Fifty-Eight Countries to Boost HIV/AIDS Care and Treatment
June 25, 2001
New York -- Efforts to improve and speed up access to care for people living with HIV/AIDS are gaining new momentum, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said today.
A total of 58 countries have now expressed interest in gaining access to lower-price drugs -- including treatments for opportunistic infections and antiretroviral therapy -- in the context of the public-private partnership started in May 2000 by five United Nations agencies and five private sector companies.
Five research-based pharmaceutical companies (Boehringer Ingelheim, Bristol Myers Squibb, Glaxo Wellcome, Hoffman La Roche and Merck) and the World Health Organization, World Bank, UNICEF, UNFPA and the UNAIDS Secretariat have been exploring ways of speeding up access to HIV/AIDS-related care and treatment in developing countries.
Twenty three countries have indicated interest in the past month alone. Eleven of the participating countries (ten of them in Africa, one in Latin America) already have reached agreements with manufacturers on significantly reduced drug prices.
The process is gaining new momentum as regional groups of countries recognize the potential of driving drug prices lower through regional procurement. This regional approach potentially also offers people moving between countries in a region access to fairly standard levels of care. Countries in Southern, Eastern, and West Africa are actively pursuing this option.
"A regional approach holds strong potential to expand the benefits of improved access to care, for example through the possibility of bulk purchasing, shared technical assistance and joint resourcing," said Dr. Peter Piot, Executive Director of UNAIDS.
Competition from generic manufacturers and a proactive attitude on the part of the research and development-based industry have helped reduce drug prices. Uganda's approach to lowering prices, for example, has involved direct competition between generics and research and development-based manufacturers.
Aiding the process is a database of drug suppliers set up by UNICEF, WHO, and the UNAIDS Secretariat, in conjunction with Médecins Sans Frontières. The database identifies prices and sources of selected drugs used in the care of people living with HIV/AIDS, including essential drugs to treat opportunistic infections and several antiretroviral drugs. A total of 34 manufacturers of drugs (29 of them manufacturers of generic products) have applied to be listed as potential suppliers.
"Significant price discounts are being achieved, but prices of HIV/AIDS drugs are still far beyond the reach of the majority of people who need them," said Dr. Piot.
Several other approaches are being used to ensure sufficient resources are allocated to comprehensive care programmes in hard-hit countries.
Governments are devoting more public funds toward prevention and care. Some -- like Côte d'Ivoire, Cameroon, Gabon, Mali, Morocco, and Senegal -- are allocating special funding to subsidize access to antiretrovirals for people who are unable to afford the drugs. Other countries, including Burundi and Rwanda, contribute to a special fund for purchasing drugs at subsidized prices.
Countries are also directing debt relief funds toward HIV/AIDS prevention and care programmes. Cameroon and Mali, for example, have converted part of their debt into a fund for care and subsidizing access to drugs.
Some governments have invited private companies to subsidize access to drugs for their employees and their families. In countries like Brazil and South Africa, regulation of existing insurance schemes has provided access to HIV/AIDS care for thousands of people who would otherwise have been unable to afford it.
"We have seen a sea of change in the way many governments approach the HIV/AIDS epidemic," said Dr. Gro Harlem Brundtland, Director-General of WHO. "The possibility of treatment has given new hope, making countries scale up their efforts to fight the disease, through prevention and better diagnostics as well as beginning to provide care for those already infected."
Despite these advances, there remains a pressing need for even stronger progress on a range of other fronts.
Access to care and treatment will remain uneven until countries are able to afford AIDS-related drugs and diagnostic equipment, strengthen their health systems with the necessary infrastructure and trained staff, and provide adequate voluntary counselling and testing services and psychosocial support.
While significant price discounts for antiretroviral therapy have been achieved, the vast majority of people affected by HIV/AIDS remain without access to even basic drugs and medicines. Ensuring that essential care -- palliative care, prophylaxis and treatment for opportunistic infections -- is rolled out rapidly is as critical a challenge as making antiretrovirals more widely available.
No matter how low prices go, additional funds will be needed to meet the costs of care for the poorest. Most of it would need to come from increased development assistance that adds to what is already being spent on other, common and deadly diseases such as malaria.
Developing countries and donor agencies increasingly act on the awareness that care and prevention efforts are intimately linked. Consequently, they are viewing AIDS-related care as a good investment that holds direct benefits for people living with HIV/AIDS and brings indirect spin-offs for AIDS prevention in the wider community.
At least, 90% of the world's 36.1 million people living with HIV/AIDS live in developing countries -- 25.3 million of them in sub-Saharan Africa.
Countries That Have Registered Interest in Collaborating with UNAIDS on Care and TreatmentA total of 58 countries have indicated their interest in collaborating with UNAIDS on access to care and treatment.
Forty of them are in Africa: Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cap Vert, the Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of Congo, Ethiopia, Gabon, the Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Malawi, Mali, Mauritius, Morocco, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sierra Leone, Senegal, Seychelles, South Africa, Swaziland, Togo, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe.
Twelve countries in Latin America and the Caribbean have registered their interest in collaborating with UNAIDS on access to care and treatment: Barbados, Belize, Chile, Costa Rica, Guatemala, Honduras, Mexico, Nicaragua, Panama, San Salvador, Trinidad and Tobago, and Venezuela. In Europe, Belarus, Romania and Ukraine have indicated their interest, while in Asia, Malaysia, Thailand and Vietnam have done likewise.
Eleven of these countries (bold, in italics above) have reached agreement with manufacturers on significantly reduced drug prices.
Price Details, Generics, and Research and Development CompaniesExamples of manufacturer prices (generic and R&D, respectively) per defined daily dose (ddd) in Uganda in December 2000 are shown in the first two columns of the table below. In April 2001 the research and development industry announced further price reductions on a number of drugs, which will be effective at the next order of drugs by the country. Those prices are shown in the right-hand column.
Prices of drugs from the research and development based industry in Uganda, Senegal, and Rwanda are very similar to those shown here.
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