New York/Durban, 13 July, 2000 — At the XIII International AIDS Conference in Durban, Doctors Without Borders/Médecins Sans Frontières (MSF) called for rapid introduction of national programs to reduce mother-to-child transmission (MTCT) of HIV, and staged introduction of antiretroviral projects where possible. Presentation after presentation at the conference have stressed the growing consensus that treatment interventions can be effective in resource-poor countries in Africa, Asia, and Latin America. Access issues have dominated this conference, but political will on the national level and funding on the international level have not been forthcoming.
"We are carrying out programs to reduce HIV transmission from mothers to newborns and we know it is working. But we are also seeing a dramatic impact on people's willingness to get tested and their attitude toward HIV due to the existence of these programs," said Eric Goemaere, MD, Head of Mission, MSF-South Africa. "We have never claimed that one can control an epidemic by treatment alone, but MSF is now convinced that prevention without any possibility of care is not working. Why should people get tested if they have no chance of accessing treatment? Treatment programs will reinvigorate prevention efforts."
Several courageous African governments, such as Ivory Coast, Botswana and Uganda, have shown determination to implement MTCT programs and begin expanding antiretroviral pilot projects. Others have so far remained silent. In addition, announcements of international initiatives from the United States and the European Union have been weak on treatment components relative to the enormity of the need.
"In Kenya, we are losing 200 people to AIDS per day. We simply cannot afford to wait to build the ideal infrastructure. Steps can be taken now, especially to reduce mother-to-child transmission," said Chris Ouma, MD, who works with MSF in a Nairobi public hospital. "We know that we can prevent infection in a significant number of the 40-50,000 babies who are born with HIV each year in Kenya. Data presented in Durban show that with effective use of the antiretrovirals AZT or nevirapine, this number could be reduced by half."
There is also an urgent need for affordable antiretroviral drugs in order to begin implementation of new treatment strategies.
Over the past four days, announcements of new initiatives on the part of drug companies and international agencies have been greeted with fanfare. Although MSF is encouraged that drug companies are attempting to address the access crisis, these initiatives need to be put into perspective. Past experience with the proposed Pfizer fluconazole donation shows that these programs are likely to come with unacceptable conditions for national health ministries and will not be sustainable over the long-term.
"What is missing is an attempt to build on the successful strategies of Brazil and Thailand to dramatically reduce the prices of AIDS drugs," said Daniel Berman, of MSF's Access to Essential Medicines Campaign. "The few developing countries that have achieved significant access for people with AIDS have done so by aggressively pursuing generic strategies. The numbers are staggering: 80,000 people were treated in Brazil through use of affordable generic drugs that brought the cost of triple-drug therapy down to approximately $1000 per year. But in Uganda, where the government was working with brand-name drugs in a UNAIDS initiative, fewer than 1,000 people were treated."
A recently released MSF report on HIV/AIDS drugs pricing states that, through dramatically expanded generic production and bulk purchasing, the price of antiretroviral treatment could be reduced to as little as US$200 a year.
MSF also called for increased funding to procure these treatments as well as to strengthen national AIDS programs in poor countries. At today's briefing, MSF stated that the situation will not improve until funding is allocated to begin programs. Wealthy nations need to make firm commitments to support national programs that UNAIDS estimates need an additional US$3 billion annually.
One third of the world's population lacks access to essential medicines. In the most impoverished parts of Africa and Asia that number is more than 50 percent. The spread of the AIDS epidemic has been exacerbated by the lack of access to medicines. Ninety-five percent of the 34 million people with HIV/AIDS remain without access to treatment. Many factors contribute to the problem of limited access to essential medicines: the emerging global trade system, which sets the rules for how products are sold within and between countries, is one. This system treats medicines like other non-essential products, and, as a medical humanitarian organization, MSF believes this is unacceptable.