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HIV/AIDS: Update on access to medicines
NewsNotes, May-June 2009

The Joint UN Program on HIV/AIDS (UNAIDS) and NGOs who focus on access to medicines give the grim details: In low/middle income countries, only 31 percent of those with HIV or AIDS who need medications receive them; for every two people on medication, five are newly infected. Only 33 percent of HIV-infected pregnant women receive treatment to prevent mother-to-child transmission. And yet, reports from Maryknoll missioners who work with people with HIV and AIDS give proof to the power of access to medicines: Children who were emaciated and dying who start treatment and months later are energetically playing, going to school, smiling; mothers who survive the birth of their children to bear and raise their infants (who do not contract the virus); adults who do not die but return to jobs or to care giving or volunteer to help others, to celebrate with their families and communities.

Unfortunately, AIDS medicines are still out of reach for 69 percent of those who need them in poor countries; children are less likely to receive antiretroviral drugs.
 While many factors severely complicate the access to these drugs, such as high cost, lack of health care infrastructure and personnel, inaccessibility of rural areas, lack of nutrition and clean water and limited national budgets, the fact remains that AIDS medicines are still too expensive to be available to the majority of poor people in low and middle income countries. In many cases where they are available, only the first line medications are accessible; if a person becomes resistant, the second line and third treatment are more expensive than the older drugs, and hence unavailable. In addition, some medicine must be available for the life of the person living with AIDS.

Major advances have been made in the development of the medicines, and tiered pricing has brought down cost in many countries: 1) The manufacture and availability of generics has been a major benefit in Brazil, India, South Africa and Thailand. 2) Direct negotiations between UNAIDS and other organizations and pharmaceutical companies has resulted in lower prices of specific medicines over the years. 3) Some countries have been encouraged to use the rights afforded them through the international trade rules and flexibilities in TRIPS (trade-related aspects of intellectual property rights).

These solutions, in some cases models for successful access programs, are temporary at best and ultimately unsustainable in a health situation and in countries that do not have adequate prevention strategies. UNAIDS reports that the sustainability of HIV treatment requires more affordable second and third line therapies. Many would say that sustainability requires countries’ ability to make use of the TRIPS flexibilities and the development and encouragement of generics pharmaceutical industries.

Some recent developments:

  • In 2008, UNITAID, an international drug purchase facility, proposed a voluntary Patent Pool that could help make AIDS medicines more affordable. Different patent-holders would make their patents available to others; generic manufacturers could access patents in said pool to manufacture or improve on medicines, paying royalties to the patent holder. This system would help to reduce the cost of medicines as well as accelerate the availability of lower prices new medicines.
  • February 2009: GlaxoSmithKline (GSK) promised to cut the prices on all of its medicines in the poorest 52 countries and introduce a patent pool for dozens of compounds and invest 20 percent of its profits (from those medicines) to develop health infrastructure in those countries. While this is an excellent example for all pharmaceutical companies, these plans do not include middle income countries (where medicines are still too costly for the majority of those who need them), nor does the patent pool include AIDS medicines; the prices will still be too high for the majority who need them.
  • April 2009: In surprise news, GSK and Pfizer announced a merger of their HIV and AIDS operations into a new company, permitting them to develop new fixed-dose combinations using existing and new medicines, cut costs to improved productivity and share the development of new drugs. One goal of this effort is to develop drugs to overcome resistance to HIV in combination pills. There has been little public response to this news to date; however, new products (still in development) are unlikely until 2013, and there is no indication that they will impact those persons living with AIDS in poor countries.
  • April 2009: UNITAID and the Clinton HIV/AIDS Initiative announced a bulk-purchase deal with generic-drug makers. The reduced prices on AIDS drugs will be available in 70 developing countries and to Global Fund recipients (through their Voluntary Procurement scheme). This is the fourth such price reduction since 2006.
While all of these efforts have positive impacts for access to AIDS medicines (especially the proposal for patent pooling) and the research and development of desperately needed new medicines, they still remain stop-gap measures for the access to medicines by people in low and medium income countries, and they are not sustainable measures.

Advocacy must continue for: 1. generic production, sales and distribution of AIDS medicines; 2. price reductions for less toxic first line ARV combinations and diagnostics; 3. development of pediatric formulations (and systematic inclusion of pediatric studies in the development of ARV formulations; 4. support for countries’ use of TRIPS safeguards such as compulsory licenses and the creation of pro-public health patent laws; and 5. development of drugs, pediatric formulations and diagnostics for resource poor settings.

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