HIV/AIDS

Our commitment to helping improve access in HIV is steadfast, to meet the evolving needs of the community.

The challenge of HIV is vast. For more than 25 years, Merck has sought to make a difference in the fight against HIV, particularly in the developing world. But the need is greater than the results any one stakeholder can deliver, requiring coordinated efforts among many. After a decade of specific efforts to increase access to HIV treatment in the developing world, it is clear that access to care is about more than the price of medicines and that collaboration has been essential to the progress made against HIV.

It Takes A Multifaceted Approach to Improve Access

Our commitment to working with governments, donors, innovator and generic manufacturers, multilateral organizations and civil society to address the full range of factors affecting access is strong. Since 1985, we’ve been engaged in research and development efforts in both HIV prevention and treatment. But research is just one part of our comprehensive strategy to strengthen access.

We have seen that ensuring access requires a broad, comprehensive approach. This is why we are committed to improving patient access through expanded availability, enhanced access strategies and extensive local community support.

To make this possible, today we employ many strategies to meet the needs of a particular region or country, including seeking rapid registration of our antiretrovirals; developing pediatric formulations; generating support for clinical studies in resource-limited settings; creating differential-pricing policies; establishing strong collaborations with government, manufacturers and other stakeholders; and providing local investment through on-the-ground support for affected communities.

We believe it is critical to invest in HIV at the local level. This investment supports healthcare professionals and the communities they serve, and assists in providing much-needed education to help ensure appropriate HIV care and treatment in all regions of the world. In sub-Saharan Africa, for example, Merck has expanded resources to provide medical education to healthcare workers and to help ensure appropriate use of our antiretrovirals. We have invested at a local level in local representatives to provide training and services through an accessible, skilled workforce in regions where HIV infection is highly prevalent. In the U.S., we are working closely with numerous U.S. AIDS service organizations (ASOs) to help address healthcare disparities through educational programs and resources that align with the National HIV/AIDS Strategy (NHAS).

To facilitate access in sub-Saharan Africa, and in low-income countries, the areas of greatest need and least ability to finance healthcare, we instituted an innovative model that utilizes a low-cost supply chain with manufacturing partners. This enabled us to reduce our lowest Access price in these specific countries. We have also granted non-exclusive voluntary licenses to two generic manufacturers to supply generic raltegravir in these regions. This is coupled with our commitment to provide local, on-the-ground support, including medical education in Sub-Saharan Africa. This initiative was announced in June 2011.

Given the different levels of economic development and national strategies, we have implemented a different approach for middle-income countries to make meaningful improvements in patient access. We are focused on working with governments and with other country stakeholders to develop strategies tailored to each country's HIV access needs. As part of this effort, we have implemented a differential pricing policy based on, among other things, a combination of treatment guideline positioning, patient access, market conditions, country income and disease burden. We continue to explore the best country-specific models in these regions.

In developed countries, our commitment to addressing patient access needs has not waivered. In the United States, for example, many state AIDS Drug Assistance Programs (ADAP) have struggled to meet growing need. Over the last two decades, Merck lowered or froze the price of its antiretrovirals four times. Since 2010, Merck has worked with Welvista to offer immediate access to no-cost HIV medicines to patients on ADAP waiting lists. We also continue to offer support to eligible patients through Merck's comprehensive Patient Assistance Programsand Co-Pay Assistance Program.

Innovation and Collaboration Leads to Results

We constantly strive to discover new ways to apply our expertise, human and financial resources, and market-based solutions to address the complex challenge of patient access. Our strategies are designed to enable us to facilitate access while continuing to develop new medicines. They also help us move beyond the limits of what we can achieve if we work alone.

