Poor Nations’ Health Systems Must Be Built Up to Benefit from Cheap, Available Drugs

The benefit of getting more and cheaper AIDS drugs for poorer nations could be derailed unless those countries' public health systems are strengthened, American and African experts say, the New York Times reports. Representatives of American foundations and African health officials say that "ineffective distribution or misuse" of the drugs could lead to new strains of drug-resistant HIV. The Times reports these concerns in advance of two "major" meetings to be held in Africa this month that will highlight drug distribution and use, among other issues surrounding the pandemic. African experts and American donors will meet April 18 to April 20 in Kampala, Uganda, and an African regional meeting on AIDS will be held from April 25 to April 27 in Abuja, Nigeria. In addition, a special "high-level" U.N. General Assembly session on AIDS will take place in June.

Preparing for Wide Use
The Times reports that while countries such as Uganda and Senegal have been "leader[s]" in strengthening their public health and information systems, "many countries in Africa and Asia do not have similar services" (Crossette, New York Times, 4/1). In Malawi, for example, there are only two doctors per 100,000 people, the Boston Globe reports (Donnelly, Boston Globe, 4/1). The Associated Press reports that the African continent would have to "undergo a construction revolution" before a comprehensive drug administration program could begin, building roads to remote villages and laboratories to analyze blood samples. "Most people do not even have enough food to help them digest AIDS drugs, or a clean glass of water to wash down the pills," the Associated Press adds (Associated Press, 4/2). But the Globe notes that there no formal plans to build such an infrastructure yet exist, adding, "No one has an accurate cost estimate. There is no country-by-country analysis of what needs to be done. In fact, there is no analysis of what needs to be done in even a single country in sub-Saharan Africa" (Boston Globe, 4/1).

Fears of Resistance
In addition, the Times reports that many public health officials are concerned that people need to be taught to take the "new AIDS drugs correctly," which could be a "big burden" to governments and local health authorities. Dr. Gordon Perkin, director of the global health program of the Seattle-based Bill & Melinda Gates Foundation, said, "There's a lot of concern about compliance -- that if you don't get large numbers of people taking [the drugs] consistently and correctly, you risk the probability of getting a resistant strain of HIV emerging. Just like antibiotics" (New York Times, 4/1). Resistant strains could also emerge if African governments temporarily run out of money to buy medicines, the Associated Press reports. "You'd be better off taking the money that you'd use making antiretrovirals available across the country and pouring it into prevention programs across the country," Dr. Robert Carter, an American working in Zambia, said, adding that focusing so much attention on medicating all AIDS patients is "simply irresponsible" (Associated Press, 4/2).

'Opportunity for Corruption'
Arthur Mbanefo, Nigerian ambassador to the United States, also said there exists a "great opportunity for corruption in making, selling or distributing AIDS drugs." According to experts in Nigeria, studies have found that over-the-counter sales of pills often are "fraudulent or substandard." Furthermore, organizers of the U.N. special session say they "want to move the conference beyond the issues of drug prices and accessibility." Penny Wensley, Australian ambassador to the United Nations, said, "There's no doubt that access to drugs is important for huge numbers of people who are suffering from HIV/AIDS and are currently unable to afford them. But we have to deal with this in a comprehensive and sustainable manner. At this special session, we've got to galvanize the community, we've got to mobilize resources." She added, "We have to look at distribution systems. We have to look at health infrastructure, and we have to look at quality control. We have to make sure that there are continuing incentives for research" (New York Times, 4/1).