Anti retroviral therapy in HIV/AIDS  - update  2002

Less than 30,000 people (0.1%) of the 28.5 million infected Africans were estimated to have received antiretroviral therapy in 2002, despite even further drops of prices in the last 18 months.  In contrast up to 30% of all infected people receive antiretroviral therapy in the developed world. Even Uganda despite its relative success in bringing down the HIV/AIDS prevalence rate has struggled in its efforts to expand treatment and care and the vast majority of Ugandans with HIV infection still do not have access to antiretroviral therapy.  Why is this still the case?

The debate of prevention over treatment is over, but despite several studies showing that anti retroviral (ARV)drugs can be used as an effective tool in the prevention of HIV/AIDS, only a miniscule number of Africans are getting access to these medicines. At the beginning of April 2001 African governments said they could only provide ARV treatment for 1- 2% of HIV infected people in their nations, in spite of significant price reductions.

The falling price of anti retroviral drugs

In April / May 2001, Medilinks undertook a study to compare the cost of the various combination therapies of ARVs available. It found the cheapest drugs were generics that were produced by companies in India. However at $385 dollars a year ($1.1 dollars a day), even the lowest priced were still out of reach for most African nations, where the majority of people live on $1 dollar a day.

Twenty months later prices have decreased by almost 5 times for the lowest priced drugs. The lowest priced anti retroviral combination is now at $128 dollars a year equivalent (35 cents a day). Note this is a combination in one pill, not three separate drugs!  Not only that, the range of different combinations priced at less than $1000 dollars has increased substantially. This means the issue of problems around compliance has been greatly reduced.

Why drugs are still not available?

But the drugs are still not getting to the patients. Why?  Price is one of the significant barriers to distribution of drugs.  But prices have dropped dramatically. So why aren’t African HIV/AIDS patients getting access to these cheap drugs?

Quite simply, the fact is the cheapest drugs are generic medicines. And paradoxically, generic producers (India, Brazil, Thailand) are currently restricted in exporting these drugs to other developing countries. It is startling to realize that even in the face of the prospect of 50 million dead Africans by the end of the decade, governments in developed nations are still showing a marked reluctance to removing these restrictions and have not signed any agreements to ensuring these drugs will be made available.

It is a year since the Doha meeting in December 2002, where trade ministers reinforced the priority of public health over patents (“patients over patents”). Yet at the Sydney meeting in 2002, MSF and developing countries have raised the concern that developed countries are promoting policy options that will place significant barrier to the access of generic drugs in developing countries. 

“Under the WTO's Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement, developing countries with no pharmaceutical manufacturing capacity are allowed to import generic drugs to meet health needs. Paradoxically, generic producers are currently restricted in exporting these drugs…Removal of export restrictions on generic producers is a simple, effective solution that balances public health demands and intellectual property protection in the spirit of the 2001 Doha meeting.”

Source:

1. Medilinks: Anti-Retroviral Drugs Used In HIV/AIDS
2. MSF Access to drugs: Untangling the Web of Price Reductions: a Pricing Guide for the Purchase of ARVs for Developing Countries June 2002; 2nd edition 
3. UNAIDS.Org