Challenge of treatment access in Africa

The World Health Organisation (WHO) has thrown down a challenge to the international community at the AIDS 2002 conference in Barcelona this week, calling for three million people to have access to antiretroviral (ARV) therapy by 2005.

WHO's goal represents half of the six million people who need treatment now, and a fraction of the 40 million currently living with the virus. Although modest in numbers, the challenge represents a significant hurdle given the current state of global funding for AIDS, doubtful political will, drug availability, and technical capacity.

WHO has not produced a road-map or a detailed timetable to reach its goal. It has been quick to point out that the three million figure was "aspirational", but it does at least represent a target to work towards, some activists acknowledge, especially since, in Africa, fewer than 30,000 people were on ARVs in 2001.

No more talk

"There's no need to continue talking about scaling up treatment, we know what to do," Mark Heywood of South Africa's Treatment Action Campaign (TAC) told PlusNews. He said that a number of pilot programmes had proved that effective ARV therapy can be delivered to the rural poor without the need for sophisticated laboratories, and that cheap generic drugs could be manufactured by underdeveloped countries. "We need an international treatment plan, and if we don't get close [to WHO's target], heads have got to roll," he said.

The goal "is feasible but we need a huge amount of political commitment, donor commitment and more money," said Joseph Scheich, the past head of the Global Network of People Living with AIDS. "We need that US$10 billion," he added, in reference to the Global Fund to fight AIDS.

So far, out of the US$10 billion required annually by the Fund, only US$2.1 billion has been pledged with US$700-800 million available for disbursement in 2002. The US$10 billion a year target would represent just 0.05 percent of the gross national product of the G8 countries, according to the AIDS coalition Act-Up. It would not only save lives in the developing world, but reverse steep forecasted falls in economic growth.

African political leadership needed

African leaders meeting in Abuja, Nigeria, last year committed themselves to increasing health spending to 15 percent of their national budgets. Few are reportedly even close to that goal. The head of Cameroon's national AIDS programme, Shiro Koulla, told PlusNews that it would be difficult to dedicate that level of spending "only to the health sector", given the government's other priorities.

As an example of how far African governments need to stretch, in 1998 only Zimbabwe devoted 15 percent or more of its budget to health. Eighteen countries, Cameroon included, spent less than six percent. As a result, the reality of the public health services in much of Africa is one of "no doctors and no drugs", Joshua Kimani of Kenya's University of Nairobi explained.

According to Dickson Opul of the Uganda Business Coalition, the new path that now needed to be explored was one of partnership between the government and specialist NGOs with external resources. "NGOs can complement the function of the state," he noted. "It would be too long a wait for government-led initiatives."

Another significant hurdle in access to ARVs is price. Although the drug industry-led "Accelerating Access Initiative" has seen prices fall, these discounted prices are negotiated on a bilateral basis with governments and vary widely, Medecins Sans Frontieres (MSF) said in a new report.

The other approach involves cheaper generic drugs. By the end of 2000, prices of US$500-800 per patient per year for patented drugs were being negotiated by governments. At the end of 2001, the Indian generic company Cipla was offering triple therapy ARVs at US$350. Competition between generic manufacturers and bulk procurement could see prices fall further.

MSF believes that a treatment cost of US$50-100 per patient per year is possible, and could even involve a single pill taken once a day. To achieve that, international cooperation is needed for an "equitable pricing policy" based on competition and local production.

"WHO and [the UN children's agency] UNICEF should offer technical support, including pre-qualification of medicines [for countries that do not have strong regulatory authorities to assess drug quality], bulk purchasing and assistance in overcoming patent barriers to access more affordable medicines," noted the MSF report.

[This item is delivered to the English Service of the UN's IRIN humanitarian information unit, but may not necessarily reflect the views of the United Nations.]