A Crucible for Generic AIDS Medicines

Generic AIDS drugs will soon face several key field tests in Africa and India. Nigeria this week announced plans to use cheap generic drugs starting in September to treat as many as 15,000 people. A smaller project in India is also about to launch, targeting a crucial population of migrant laborers. Kenya recently passed a law opening the door to production of generic AIDS drugs. Bombay-based drug maker Cipla Ltd., whose low pricing was a catalyst for international debates regarding generic AIDS drugs, said that in the past few months at least 20 countries -- from Cameroon to Jamaica to Iran -- have either purchased or said they plan to purchase its AIDS generics.

Program administrators are quick to acknowledge the difficulties of treating AIDS. A big problem is getting patients to adhere to the regimen of pill-taking. Some worry that resistant strains of HIV could develop if patients are lax and supervision breaks down in impoverished settings.

Nigeria's plan will likely encourage other African countries to follow suit. In Nigeria, drugs will be administered at 17 sites, and patients will be charged only $7 to $8 a month for the treatment. Nigerian officials negotiated a special deal under which the state subsidizes about 80 percent of the drugs' cost. India's program is more modest in scale, with a goal of treating only 400 patients. About 200 will be in remote desert villages where many migrant workers have returned from the cities with HIV, and such isolation makes it difficult for clinics to achieve directly observed treatment. Instead, the Association Francois-Xavier Bagnoud, a Swiss group running programs in India and Uganda, is training family members and the village community to take responsibility for seeing that patients stick to their treatment.

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