Newsday - July 11, 2000
Laurie Garrett, Staff Writer

The global disparity in life expectancy, driven by expensive drug therapies used in the wealthy world but unaffordable to 90 percent of those infected, fueled an explosion of outrage at the meeting. It drowned out the science-even voices that argued that preventing further spread of HIV was more important than treating those already infected.

"This gathering can address the drug companies now," South African High Court Justice Edwin Cameron said in a speech to the 10,000 conferees. "It can demand urgent and immediate price reductions for resource-poor countries."

Cameron, who is HIV-positive, set the tone of yesterday's confrontational atmosphere by saying that most Africans dying of the disease have had no treatment, while individual Americans can spend $50,000 or more on care every year. He compared the disparity to "how Germans or white South Africans could tolerate living in proximity to moral evil [during the Holocaust and apartheid]."

"Treatments are denied to those who need them for the sake of aggregating corporate wealth for shareholders who, by African standards, are already unimaginably affluent," Cameron cried to thunderous applause and a standing ovation.

Conference organizer Dr. Hoosen Coorvadia noted, "In the way we fought apartheid, we need now to tackle drug prices."

Psychologist Vera Paiva, who coordinates AIDS-prevention studies for the University of Sao Paulo in Brazil, argued that access to anti- AIDS drugs "is a privilege of citizenship" that must be extended to the entire world community. If the drugs are too expensive to be covered by national health budgets, she said, simply "take the money from corrupted politicians or from building roads to Amazonia. Take the money from the banks."

Health providers and scientists, she argued, must be "social revolutionaries."

It's becoming clear that what might be labeled a Marxist agenda has emerged on the AIDS scene.

Countering it as aggressively as they can are the drug companies, United Nations agencies and the Bill and Melinda Gates Foundation, which are jointly trying to reach agreements on drug pricing and distribution to Africa and other hard-hit poor regions of the world.

"Access to care for us is a priority," Awa Coll-Seck of the United Nations AIDS Programme said in a news conference. "It's a priority for the entire UN system."

Flanked by the ministers of health from five developing countries, representatives of five drug companies and World Health Organization officials, Coll-Seck announced that a dialogue is under way aimed at getting anti-AIDS drugs to poor nations.

"We are conscious of the fact that we need to build a ship as we sail it," Dr. Daniel Tarantola, deputy director of the World Health Organization, said. "We are not just in the business of negotiating for access to drugs. We are in the business of strengthening national capacity."

The first such agreement was signed Wednesday by the president of Botswana, executives from three drug companies and the Gates Foundation. Under the terms of the deal, Merck Vice President Guy MacDonald said, the partners will spend $100 million in cash and cash- valued anti-AIDS drugs and technical services over the next five years to revamp AIDS-related services and treatment in tiny Botswana, where some 35 percent of the 1.7 million population is HIV-positive. The deal isn't just about drugs: It's an overhaul of everything from HIV-prevention campaigns, testing and counseling to treatment of AIDS and associated ailments such as tuberculosis.

"What you're talking about is building the health infrastructure of Africa," MacDonald said.

Botswana Minister of Health Joy Phumphi said that her nation will be a pilot project, testing whether such a commitment can slow the epidemic and also provide humane care.

Peter Moore, of Britain's Glaxo Wellcome drug company, insisted that "the philosophy and practice we pursue is preferential pricing. That's the way to go." In other words, charge Americans and Europeans high prices for drugs, while discounting them to poor countries.

But epidemiologist Roy Anderson of Oxford University warned that the global epidemic's "explosive growth" has only just begun.

He warned that stopping further spread of HIV must be the top priority-even using untested, unproven methods of motivating social behavior change.

Dr. Kevin de Cock, who is based in Kenya for the U.S. Centers for Disease Control and Prevention, insisted resources spent on treatment of AIDS should take a backseat to the urgent primary needs for safe blood, sterile syringes, use of drugs to block transmission of HIV from mother to child, services for AIDS orphans, treatment of contagious secondary infections such as TB, surveillance of diseases, sex education and, most of all, rigorous instruction of HIV-positive people about their responsibility to not spread the virus.

Dr. Steve Hyman, director of the U.S. National Institute of Mental Health, underscored that, saying, "Prevention is today's vaccine."

The World Bank estimates that a serious AIDS epidemic slows national economic growth by 1 to 2 percent a year, meaning that Africa is losing about $6 billion a year.

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