This desire to redraw the bounds of possibility enabled Merck to pave the way for two successful private-public partnerships that were created in the last decade in some of the countries hardest hit by HIV. Merck has donated its antiretrovirals to the African Comprehensive HIV/AIDS Partnerships and The Merck Company Foundation has committed more than $115 million to both this partnership and the China-MSD HIV/AIDS Partnership. By 2010, over 90 percent of people in Botswana in need of HIV treatment were receiving it, compared with 5 percent when the program began in 2000. In the areas served by the partnership in China’s Sichuan Province, the number of AIDS patients on treatment increased from 0 to close to 1,500 in just three years.

Merck remains committed to fulfilling our shared responsibility to improve access and to helping the world win the long-term battle against HIV. Continued dedication and strengthened investment from all stakeholders are needed to fully address the evolving challenges of the epidemic, including the multifaceted barriers to access. We look forward to building new partnerships and collaborations to move toward our common goal of achieving greater access to healthcare and continuing the fight against HIV.

Despite Merck's efforts to develop and implement effective philanthropic and business strategies to help remove barriers to access, challenges remain because of the complex and multifaceted nature of the problem.

Improving access to HIV medicines requires more than simply making our medicines and vaccines available at reasonable prices. We believe that to truly address—and, ultimately, solve—the issue of access in low- and middle-income markets, the international community must pool its resources and expertise to strengthen healthcare infrastructure, ensure adequate financing for health, and help to build local healthcare capacity through training and support. Pharmaceutical companies alone cannot solve these immense public health problems. Sustainable solutions will come from comprehensive approaches that draw on the expertise of all stakeholders.

For this reason, a key element of Merck's approach to increasing access to HIV medicines is promoting and participating in public-private partnerships with governments, multilateral organizations, community-based organizations, other corporations and nongovernmental organizations (NGOs) to address specific health and development challenges beyond those over which Merck has immediate and direct control. While many include financial or in-kind support, we also seek to leverage our expertise and the skills of our employees to contribute in additional meaningful ways.

Ensuring Access to Our HIV Medicines to U.S. AIDS Drug Assistance Programs (ADAPs)

We have a long history of working closely with leaders from the HIV community to ensure that our approach to pricing our medications is fair and reasonable, balancing Merck's interest in conducting extensive HIV research while supporting broad access to our medicines.

Merck was the first company to provide a price freeze to the unique state U.S. AIDS Drug Assistance Programs (state ADAPs) when, in the late 1990s, they began to suffer a funding challenge. In 2008, Merck announced a price freeze on ISENTRESS® (raltegravir) for state ADAPs, and in 2010 Merck extended that price freeze of ISENTRESS and that of CRIXIVAN® (indinavir), which was first established in 2003 to eligible state ADAPs, through December 31, 2013. Merck also is providing expanded financial relief to state ADAPs through increased discounts.

Welvista

Through Welvista, Merck provides ISENTRESS and CRIXIVAN to patients on waiting lists for drugs under the ADAP program.

Merck's Patient Assistance Programs (PAPs) in the United States

Merck's commitment to patients' access to its products is reflected in its SUPPORTTM Program, which helps answer questions related to insurance coverage and provides free reimbursement support services for patients who have been prescribed ISENTRESS or CRIXIVAN. The SUPPORT Program can also help patients apply for , which provides ISENTRESS and CRIXIVAN free of charge to eligible patients who do not have insurance coverage. More information about the SUPPORT™ Program can be obtained by calling 1-800-850-3430 or visiting this site.

Merck's Co-Pay Assistance Program in the United States

In addition to the SUPPORT Program, Merck has a in the U.S. for eligible patients on ISENTRESS. If patients have private insurance and an out-of-pocket cost for ISENTRESS, they may be eligible to receive a savings coupon. The coupon provides savings toward their out-of-pocket costs, up to a maximum of US$400 per prescription (regardless of the number of tablets supplied on the prescription) of ISENTRESS. The coupon can be used up to 12 times prior to the expiration date. Restrictions and Terms and Conditions apply. Learn more.

Merck actively engages with stakeholders involved in HIV/AIDS outreach and public policy through a number of mechanisms.

