Recycling Medication: Facing the Challenge in Developing Countries

"The convergence of global stakeholders at AIDS 2006 has provided an ideal opportunity to examine the gap between what society is capable of doing in the face of this unprecedented humanitarian crisis and the actual level of response"
-- Dr. Helene Gayle, President, International AIDS Society, speaking at the XVI International Conference on AIDS in Toronto

Against the backdrop of the 25 million men and women whose deaths from AIDS have devastated communities and orphaned millions of children, more than 40 million people are today living with HIV.

Antiretroviral therapy has been shown to significantly extend and improve the lives of people with HIV, reducing AIDS-related deaths by over 70%, even enabling patients in the final stages of AIDS to return to productive lives. But only 24% (1.6 million out of 6.8 million) of people with HIV in low- and middle-income countries who need medication have access to it.

In the U.S., people with HIV who change their treatment regimens may have unused supplies of one or more drugs. These excess medications are normally discarded, but could instead serve as a lifeline for those without access to treatment. The same is true of unused portions of the prescriptions of deceased patients.

While federal laws prohibit the redistribution of unused prescription medicines to individuals within the U.S., these medicines may be donated to designated not-for-profit organizations that then distribute them in other countries as "humanitarian aid."

Organizations Involved in Recycling Medications

One of the largest organizations involved in medication recycling is New York-based Aid for AIDS (AFA), a non-profit committed to improving the quality of life of people living with HIV/AIDS in developing countries and of immigrants in the U.S. AFA works to empower people with HIV, their caregivers, and the community at large by providing access to medication, education, prevention, and advocacy, and by promoting leadership and capacity building.

AFA's Recycling Medications Program and AIDS Treatment Distribution Program collect, recycle, and distribute excess HIV/AIDS medications, before their expiration date, to individuals in developing countries who do not have access to life-saving treatments. AFA's programs include antiretroviral medications, medications that combat opportunistic infections, and antibiotics.

In addition to working with organizations outside the U.S., AFA reaches out to physicians who prescribe these medications, enabling them to work with patients and their caregivers to save unused medications.

AFA's "Be A Hero" campaign also directly targets people with HIV in the U.S. who are on treatment through magazine ads, posters, flyers, and its website,

In 2005, AFA collected $4.2 million worth of antiretroviral medications and another $1 million in prophylactic meds. At the end of last year, AFA distributed recycled medications to 5,000 people in 24 countries, including Venezuela, Colombia, Mexico, the Dominican Republic, and other Latin American nations, and to countries in the Caribbean, Africa, and the Middle East.

Potential recipients are screened for specific criteria, such as not having other sources of medications, having a CD4 count below 200, having a viral load greater than 100,000, etc. In addition, clients need to be involved in HIV/AIDS work in their communities through prevention, advocacy, policy change, or community outreach. AFA's programs require that local doctors are available to work with its doctors and staff.

AFA does not receive federal funding for its medical recycling program, and relies on support from the private sector and from foundations such as the Bill and Melinda Gates Foundation (which has taken a very visible role in the fight against AIDS), the M.A.C AIDS Fund, and the Elton John Foundation, as well as AFA's own fundraising events, including the "My Hero" gala set for this November.

Over the years, other organizations have begun efforts to recycle surplus medicines, benefiting patients in Algeria, Morocco, Tunisia, Cuba, Chile, Thailand, the Philippines, and Zimbabwe, among others. The Recycled Aids Medicine Program, or RAMP ( in San Francisco and Los Angeles similarly gathers unused HIV medicines and delivers them to organizations overseas, which then redistribute these drugs to patients under a doctor's supervision. RAMP also donates surplus medicines to, among others, AFA.

The Starfish Project at the Center for Special Studies, New York-Presbyterian Hospital/Weill Cornell Medical Center ( gathers unused "leftover" medication from U.S.-based patients who have stopped or changed their HIV meds and sends them to two partner clinics in Nigeria. Started in 1998 by a visiting physician from Nigeria, the program has shipped over 304,000 pills to partner clinics, providing free HIV therapy to over 70 patients in Nigeria, and is a major source of highly active antiretroviral therapy (HAART) provided free of charge in that country. The Project also provides technical assistance to these clinics and training for local health care providers.

These medication recycling programs help improve the lives of people living with HIV by providing the process for, awareness of, and access to life-saving medication that would otherwise be discarded. A huge amount still needs to be done, as only a small percentage of usable drugs are re-channeled to those who need them in developing countries. Yet these programs also demonstrate "what society is capable of doing," as Dr. Gayle put it at this year's AIDS conference.

Roberto Perez is a writer and editor in the New York area.