Inter Press Service - November 8, 2000
Mario Osava

That was one of the chief conclusions of the panels held Wednesday during the Nov 6-11 Forum 2000 (the First Forum and Second Latin America and Caribbean Horizontal Technical Cooperation Conference on HIV/AIDS and Sexually Transmitted Diseases).

Anti-retroviral drugs played a decisive role, for example, in reducing AIDS (Acquired Immune Deficiency Syndrome) mortality from 32 to 23 percent at the Emilio Ribas Hospital in Sao Paulo -- Brazil's largest city -- between 1996 and 1997, stressed one of the hospital's directors, Vasco Pedroso de Lima.

However, less than five percent of carriers of the AIDS-causing HIV (Human Immunodeficiency Virus) worldwide have access to anti- retroviral drugs, noted Marco Antonio de Avila Vitoria, an expert with the Brazilian government's anti-HIV/AIDS programme.

Cost is a major hurdle standing in the way of wider distribution and availability of the drugs which, moreover, only work if used as part of a "cocktail" treatment of two or three at the same time.

But costs could be brought down through three specific measures that have already proven effective in several countries, said Badara Samb, a consultant with the joint United Nations Programme on HIV/AIDS (UNAIDS).

Those strategies are to negotiate with patent-holders to eliminate or reduce the payment of royalties, produce or import generic medicines, and lift tariffs on imports.

Experience has shown that prices plunge where conditions are set in place for competition in the pharmaceutical industry. One example of that is Brazil, where prices have dropped significantly in the past few years, and where anti-HIV drugs now cost half of what they cost in African countries like Uganda, said Samb.

In Chile, meanwhile, the lifting of tariffs led to such a steep drop in prices that patient access to the drugs rose 20 percent, he added.

However, efforts must be stepped up, said Samb, because there are 39 million people living with HIV worldwide, and 30 million -- "more than the total number of people killed in the two world wars" -- will die in the next 10 years if effective measures are not taken.

Although treatment is expensive, the benefits compensate the costs, said Pedroso Lima.

In Brazil, for example, the money earmarked for anti-retroviral drugs soared from 34 million dollars in 1996 to 10 times that in 1999, and is expected to climb to 400 million dollars this year.

However, that increase meant 47,332 less hospital admissions in 1998 than in 1997, and resulted in savings of nearly 100 million dollars in hospital costs, and much more than that in medications, he underscored.

In addition, anti-HIV treatment has "external positive effects," because it not only benefits HIV-carriers but everyone close to them as well, added Dr. Pedro Cahn, who specialises in infectious diseases and teaches at the University of Buenos Aires.

Anti-retroviral treatment also reduces the probability of mother to child transmission at the time of birth, while lowering the risk of sexual transmission by reducing the concentration of HIV in an infected person's bodily fluids, he pointed out.

De Avila Vitoria, with Brazil's anti-HIV/AIDS programme, meanwhile, argued that top-priority actions aimed at controlling the deadly epidemic in Africa would cost just a fraction of the three trillion dollars that go towards military spending globally.

However, the question must not only be looked at in economic terms, but also in the light of ethics and the rights of those living with HIV, said Javier Hourcade, a human rights advocate from Argentina.

It is "perverse," he charged, that in Chile, one of the countries with the highest per capita incomes in the region, only 50 percent of HIV-carriers are treated with anti-retroviral drugs.

Hourcade also pointed out that virtually no one has access to the drugs in Bolivia, while 20 percent of patients in Ecuador receive treatment, compared to 60 percent in Mexico.

The rest of those infected with HIV are condemned to an early death due to "the negligence of bureaucrats and politicians who use double-speak," he complained. In countries like Paraguay and Peru, no advances have been seen in the past five years, the activist stressed, adding that "it is impossible to fight HIV without education and medication."

Panamanian pediatrician Orlando Quintero, who has lived with HIV for 13 years and is the director of a foundation that treats HIV/AIDS patients, said the anti-retroviral treatment changed his life in the past six years. Before the new drugs, "AIDS simply meant death," he said.

However, treatment requires more than just the cocktail drug therapy, participants at this week's conference concurred. Without close supervision and follow-up of patients, the treatment becomes much less effective.

Slip-ups in the day-to-day regimen of pill-taking, due to inadequate supervision, can increase resistance to the virus, they explained.

Furthermore, the drugs have many side effects, their potency is limited, the risk of driving up the virus's resistance to the drugs is still high, and it is difficult to make sure that patients carefully follow the doctor's orders, said De Avila Vitoria.

Improving the drugs would mean reducing side effects, boosting strength, simplifying treatment regimens, and lowering costs, he said, adding that around 30 new drugs are currently being tested and could hit the market in the next five years.

However, many of the new medications will only entail "slight changes" from the ones already on the market, will bring no additional benefits for the patients, and are merely the result of the drive for profits, the Brazilian physician complained.

One route that should continue to be explored, he said, are new combinations of existing medications that could offer major advantages, as was the case with the double or triple cocktails in use for the past few years.

Finally, De Avila Vitoria pointed out that a vaccine would not be available for at least five or 10 years, during which more than 20 million AIDS patients will die worldwide.

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