Drugs for the Developing World

The disparity between HIV haves and have-nots has become sharper and sharper with the growing list of new treatments. Only 10% of people infected with HIV live in countries where an adequate supply of HIV drugs is available, while limited resources make sophisticated HIV therapy beyond the reach of the other 90%. In response to this situation, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the pilot phase of its HIV Drug Access Initiative on November 5. Four developing countries -- Chile, Ivory Coast, Uganda and Vietnam -- will be participating.

Under the Initiative, the pilot countries will develop their medical infrastructures to improve care for HIV-infected individuals and ensure the effective distribution and use of HIV-related drugs. Participating pharmaceutical and diagnostic companies, such as Glaxo Wellcome and Hoffmann-La Roche, will subsidize purchases of drugs and virological services and tests. Drugs will include antivirals, as well as antimicrobials to treat opportunistic infections and antibiotics to treat sexually transmitted diseases. Special oversight committees in each country composed of local medical, public health and community representatives will coordinate the effort, devise policy and institute entry criteria for the selection of patients. In addition, specially created nonprofit organizations will place and receive drug orders and channel subsidies from participating donors. Each country will also receive training and education funded by UNAIDS.

Problems can occur, as they already have in the Ivory Coast, when patients are asked to contribute towards the cost of their treatment. Even if pharmaceutical companies subsidize a large portion of the cost, prices for drugs will still be beyond the reach of the majority of the Ivory Coast's one million HIV-positive people. The average per capita income in this nation is only about $500.

The pilot program also is quite small, and can only serve the needs of several thousand AIDS patients per country. If successful, the Initiative will be extended to other countries in three years. The ultimate goal is to provide a base for the developing nationwide health care systems to treat and educate those infected and affected by HIV. Local health ministries will be encouraged to create new sources of funding and to build on existing programs in an effort to achieve financial stability. According to Dr. Joseph Saba, coordinator of the Initiative, "We are hopeful that this new collaborative approach will bring us a little closer to making treatment for HIV and AIDS a reality for many people in the developing world, who have little or no access to care today."