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Scale-up of treatment in the developing world the focus of the third day of the XV International AIDS Conference
XV International AIDS Conference Press Release. 13 July 2004.
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Community leaders, people living with HIV/AIDS and scientific experts participating in the XV International AIDS Conference today called for a dramatic scale-up in access to HIV/AIDS treatment in the developing world. While acknowledging the current debate on the use of generic versus branded drugs, Conference participants argued that such controversies must not be used as an excuse for further delays.
?“Further delay in access to HIV treatment is measured in lives,?” said Dr. Joep Lange, Conference Co-Chair and President of the International AIDS Society. ?“While the task of scaling up access to treatment is formidable, it is within our reach if political leaders have the will to do so. Increased resources are a critical first step.?”
The Treatment Challenge
Only 7% of the 5-6 million people needing HIV treatment in low- and middle-income countries had access by the end of 2003. Without access to treatment and if current infection rates continue, 60% of today?’s 15 year olds in Africa will not reach their 60th birthday.
In his plenary remarks, Dr. Jim Yong Kim, Director of HIV/AIDS for the World Health Organization (WHO) argued that, with commitment and adequate resources, success is within our reach. In discussing the WHO and UNAIDS goal of ensuring access to HIV treatment to three million people with HIV/AIDS by the year 2005 (referred to as the ?“3 by 5?” Initiative), Dr. Kim stated, ?“We?’ve failed to do enough in the precious years since Barcelona. Three by five is our best chance.?” Dr. Kim also acknowledged the critical role activism has played in getting us this far and named a myriad of NGOs, UN agencies and donors who are striving to meet this target. ?“Treatment access did not begin with 3 by 5.?” He urged activists to continue to pressure large organisations and the powerful.?”
Barriers to Scaling Up Access to Treatment
The high cost of antiretroviral treatment was identified as a particular barrier to treatment scale up. Over the past few years, negotiations and activism have contributed greatly to the reduced cost of therapy, yet the cost of treatment is still considered high for many in need of care. The trade off between the role of intellectual property as an incentive for continued research and efforts to maximise the use of limited resources through the use of less costly generic drugs was a topic of discussion in many sessions during the Conference.
WHO has pre-qualified a number of both brand name and generic antiretroviral drugs to treat HIV/AID, and earlier this year, the United States announced that the U.S. Food and Drug Administration will provide an expedited, or fast-track, review process for generics. Dr. Anthony Fauci, Director of the National Institutes for Allergy and Infectious Diseases at the NIH stated, was scheduled to deliver a special lecture on Tuesday.
Apart from the cost of treatment, other critical barriers to scaling up treatment in the developing world include a limited pool of trained providers ?– including doctors, nurses, pharmacists, lab technicians and community health workers ?– and weak overall health systems in many areas.
Conference organisers emphasised that these issues must be addressed at the same time as issues related to drug accessibility. The need for simpler treatment regimens that involve fewer pills was also a topic of discussion at the Conference. Dr. Kiat Ruxrungtham, HIV Netherlands Australia Thailand Research Collaboration, said that triple combination therapy currently available is good, but we need one better. We need committed patients to ensure adherence to therapy,?” he added.
Several Conference sessions also underscored the need for the scale-up of HIV treatment services to go hand in hand with comprehensive HIV prevention efforts. The Intersection Between HIV and Other Diseases In a plenary presentation on the clinical manifestations of HIV/AIDS in various parts of the world, Dr. Diane Havlir of the AIDS Research Institute at the University of California, San Francisco discussed the importance of treating HIV in the context of other major diseases. ?“The biggest challenge of the HIV epidemic is that it is super-imposed on pre-existing epidemics of TB, malaria and sexually- transmitted diseases, all fuelled by inadequate health care infrastructure,?” said Dr. Havlir. On the issue of HIV and TB co-infection, Dr. Papa Salif Sow of Dakar University Teaching Hospital in Senegal, added, ?“More financial support for both diseases is needed from governments and international institutions.?”
Access to Treatment in Thailand
Thailand has made significant progress in getting antiretrovirals to people living with HIV/AIDS. The number of people treated climbed from 2,095 in 2000 to 27,000 by April 2004.2 Since the start of the Conference, Thailand?’s Prime Minister Thaksin Shinawatra has pledged to provide free antiretrovirals to all Thais in need, and to donate US$5 million over the next five years to the Global Fund to Treat AIDS, Malaria and Tuberculosis (which currently pays for 20% of the Thai antiretroviral program). |
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