In the United States, Merck has established ethnically diverse HIV Community Advisory Boards that include HIV community leaders from across the nation. Merck meets with these boards regularly to discuss new data, clinical trial design and marketing and access strategies. We also meet regularly with the European Community Advisory Board of the European AIDS Treatment Group to discuss similar issues, and we engage with stakeholders in public policy discussions through numerous scientific and policy events and initiatives.

Improving access to care requires more than simply making our medicines available and affordable. Collaboration is essential to enhancing access in HIV.

The most important factors for long-term sustainability are strengthening healthcare infrastructure, ensuring adequate financing for health, and helping to build local healthcare capacity through training and support. Public-private partnerships have a critical role to play in this process, drawing on the complementary expertise of all stakeholders—governments, international agencies, community organizations, donors, the private sector, nongovernmental organizations (NGOs), patients and others—to identify the most promising and efficient ways to address the impact of HIV in a variety of resource-limited settings.

In this section, we outline some of the many programs and partnerships Merck supports around the world to help address the challenge of HIV.

Africa

African Comprehensive HIV/AIDS Partnerships (ACHAP)

In 2000, the Government of Botswana, The Merck Company Foundation/Merck, and the Bill & Melinda Gates Foundation established the African Comprehensive HIV/AIDS Partnerships (ACHAP) to support and enhance Botswana's response to the HIV/AIDS epidemic through a comprehensive approach to HIV/AIDS prevention, care, treatment and support. In 2010, Merck renewed its commitment to ACHAP with an additional grant of $30 million for the period 2010–2014—bringing its total to $86.5 million over 15 years. Merck also agreed to continue the donation of its antiretroviral therapies (ARVs) for the duration of the partnership. By 2010, over 90 percent of people in Botswana in need of treatment were receiving it, compared with 5 percent when the program began in 2000. Learn more.

Keeping HIV-Positive Mothers and Their Babies Healthy: mothers2mothers

Since 2008 Merck has supported mothers2mothers (m2m) to facilitate HIV-prevention programs for mothers at prenatal clinics in rural Lesotho. The program aims to reduce the number of babies born with HIV through the prevention of mother-to -child transmission (PMTCT). M2m also develops and implements HIV-skills training for women in HIV management, in order to better serve the community. Since m2m initiated its program in Lesotho, the organization has opened 66 sites, hired 24 site coordinators, trained 86 “Mentor Mothers,” enrolled 13,600 patients and fostered 80,900 client interactions

Educating and Empowering Young People through Soccer

Merck has supported Grassroot Soccer's program in Namibia since 2008. The Football for an HIV Free Generation (F4) program combines outreach programs for youth that foster educational, leadership and life-skills development. The key aims are: (1) to reduce the rate of HIV infection; (2) to engage young people across Namibia as advocates in the fight against HIV, to help them make a positive difference in their communities; and (3) to help boost leadership and increase country-level focus on improving HIV prevention. The Namibia program, which began in 2006, has trained 184 coaches and graduated 11,025 young people.

Eastern Europe/Middle East

Promoting Prevention and Raising Awareness in the Russian Federation

Merck has supported the Social Partnership Development Fund (SPDF) in the Russian Federation to expand HIV prevention and community outreach projects. The strategic aim of this fund is to raise awareness of HIV treatment among people living with HIV/AIDS, medical specialists, service providers and healthcare officials. The SPDF has provided web-based updates on HIV treatment and care guidelines, has expanded HIV information on drug registration/availability, and has developed and disseminated materials on HIV treatment in Russian.

Educating and Empowering Young People: U Ch00se (Bulgaria)

Since 2009, Merck has supported the U Ch00se campaign in Bulgaria to increase awareness about the prevention and consequences of STDs (mainly HIV/AIDS and HPV) among youth and young adults between the ages of 11 and 26. The campaign aims to teach by disseminating information, encouraging communication to promote key messages, and training peer educators.

Since 2010, the campaign has established an online presence that includes educational information, a blog and other opportunities for dialogue about topics that can be hard to talk about. The campaign also produced a film profiling the youth point of view on the issue of STDs. Additional updates on the program’s progress in 2011 are forthcoming.

