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A Comprehensive Remedy for HIV/AIDS Requires Lower Drug Prices, Infrastructure Development, Training, Access, and Political Leadership
A Statement from José Zuniga,
President of the International Association of Physicians in AIDS Care

December 2000

Several pharmaceutical companies announced plans in June to slash prices for their AIDS drugs as a mechanism to expand access to HIV/AIDS care in Africa. The importance of this declaration becomes even more apparent in the wake of the most recent figures from UNAIDS, which estimates that 3 million people died from AIDS in the year 2000, and that approximately 36.1 million people are now HIV-infected worldwide.

In a world where the vast majority of people living with HIV/AIDS cannot obtain the level of HIV care that has proved clinically beneficial, the International Association of Physicians in AIDS Care (IAPAC) strongly encourages research-based drug manufacturers and others to facilitate greater access to medicines through lower priced drug donations. In particular, drugs that reduce the risk of mother-to-child transmission should be made available. However, while drug donations are a key component of a comprehensive remedy, they alone will not make an appreciable dent in this pandemic.

As an African health official recently told me, "The companies can give us a supertanker of free products. Unfortunately, the drugs will only reach a small number of people with access to the medical knowledge and healthcare infrastructure that will allow them to be used correctly and, thus, improve their health." The other required elements in a comprehensive remedy for HIV/AIDS are infrastructure development, training and education, access to vaccines and microbicides, and political leadership.

Strong medical and social infrastructure is necessary to support and sustain both ongoing basic healthcare and the introduction of antiretroviral drug combinations that can transform HIV from a certain death sentence into a manageable disease. Most Americans and Europeans do not realize that developing nations have severely constrained medical systems. Fundamental services taken for granted in other parts of the world are unavailable to the majority of African populations.

Physicians, where present, are often not trained in the basics of HIV diagnosis and treatment. A physician's knowledge has a positive impact on patients' treatment outcomes, quality of life and odds of surviving. In our push for solutions, IAPAC is developing an HIV medical training and certification program to accelerate physician training in resource-limited countries. This approach will quickly expand the cadre of local experts with the skills required for this highly specialized area of medical treatment, thus promoting the safe, optimal use of antiretroviral drugs.

Antiretroviral drug therapy requires close monitoring by trained medical professionals. Otherwise, these drugs are potentially dangerous to individuals and to the population at large. Because the HIV virus constantly replicates, or makes copies, it can adjust its DNA to "resist" obstacles such as antiretroviral drugs. This phenomenon, known as "drug resistance," presents a significant public health threat when medications are inappropriately prescribed or drug regimens are not properly followed. The threat of a mutant virus that resists known medications concerns many and cannot be underestimated or ignored. To this end, we strongly believe that drug companies and other entities must expand their largesse to include funding to educate people and to build health services to administer and monitor the use of these drugs.

Infrastructure development is not only important for improving access to life-saving medicines, but also for the deployment of vaccines and microbicides as they become available. Prevention measures such as vaccine and microbicide development and distribution are essential components of any comprehensive response to curb the spread of HIV/AIDS.

Finally, political leadership is critical in addressing this issue. Individual countries need to acknowledge the problem and take positive action. Economic choices must be made responsibly. If we look at budget outlays in wealthier African countries, there is a disparity between what is spent on military defense versus what is allocated for basic healthcare, never mind care for HIV disease and its associated complications. What level of investment will be made to fight the virus? Which "enemy" poses the greater threat?

An effective remedy to this pandemic must combine education for clinicians, healthcare workers and the general population with an unwavering commitment from the leadership of the countries most affected by this virus. Moreover, this remedy must include a true commitment on all levels -- public and private -- to forge partnerships heretofore only dreamt about by policy wonks and idealists. Only then will the multitude of Africans living with and affected by HIV/AIDS receive the help they so desperately need.

Our members -- 10,000 physicians and healthcare professionals in 52 countries -- want lower drug prices. They also want, and desperately need, infrastructure that will allow these drugs to be responsibly and effectively used. This approach, combined with support from the leadership of the countries themselves, will better the quality of care provided to all Africans living with HIV/AIDS.


José Zuniga is the political editor of the Journal and Deputy Director of the International Association of Physicians in AIDS Care.




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