United Press International - August 30, 2002
Roger Bate

He was expected to tell WSSD delegates Friday night he is annoyed by the lack of government action on controlling acquired immune deficiency syndrome on the African continent.

Piot has been working, meanwhile, with non-governmental organizations and business groups to deliver AIDS relief and says he will consider spending a good portion of the UNAIDS $2 billion Global Fund on AIDS, malaria and tuberculosis on corporate programs, an idea unthinkable even three years ago.

Piot Friday is to launch the latest UNAIDS report "HIV/AIDS: Human Resource and Sustainable Development" and he hopes it will generate interest among African ministers, who he says appear "lukewarm on the subject." The only significant mention of AIDS during the summit plenary session was made by Nitin Desai, WSSD secretary-general, in his opening speech.

In the corridors, however, the question being asked is: "How can Africa develop sustainability without controlling the AIDS pandemic?"

To the annoyance of many NGOs, it is public-private partnerships and business schemes that likely will receive the attention from delegates, but it is the NGOs that are responsible for putting AIDS on the agenda at all.

For years, African nations have ignored the growing AIDS problem and in countries where rape is a daily occurrence and safe sex is unheard of, it has been the job of groups like Doctors Without Borders, the Treatment Action Campaign and the various gay organizations -- such as Act UP -- to overcome the taboo of discussing sexual issues in public.

At Thursday's opening of The Women of the Sun Film Festival, the talk was of a film called "Shouting the Silence." Director Xoliswa Sithole breaks through many African taboos in this film about the life of women in Africa, where young girls often are gang-raped and infected with HIV, which causes AIDS.

There is no doubt movies and NGO pressure work. At previous aid and health meetings it has always been possible to find a black African politician prepared to deny AIDS is caused by sex, but such politicians were scarce at the festival.

The NGOs and independent film producers deserve credit for this, but now the former are in danger of becoming redundant, because they are incapable of really delivering drugs.

The main role of the NGOs has been to pressure major pharmaceutical companies to reduce drug prices. They also have promoted the attenuation of company drug patents. The price of drugs has fallen, in some cases by 99 percent.

Dr. Chris Ouma of Action-Aid Kenya says, "We are really fighting for cheap generic anti-retrovirals because accessibility will increase in countries like Kenya from the current 6,000 people to 20,000."

A Nigerian doctor at the conference said the "price has already fallen by 95 percent and there is no more take up of the drugs."

To counter the possible influx of Indian generic or patent-breaking drugs, Western drug companies have begun partnering with various countries to deliver anti-retrovirals. The largest partnership is among pharmaceutical giant Merck, the Bill Gates Foundation and the Botswana government.

Botswana has the highest AIDS rate in the world with more than 36 percent of adult men HIV positive. The initiative, which includes $50 million in support from Gates and $50 million from Merck as well as its drugs, certainly is improving matters.

Even larger programs are proposed. Mining companies like Anglo American are saying they will provide antiretroviral drugs to any of their tens of thousands of workers who require them and other companies may follow suit.

Piot and the NGOs realize, however, while companies will help their work force, they are unlikely to be able to do the same for entire communities. And it is the poor communities where AIDS is rife.

So although "more drugs are now available, they may not work effectively without proper health infrastructure," Ouma said.

One consequence of not having a proper health system is that resistance to AIDS drugs is far higher in Africa than in America or Europe. In some Ugandan studies, resistance is more than 75 percent, which makes the drugs almost useless, whereas studies in the West show resistance is below 15 percent. The result of resistance is to reduce the number of drugs available to treat patients.

This may become a problem, because according to data from a local South African health NGO, the number of new anti-retrovirals in production has dropped by at least 20 percent in the past two years. An industry spokeswoman said this is based on "only one published study" and it may not show the complete picture.

Nevertheless, a reduction in AIDS research would be consistent with the general message from drug companies that patent protection is essential as an incentive for research. It is ironic that NGOs may not be able to deliver drugs, but they certainly can scare the drug companies.

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