After South Africa Court Case, ‘Unified Strategy’ on HIV/AIDS May Be Difficult to Find

Now that 39 pharmaceutical companies have settled their lawsuit against a South African law that would permit the importation and production of generic AIDS medications, the focus of the international health community is shifting to the development of a "unified strategy" to deliver the drugs to those in need in developing nations, the Washington Post reports. But developing an international anti-AIDS initiative may be an "even tougher challenge" than the "battle" activists and health experts have fought for lower drug prices. Advocates and health workers cannot agree on whether to concentrate money and resources on "sophisticated treatment" of AIDS patients using the discounted drugs or on prevention, basic health programs and treatment of AIDS-related diseases, and funding for any such program is uncertain. According to an unnamed international health official, "it's so politically incorrect to say, but we may have to sit by and just see these millions of [already infected] people die." Though this idea is "unacceptable" to many in the developed world, the official continued, "If all of these resources go to treating the terminally ill, then we can in fact see this process turn into one that's really negative for the development of effective prevention programs." Bill Gates, who has contributed more to the international effort against AIDS than any single donor, also warned that the emphasis on treatment "risked undermining prevention efforts." Critics of a strategy that relies on antiretroviral therapy point out that Africa has "neither the health infrastructure nor the personnel to support widespread use of the complicated [drug] regime."

Who Will Foot the Bill?
Creating a comprehensive strategy has taken on a "new urgency" as several major donors have recently "indicated willingness" to provide "substantial new funding" for a global initiative. UNAIDS has estimated that an annual minimum of $3 billion is needed to "establish basic HIV prevention and non-antiretroviral treatment in sub-Saharan Africa." Adding antiretroviral therapy for those already infected would push the total to $10 billion a year. Currently, international contributions come to less than $1 billion. USAID, the largest national donor, currently spends $114 million on HIV/AIDS efforts in Africa (DeYoung, Washington Post, 4/23). Total U.S. international AIDS funding for FY 2001 equalled $464 million (San Francisco AIDS Foundation release, January 2001). In its recent budget resolution, the Senate voted to increase that amount across two years to $1 billion, but that version has yet to come before President Bush, who proposed a "small fraction" of that total in his budget plan. Japan and the European Union have also recently indicated that they will provide "major new funds" to a global AIDS initiative. But according to the Post, "nobody believes that $10 billion is a realistic expectation for the near or middle term."

Colliding Strategies
Today in London, members of UNAIDS are expected to present a "broad" plan for the establishment of an international trust fund to be administered by a "joint governing committee" of donors and aid recipients. Representatives from each of the Group of 8 nations, the Netherlands and Scandinavian countries, and private donors such as the Gates Foundation are participating in the meeting. U.N. efforts, however, were recently "thrown into an uproar" when UNICEF Executive Director Carol Bellamy wrote in a New York Times op-ed that her agency was "prepared to step forward as the lead United Nations agency in the procurement" of anti-AIDS drugs. That op-ed, which was not approved by U.N. Secretary General Kofi Annan, "upset" other agencies within the U.N., as well as World Health Organization Director General Gro Harlem Brundtland, who saw the op-ed as a "premature policy proposal" and a "public challenge to WHO's primacy on AIDS," the Post reports. A group of Harvard scholars, led by economist Jeffrey Sachs has also drawn up a proposal for a global AIDS trust fund. That proposal was criticized by activists for including the major drug companies at the exclusion of generic drugmakers, who many see as responsible for helping to drive drug prices down.

An African Solution
The "big decisions" in AIDS policy may no longer lie with international health organizations or the drug companies, said James Love of the Consumer Project on Technology. Instead, Love said African nations must "have the guts" to take the next step in battling HIV/AIDS by drafting legislation to produce and import generic drugs. African governments "seem caught between their desire" to procure part of the proposed new funding and "early resentment of the expected onslaught of advice and dictates" from western officials. "We'll do what we can, not because of pressure, but because we think it's right," South Africa's Foreign Minister Nkosazana Dlamini-Zuma said last week at the settlement of the drug lawsuit (Washington Post, 4/23).