Present Danger

The world has the means to treat HIV/AIDS, but does it have the will?

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On Monday, World AIDS Day, UNAIDS and the World Health Organization launched an initiative with the goal of providing 3 million people with anti-retroviral drugs by 2005. In the industrialized world, HIV has changed from a death sentence to a treatable condition which, while chronic, can be held stable for years by anti-retrovirals. This is in stark contrast to the developing world, especially Africa, where AIDS continues to kill millions each year.

HIV drugs are expensive, and cost is often cited as the biggest reason why AIDS sufferers in the developing world can’t get the medicine they need. And though the U.S. is helping to do its part by setting aside $2.4 billion to fight AIDS, some say that America’s strict positions on drug patents won’t help make drugs more affordable. Only 400,000 of the 40 million people around the world with HIV are currently receiving proper treatment for the disease. The WHO plan, called the “3 by 5” (3 million by 2005) aims to change this via radically simplified testing, diagnosis and drug treatment by specially trained healthcare workers.

But the good that’s happening shouldn’t obscure the grim facts. A recent U.N. report finds that the global AIDS crisis is getting worse, not better, and that this past year has been the most harmful in the epidemic’s history, with 3 million dead and 5 million newly infected. The report also warned that if nothing is done to curb the disease, the epidemic will skyrocket in countries like Russia, China, India and Indonesia.

U.N. Secretary General Kofi Annan recently pointed out the discrepancy between developed countries that have access to life-saving drugs, and other parts of the world, which don’t:

“I feel angry, I feel distressed, I feel helpless and I also feel that, to live in a world where we have the means, we have the resources to be able to help all these patients, what is lacking is the political will.”

The key to fighting AIDS is making treatments and medicine more affordable. It can be done: Médecins Sans Frontières, a health organization that has pioneered free drug treatment in some of the poorest parts of Africa. In the clinics they provide, they are able to get cheap drugs and have seen significant results. The Guardian outlines how MSF defied the odds:

“Médecins Sans Frontières has pioneered free drug treatment for HIV in the most destitute parts of Africa, something many in the US and Europe said would be impossible. The drugs were too expensive and too difficult to take, the diagnosis needed hi-tech tests and patients would have to be monitored long-term by doctors, they said. … MSF has patiently demolished every argument.”

The example set by Médecins Sans Frontières is what the U.N. hopes to base its latest initiative on, but Dr. Morten Rostrup, the president of the group, says it will only work at no cost to the sick: “The treatment has to be free; if the treatment is not free, they will not meet their goals.”

One way to make drugs more affordable is by making patented, brand-name drugs in generic, cheaper forms. In late August, the World Trade Organization (WTO) agreed to let poor countries waive intellectual property rules and import generic versions of patented drugs to treat epidemics like AIDS. The agreement means that developing countries can issue compulsory licenses to other countries—those governments can let generic drugmakers break patents in order to provide them at lower costs.

But is this working? Not necessarily. Some countries find that negotations with drugmakers failed to reduce prices to acceptable levels, and are starting to take matters into their own hands. In September, Brazil announced it was prepared to start producing or importing generic versions of three patented AIDS drugs. The Brazilian Health Ministry issued a decree stating the government could declare a national health emergency that would give it the authority to break patents on three antiretroviral drugs.

Lately, the U.S. has been praised for stepped-up efforts to fight HIV/AIDS; congress recently agreed to provide $2.4 billion in 2004 as part of a 5-year $15 billion plan to combat AIDS in Africa. But Tommy Thompson, U.S. Health and Human Services secretary recently pointed out the gravity of the problem when he said that not enough is being done to fight HIV/AIDS:

“This war has caused more casualties than any other war. We need America, the European Union and everybody. Nobody is going to be spared unless we all come together in the fight against this disease.”

Critics agree with Thompson’s assessment that not enough is being done, though for many the U.S. is part of the problem. Watch-dog groups say that th e U.S. is using pressure tactics so that developing countries won’t break patents. The Guardian reports that research by Oxfam, a British anti-poverty organization, shows that the U.S. has a list of 27 governments they are prepared to impose trade sanctions on as punishment for insufficient patent protection for medicines, many of those developing countries. The Guardian reports:

“Many of the US complaints relate to the production of generic drugs in countries such as India, Brazil, Argentina and Egypt, with manufacturing capacity and the ability to export to poor nations in Africa. One of the demands raised increasingly by the US is that those countries respect the confidentiality of data from the drug companies’ clinical trials for at least five years – delaying generics companies’ efforts to make and register copies of new medicines.”

The hand of the US government can also be detected in individual company battles. In Thailand, Bristol Myers Squibb successfully fought production of a generic version of its Aids drug Didanosine or ddI. The US threatened trade sanctions and action for compensation. Thailand bowed to the pressure, but last October a court ruled that the scope of the BMS patent had been wrongfully expanded and a further legal review may allow generic production to begin.”

New York Times columnist Nicholas Kristof discusses the impact that corporations can have on efforts to stem the international AIDS crisis. He says Latin American countries are especially wary of buying generic drugs for fear of offending the U.S.:

“Even now, some governments in Central America choose to let their people die rather than distribute cheap generic AIDS drugs that would save more lives but might irritate the United States. And now America is trying to make it more difficult for these countries to use generic drugs.

Even now, ahead of the FTAA, Guatemala and Honduras avoid using generic anti-retrovirals for fear of offending the United States. Guatemala, for example, has 67,000 people, including 5,000 children, with HIV or AIDS. Most will die. Astonishingly, the country spends most of its scarce money on brand-name AIDS drugs rather than cheaper generics, which could treat three times as many people. Honduras does the same, preferring to let people die than use generics.

Why would these countries do this? The doctors and public health officials I interviewed said that Central American nations had a strong desire to curry favor with Washington, perceived as hostile to generics.”


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