Newsweek Interviews Pediatric AIDS Doctor in South Africa on Drug Access

In a Newsweek/MSNBC.com "Web exclusive" interview, Dr. Mark Cotton, a senior specialist and head of the pediatric infectious-diseases unit at Cape Town's Tygerberg Hospital, discussed his views of the patent lawsuit 39 drug companies have filed against a South African law that would permit the country to import and manufacture cheaper versions of antiretroviral drugs for people with HIV/AIDS. Cotton said that the hospital is "desperate" for cheaper and more accessible drugs and that the drugs "would make an enormous difference to an unbelievable number of people." He explained that in South Africa, "access is entirely dependent on how much money you've got and if you've got medical insurance," noting that only 5% to 10% of those who need antiretroviral drugs receive the treatment and the other 90% "get nothing." Recent offers by pharmaceutical company Merck and Indian generic drug maker Cipla to cut drug prices to $600 per patient per year are still too expensive for many Africans, but Cotton said that the price cuts mean that treatment may be accessed by "50% of those who need it, instead of only 5% to 10%." He added that the country will "need to learn how to use the medications more effectively too -- to follow the Brazilian line, which is to wait until they show that they really need them." Currently, the hospital is able to treat the symptoms of AIDS, such as oral candidiasis and recurrent bacterial infections, but without antiretroviral drug therapy the facility is unable to treat the underlying disease. Although the South African government began a program to offer free nevirapine to pregnant women in January, it only operates in 18 clinics across the country. Cotton explained, "It's not like in America where you can send out a directive and the funds are there for the medication and the counselors and everything gets put in place very quickly." However, he said he is "confident" that "the tide has turned and over the next couple of years the momentum will grow." Cotton said that it is "tough" to be on the front lines of the AIDS crisis and that health care providers at the hospital, which treats about 500 HIV-positive children, "take comfort with small victories [like seeing] a patient pulling through a difficult time." He called South African President Thabo Mbeki's suggestion that poverty, not HIV, causes AIDS "damaging. Not only to us, but to the country and to the people with HIV" (Newsweek/MSNBC.com, 3/9).