Asia Pacific

China-MSD HIV/AIDS Partnership

The China-MSD HIV/AIDS Partnership (C-MAP), a collaboration between The Merck Company Foundation and China's Ministry of Health, works toward the comprehensive prevention and treatment of HIV/AIDS in China. Established in 2005 with an initial seven-year, US $30 million commitment from The Merck Company Foundation, the program is the most extensive HIV/AIDS prevention and treatment initiative to be conducted to date through collaboration between the Chinese government and a foreign company in China. First introduced in three counties in Liangshan Prefecture, Sichuan Province, C-MAP has been extended to another 20 regions and prefectures in Sichuan, reaching a total of 62 project sites. In the areas served by the partnership in China’s Sichuan Province, the number of AIDS patients on treatment increased from 0 to close to 1,500 in just three years. Learn more about C-MAP and the progress being made through this collaborative effort.

"Reaching Out" to People Living with HIV/AIDS (PLWHA) in Malaysia

In 2010, Merck supported the Malaysian Society for HIV Medicine's "Reaching Out" program, which is designed to help women, single mothers and injecting drug users (IDU) living with HIV/AIDS in need of psychosocial support and life skills. This support led to MASHM implementing in 2011: (1) workshops for HIV caregivers that will provide updates on the use of new agents and their development for ID specialists focusing on both national and international guidelines; (2) life-supporting skills and psychosocial support to women, pregnant women and single mothers living with HIV; and (3) self-management support to IDUs on HAART (highly active antiretroviral therapy) regimens.

United States

Merck is committed to reducing healthcare disparities and improving access to HIV treatment and care in the United States. As part of this commitment, Merck engages in collaborations to reduce the impact of HIV on those most in need and most at risk. Merck works with leading AIDS service organizations (ASOs) to develop solutions that strengthen access to treatment, care and support for disproportionately affected communities.

The Black Treatment Advocates Network (BTAN)

Black Americans face a severe burden of HIV in the U.S., accounting for almost half (46 percent) of all people living with HIV. Among individuals living with HIV/AIDS in the U.S., Black Americans are less likely to receive HIV treatment and often are the least likely to remain in care.

To address the critical disparity in HIV-treatment outcomes and strengthen the link to care, in 2010 Merck established a collaboration with the Black AIDS Institute (BAI) to launch the Black Treatment Advocates Network (BTAN). BTAN trains, mobilizes and equips teams of treatment advocates to link HIV-positive Black Americans with care, raise science and treatment literacy, and strengthen local and national leadership. The initiative has trained 150+ high-potential advocates and supported access and linkage efforts in high-prevalence communities. BTAN has served more than 70,000 people living with HIV/AIDS and is active in nine high-burden U.S. regions. Through this initiative, Merck and the BAI work together to address disparities in HIV care in Black communities across the United States.

"Everyone Has a Story"

In the United States, women account for more than one-quarter of all new HIV/AIDS diagnoses. Among Black Americans, one in 30 women will receive a positive HIV diagnosis at some point in her lifetime.

To address the disproportionate impact of HIV on Black American women, in 2009 Merck began collaborating with SisterLove, Inc., an Atlanta-based HIV/AIDS service organization, to develop a mini documentary that addresses the unique challenges HIV-positive women of color face. The result was “Everyone Has a Story” (EHAS)—an educational capacity- and skills-building initiative for healthcare professionals (HCPs) and HIV-positive women. EHAS uses video-based storytelling to empower individuals to address stigma, navigate disclosure, build strong relationships with providers and live healthier lives. It also improves cultural competency among HCPs. Since launching EHAS in March 2011, Merck and SisterLove have distributed more than 6,500 workshop guides to community organizations, clinics, universities and international decision-making bodies in high-burden cities across the U.S. and in South Africa. The initiative remains active across the United States.

