel to clinics for regular check ups will throw more light on how to improve HIV care programming in the Global South. 

The writer of these blogs is an American Political Scientist. Read more of these blogs please. Thank you.


                                       










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