South African Judge Speaks on Disparities in Treatment Access Between Africa, Developed World

At the National Press Club yesterday, South African Supreme Court of Appeals Justice Edwin Cameron, who is openly HIV-positive and openly homosexual, addressed the disparities of treatment access in southern Africa versus the developed world. "I'm here because my life exhibits an intolerable iniquity that is presenting itself to the rest of the world today. And that iniquity is the disparity between what is available ... in the wealthy world, the world of North America and Western Europe, as opposed to the developing world, primarily Africa," Cameron said in his opening remarks. He went on to explain the "threshold reasons" for that disparity, namely the pricing of anti-AIDS medications, which have "conferred new life" on those who can afford them. The drug companies "deserve credit" for the "dramatic" ways in which they have addressed their pricing practices over the last year, he said. However, the prices remain too high, he said, adding that the cheapest combination therapies available in Africa cost approximately $100 a month and remain too expensive for more than 99% of Africans. Cameron's life "embodies this iniquity" because he is one of the few Africans who can afford antiretroviral medications, he said, adding that the disparity in drug access is "intolerable." Cameron said the issue of drug prices has not been "sufficiently" addressed; prices need to be further reduced, and generic drugs and parallel imports "have to be permitted," he added. Once prices are lowered, other "conceptual" issues must be dealt with, he said.

Treatment Versus Prevention
Cameron called remarks made last week by a "senior U.S. official" suggesting that international AIDS efforts should focus on prevention over treatment a "fundamental error," saying that the two are interrelated. Treatment practices, such as offering antiretroviral drugs to pregnant women to stop vertical transmission, are part of prevention. The medicines also give people "hope," giving them more "incentive to come forward," he added. By doing so, treatment can change the "social nature" of the disease and help to reduce the "terrible" stigma associated with HIV in sub-Saharan Africa. Cameron said he struggled with his decision to reveal his HIV-positive status, but because his job is "constitutionally protected," he had less to lose than some. "Political will," on the parts of both African leaders and Western leaders, will be necessary for an international HIV/AIDS initiative to work, he said. He said he "hopes" the initial U.S. contribution to the proposed Global AIDS and Health Fund is only a beginning and will be "superseded rapidly" by more funds. The AIDS-related deaths that have already occurred "need not be matched," he said, adding that preventing them is a "moral issue" for the entire international community.

An 'Emergency Relief Plan' for Africa
Cameron was joined by Cornelius Baker, executive director of the Whitman-Walker Clinic in Washington, D.C., who said that the challenge facing Africa is "no greater" than the one faced by the United States at the beginning of the AIDS epidemic 20 years ago. Baker said that the U.S. health care system was not equipped to address the epidemic at the time, and Congress passed the Ryan White CARE Act as an "emergency relief system" to build the necessary infrastructure. African officials are asking for a similar system to tackle HIV/AIDS. Cameron added that South Africa's medical system is the "most advanced" and there is "nothing to stop implementation" of an HIV/AIDS program. However, changes in the system will be needed, as the system is "overburdened" and "underfunded," he acknowledged (Heather Schomann, Kaiser Daily HIV/AIDS Report, 6/13).