Treatment Education Training Program

For more than three years, Merck has supported AIDS Project Los Angeles (APLA) to develop and implement a three-day training program that brings together a diverse range of HCPs in Los Angeles, California, and Tucson, Arizona, to learn new information on key topics in HIV treatment and care. This program helps to reduce racial/ethnic disparities in timely access to HIV primary care and increases the capacity of HCPs to deliver accurate HIV-treatment information to patients.

"You Are Not Alone"

With Merck's support, Gay Men's Health Crisis (GMHC), an internationally recognized ASO, developed a social marketing campaign—“You Are Not Alone”—to raise awareness about the importance of medical care, treatment and adherence. The campaign targets the most affected groups in the U.S., including young men of color who have sex with men, women of color and Latinos. It provides critical information to help HIV-positive individuals access treatment, health information and healthcare services. Together, Merck and GMHC have distributed more than 70,000 brochures to the HIV community.

Sharing Stories, Creating Hope (Compartiendo Historias, Construyendo Esperanza)

Hispanics/Latinos make up 16 percent of the total U.S. population yet account for 20 percent of all new HIV cases. Hispanics/Latinos also experience disproportionately high of rates of delayed testing, diagnosis and entry into care.

To address these disparities, in 2011 the Latino Commission on AIDS and Merck came together to develop Sharing Stories, Creating Hope, a groundbreaking multimedia educational initiative. Set to launch in 2012, this bilingual initiative will support capacity-building efforts across the U.S. to enhance interactions between Latinos/Hispanics living with HIV and their healthcare providers, and to support access and adherence. The videos will feature interviews of patients and providers discussing strategies to overcome barriers to initiating and sticking with care and treatment.

The Quilt in the Capitol and the “Call My Name” National Tour

In 2012, Merck began collaborating with the NAMES Project to bring the AIDS Memorial Quilt to the International AIDS Conference in Washington, D.C., and to support a four-month “Call My Name” national tour. The “Call My Name” tour uses quilting workshops to raise awareness of HIV in disproportionately impacted communities and to commemorate lives lost to the epidemic. Merck’s support of Call My Name and the Quilt in the Capitol effort are part of its long-standing commitment to reduce health disparities in HIV treatment and care.

South America

Vivo Positivo and Accion Solidaria

In Chile and Venezuela, Merck has supported the ASOs Vivo Positivo and Accion Solidaria to train HIV counselors; help people living with HIV/AIDS (PLWHA) better manage care, increase adherence and improve quality of life.

Fundacion Huesped/IMLAS

The media has a critical role to play in raising awareness of HIV/AIDS. Merck has supported the Latin America Media Partnership on HIV/AIDS (Iniciativa de Medios Latinoamericanos sobre el SIDA or (IMLAS in Spanish)) to encourage a regional response to HIV/AIDs; to persuade the media to address HIV-related stigma and discrimination, and to promote HIV prevention and awareness across Latin America.

The IMLAS program PASION POR LA VIDA / PAIXAO PELA VIDA ("Passion for Life") is the first regional media effort to inspire and empower people to help stem the spread of HIV/AIDS. Profiling courageous individuals living with HIV across the region, the campaign aims to put a face on the region's HIV/AIDS epidemic, encourage the audiences to become better informed about HIV/AIDs, and reduce HIV-related stigma. The campaign's message of hope and positive action is broadcast in 13 nations by members of IMLAS—a regional partnership of the Global Media AIDS Initiative (GMAI).

Instituto Vida Nova

In response to the epidemic and in support of the Brazilian government's well-recognized commitment to address HIV/AIDS, Merck provided financial support to HIV programs developed by local nongovernmental organizations (NGOs).

For example, Merck supports Instituto Vida Nova (IVN), an organization whose mission is to improve quality of life for HIV/AIDs patients and their families in the city of São Paulo and to help protect skilled home-care professionals who are vulnerable to infection through their work. IVN provides healthcare and social development programs to 602 people living with HIV/AIDs in the city.

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