Integrated Regional Information Networks - December 14, 2004

DURBAN (PLUSNEWS) - Nearly 600 health experts, economists and policy-makers have joined an appeal for free AIDS treatment for all people living with HIV/AIDS in the developing world.

The "Free By 5" declaration will be presented to the World Bank, aid donors, the World Health Organisation (WHO), UNAIDS and many other parties in the next few days.

Of the 5.5 million HIV-positive people in need of treatment globally, only 440,000 are receiving it. In Africa, not more than four percent of people living with HIV/AIDS are on antiretroviral (ARV) treatment. Despite decreasing market prices of the drugs, many people who have AIDS in developing countries are dying because they cannot afford medication.

The declaration, initiated by the Health Economics and HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal in Durban, South Africa, urges international donors to actively promote the implementation of free treatment, and pledge additional resources to make this a reality. It also presses WHO and UNAIDS to formally adopt clear guidelines on the necessity of free ARV treatment.

"We are hoping to spur a debate that will lead to a clear commitment [from international health institutions and governments] to provide free treatment," Professor Allan Whiteside, director of HEARD, told PlusNews.

Free treatment should not only mean free ARV drugs, but also include free HIV tests, consultations with medical staff, laboratory examinations, hospitalisations, treatment of opportunistic diseases and prophylactic treatment, he added.

WHO, which aims to have three million HIV-positive people on ARVs in the course of next year, had not clearly defined what affordability meant, who the poor people were, and under which conditions free ARVs should be provided, Whiteside explained.

He demanded that governments in resource-poor settings engage in an appropriate allocation of domestic resources to show their commitment.

UNAIDS estimates that the amount of money needed for treatment and care in 2005 will be US $3.8 billion worldwide, increasing to $6.7 billion in 2007.

Only Brasil, Uganda and Venezuela are presently providing free ARV therapy. Thailand and South Africa have started implementing free ARV programmes.

But in the vast majority of resource-poor countries, access to treatment is not completely free of charge. In Senegal, for example, ARVs, the CD4 count test, which measures the strength of the body's immune system, and viral load tests, measuring the amount of HIV in the blood, are free, but other laboratory exams required to initiate therapy have to be paid for.

In countries such as Burkina Faso, Cameroon and Niger, ARV therapy is heavily subsidised but patients have to make monthly contributions. They also have to cover the costs of medication for opportunistic infections, laboratory exams, consultations and hospitalisation.

Asking patients to pay for their treatment increased the economic vulnerability of affected households. "Free treatment is a prerequisite for the achievement of universal access," the declaration proclaimed.

The "Free By 5" declaration has gathered support from nearly 600 key stakeholders and organisations all over the world, including UN Special Envoy on HIV/AIDS Stephen Lewis; vice president of the Global Fund to fight AIDS, Tuberculosis and Malaria, Helene Rossert-Blavier, who is also director-general of AIDES, a French NGO; and Gorik Ooms, executive director of Medecins Sans Frontieres (MSF) in Belgium.

For many, ARV treatment meant "the difference, literally, between life and death. However, if it is not free, then the poor will not benefit," Lewis remarked.

The declaration states that payment required for AIDS treatment excludes many patients, heightens people's vulnerability to HIV/AIDS and decreases treatment adherence, which may lead to drug resistance.

"Patient fees often make it impossible to reach those who need treatment most," explained Ooms, of MSF Belgium. "The families that are most affected by AIDS in many cases lose their income from labour and can simply not afford to pay for treatment. Where AIDS care is provided in clinics that are sponsored by international donors, but require patients to pay part of the cost, patients that can no longer afford tests or drugs will drop out."

"If we fail to provide [treatment], societies face catastrophes", the Free By 5 declaration argued.

From a medical, public health, economic and human rights perspective, providing universal free treatment to AIDS patients is a necessity: "Levels of poverty in most resource-poor settings are such that, unless treatment is provided completely for free, people will be excluded," said Whiteside. "I believe that it makes economic sense for public health services to offer free HIV/AIDS treatment."

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