San Francisco Chronicle - Friday, June 22, 2001
Sabin Russell, Chronicle Medical Writer

Prepared by researchers at UNAIDS in Geneva and a team of experts around the world, the report is the most comprehensive effort yet to put a price tag on the emerging international strategy to combat the spread of AIDS.

The money would be spent among 135 low- to middle-income nations, with half of it devoted to sub-Saharan Africa, where an estimated 25 million of the world's 36 million people infected by the AIDS virus reside.

It calls for spending equal amounts on both prevention and treatment measures, and provides a menu of initiatives ranging from condom distribution (15 cents a piece) to antiviral medications ($450 a year for patients in the poorest countries).

"Prevention and care are intrinsically linked," said Dr. Peter Piot, executive director of UNAIDS.

The blueprint requires an enormous expansion of global spending on AIDS for low- and middle-income nations to the $9.2 billion level by 2005. That effort is currently estimated to consume $1.8 billion a year -- much of it provided by local governments. The new plan envisions that one-third to one- half the money to cover the extra cost would still come from local sources -- but in the poorest nations up to 80 percent of the cost would have to be subsidized by foreign donors.

"Many countries, including some of the poorest, have shown political commitment and developed plans to scale up treatment and prevention programs. What they need is resources," concludes the report, which is published today in the journal Science.

Piot stressed during a telephone press briefing that the cost estimates are not linked to the Global AIDS and Health Fund proposed by U.N. Secretary General Kofi Annan.

The United States has pledged $200 million in seed money for the fund -- an amount bitterly criticized as insufficient by AIDS activists. On Tuesday, the Bill and Melinda Gates Foundation pledged another $100 million -- bringing the total from various governments and organizations to $580 million. Optimists are hoping the pot of pledges will swell to $3 billion by the time the so- called G8 nations -- the world's wealthy industrial powers -- meet this summer in Italy.

Piot said that it "would be wrong" to assign a specific percentage of the global fund to prevention or treatment programs. "The principal should be that the money can be used for both," he said.

Bernhard Schwartlander, chief epidemiologist for UNAIDS and a lead author of the U.N. study, said the cost projections are based on a "realistic" estimate of what is possible in developing nations with often primitive health care infrastructures. It anticipates that anti-retroviral treatments similar to those available in the West would only reach half of those infected with HIV whose conditions had already progressed to AIDS. It estimates that such treatments would extend the lives of AIDS patients in those nations an average of five years.

Indeed, given the scope of the epidemic, the goals established by the United Nations are modest. The proposal is designed to meet those goals, which include reducing by just 25 percent HIV infection among young people aged 14 to 25 and cutting the proportion of infected infants by only 20 percent.

Included in the spending plan is the establishment of programs to provide a "supportive environment" for the estimated 13 million AIDS orphans, who have lost either a mother or both parents to the disease.

The largest chunk of proposed spending in the U.N. plan would assign nearly $2.5 billion, or 27 percent of the total, to cover anti-retroviral drugs.

Priced between $12,000 and $15,000 a year in the United States, combinations of three or more of these drugs have cut AIDS death rates in half, but have been considered out of reach for patients in impoverished nations. But campaigns by treatment activists, and threats of competition from generic drug producers who ignore Western patents, have cut prices offered to developing nations to as low as $360 a year per patient.

Still, that figure would bankrupt the health budgets of nations that pay only a few dollars per person each year on health care of any kind.

The still-high costs of AIDS drugs presents the core dilemma for world leaders convening Monday for a U.N. General Assembly Special Sesson on AIDS. Lower-cost treatments raise for the first time the possibility of getting life- extending care to the regions hardest hit by the epidemic -- but the annual cost of such drugs remains out of reach without international assistance.

E-mail Sabin Russell at srussell@sfchronicle.com.
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