Concern in Africa Over Private Doctors Giving AIDS Drugs

Across Africa, the cheaper prices of AIDS drugs may have unintended health consequences. Anecdotal evidence suggests many private doctors, some without AIDS training, are prescribing partial drug regimens and failing to monitor for side effects or counsel patients about adherence. Experts worry that improper administration of the drugs in the developing world may promote the rise of drug-resistant HIV strains.

"Doctors feel that they should at least give something, and they don't realize that in the long term what they're doing isn't in the interests of the patient or the community," said Des Martin, president of South Africa's HIV Clinicians Society.

In many poor countries, people have no confidence in the public health sector, and those who can afford medical care frequent private hospitals, many run by churches.

"Both at the global and the national level there is still no clarity about how to work with the private, for-profit sector. We just don't have the tools to work with them," said Ruairi Brugha, a public health lecturer at the London School of Hygiene and Tropical Medicine. Brugha would like to see donor agencies work with the private sector to control drug stocks.

The few studies examining the issue have highlighted an extensive problem. A Zimbabwe study found that 17 percent of patients were prescribed monotherapy, and that most of the patients believed the pills cured AIDS. In Uganda, patients often had to switch drug regimens due to price variations and supply issues.

Ensuring that drug regimes available in the private sector are the same ones being offered in the public sector would help reduce the number of different drugs in circulation, Brugha said. Other experts note that fixed-dose combination drugs, such as those produced in South Africa in blister packs, are less prone to misuse. In fact, the US Food and Drug Administration has approved the South African combination drugs for use in the President's Emergency Plan for AIDS Relief.

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