War on AIDS Affordable retroviral drugs now!

Fighting the 'good fight' against AIDS in Africa

It's one of the most long-standing theoretical ethical debates: you know someone is dying, and will die if they do not get a certain kind of medicine. However, the medicine is prohibitively expensive. Do you steal this all-important medication? Or do you allow the person to wither and die, because stealing is wrong -- or rather, because the pharmaceutical companies 'deserve' to make a profit? Of course, you ensure that the individual has the medication, ideally by pressuring the store or company to give you the medicine for free. But although this moral impulse may seem like a 'no brainer' on an individual level, on a mass level, people are still dying in record numbers from AIDS in Africa, in a way that would be unacceptable, if it took place in the so-called developing world. It is essential that antiretroviral drugs are made available at no cost to these individuals, through joint charitable efforts by the drug companies that manufacture the drugs and international health agencies.

When AIDS was first discovered in the 1980s, epidemiologists and the news media alike first nicknamed it the 'gay cancer' given the population it struck -- usually white, gay males who engaged in risky sexual activities, along with IV drug users who made use of unsafe needle-sharing practices, and perhaps a few hemophiliacs or spouses who were unfortunate enough to have a blood donation or had intercourse with infected individuals. However, today we know that AIDS knows no sexual orientation, color, or lifestyle. We also know, contrary to the belief held about the disease when it was first classified, that it is not a death sentence. People live for many years, although ten years ago they were drawing up their wills after they were diagnosed HIV-positive.

This is largely thanks to the availability of antiretroviral drugs. But these drugs are often prohibitively expensive, even to Westerners, and even more so in Africa were the epidemic is particularly severe. Even after the survival rate of infected individuals began to climb in the 1990s in the developing world, it was almost accepted that people in developing countries who were infected with HIV would die, because the problems of poverty, food and water supplies were so pressing that it was impossible to treat the disease effectively. Even the provision of food and water supplies was difficult to these areas, much less medications. International charities focused on preventing other illnesses, like TB and measles, because the methods used to prevent these illnesses were less costly, and also because they often required a single vaccine, rather than long-term treatment" ("Providing AIDS drugs Treatment for Millions," 2008, AVERT).

But gradually, once the effectiveness of drugs became known, people began to ask why these antiretrovirals were not made available to people living in Africa, and why they were so expensive. "People in resource poor countries began demanding access to the medication that could save their lives" ("Providing AIDS drugs Treatment for Millions," 2008, AVERT). At first, it was alleged that individuals in poor countries would not be able to comply with the rigorous treatment schedule. However, "pilot projects such as those run by [Doctors without Borders]...demonstrated that antiretroviral treatment programs were feasible even in the poorest parts of the world. People were able to adhere to the treatment and the benefits were similar to those seen for people in Western countries. Opinion has now shifted and providing anti-AIDS medication has become a much higher priority for governments, employers and NGOs around the world" ("Providing AIDS drugs Treatment for Millions," 2008, AVERT).

A tremendous roadblock seemed to be overcome in providing antiretrovirals to Africa when in February 2001, Cipla, an Indian manufacturer of generic pharmaceuticals, offered to supply a triple-therapy AIDS drug cocktail for $350 per year to Doctors Without Borders and another Indian drug offered a similar regime for $347 per year to the organization (Miller & Goldman 2003). However,...

At the time, the cost of a non-generic triple-therapy drug cocktail was about $10,000 per year. "In South Africa, where roughly 20% of adults carry the virus, 39 drug companies sued the government to prevent South Africa from importing generic AIDS drugs such as the ones produced by Cipla," and only after many months (and many deaths) an agreement with South Africa and other AIDS-plagued nations was eventually reached to provide the drugs from the original manufactures at lower cost (Miller & Goldman 2003:3).
And still, the price of antiretroviral drugs remains prohibitively high. Despite the influx of some generics, as pharmaceutical companies have bowed to recent pressure, the "drugs are still not cheap and second-line regimens (for patients who have had to switch treatments) are much more expensive, at over one thousand dollars per patient per year" ("Providing AIDS drugs treatment for Millions," 2008, AVERT). For many living in the developed world, one thousand dollars might as well be a million dollars, given the impossibility of finding such a sum.

The problem, admittedly, is not simply the price of the drugs. More money is needed to actually get the drugs to the populace, particularly given the political instability in many African nations that are hardest-hit by the epidemic. "The full cost of providing treatment - including salaries, infrastructure and other services - is well beyond the means of many public health systems. This is why foreign donors are needed" ("Providing AIDS drugs Treatment for Millions," 2008, AVERT). Cheapness and accessibility of treatment and drugs is vital, especially when individuals who are poorly educated about health issues may not realize the seriousness of their condition. Forced to choose between eating, feeding their families, or paying for expensive medication that may cause unpleasant side effects at first, many infected Africans may choose food.

Studies have shown that: "It is important that the cost of treatment is fully covered so that users don't have to pay fees, either for the drugs themselves or for associated clinical tests. Researchers have found that even relatively small user fees inhibit treatment access and undermine health benefits. For example, a study in Nigeria found that 44% of patients took their drugs intermittently or in insufficient dosages because they could not afford to pay fees of up to $67 per month" ("Providing AIDS drugs Treatment for Millions," 2008, AVERT).

Furthermore, if clinics insist on payment from relatively 'richer' patients, while others do not, patients may go clinic-shopping, increasing the chance of further resistance: "start, patients are quick to share information, and rumors spread fast regarding ways to obtain free ARV [antiretroviral drugs] s. When patients learn that ARVs are being given at no cost only to treatment-naive patients, they may not disclose that they have taken ARVs in the past, even to experienced counselors" trained to ferret out such information (Colebunders, 2005). Many patients were later found to have an "an undetectable viral load or a CD4+ lymphocyte count higher than expected, when tested prior to starting ARVs. Only when confronted about these results did they acknowledge prior ARV experience. Such withholding of information may result in clinicians choosing inappropriate ARV regimens, thereby placing patients at risk of adverse effects or of development of resistance" (Colebunders 2005). "JOURNAL-PMED-0020276-G002#JOURNAL-PMED-0020276-G002"

When individuals take drugs in such a haphazard manner, the risk of HIV developing drug resistance grows for the entire world. Letting the epidemic rage without limits also increases the risk of mutation for the aliment. But containment is possible, as demonstrated in a new report by the World Health Organization (WHO) and the Joint United Nations Program on HIV / AIDS (UNAIDS). As a result of joint international efforts to increase the provision of antiretrovirals, combined with public pressure upon drug companies to…