United Press International - Thursday, July 08, 2004
Ellen Beck, United Press International

The Institute of Medicine released a report Wednesday concluding that the biggest problem in getting anti-retroviral medications to HIV/AIDS victims is a shortage of healthcare and support workers in poor countries.

The IOM said drug prices have come down and donations of money are up, but still needed is a "Peace Corps-like" group to ensure the drugs are distributed effectively.

"Solving the AIDS crisis will take more than just inexpensive drugs," Haile Debas, a member of the IOM panel and a professor at the University of California, San Francisco, said in a statement. "Success now hinges more on having adequate infrastructures to distribute therapies and sufficient numbers of trained healthcare workers in developing countries."

The IOM said nearly 40 million people are infected with HIV, but only 400,000 in developing countries have access to treatment. The institute estimates total annual HIV/AIDS funding needs will be $10.7 billion for 2005 and almost $15 billion by 2007 -- compared to the $4.2 billion provided in 2003.

UPI's HealthBiz asked Roger Bate, a health policy analyst at the moderately conservative American Enterprise Institute, what was preventing AIDS drugs from reaching victims in developing countries.

"It's probably poverty," Bate answered, "but most important after that is lack of political will."

Governments must take their HIV/AIDS problems seriously -- some do not -- and create the social and political infrastructure needed to ensure access to treatment, he said.

They also need to consider wider consequences. For example, when a country treats HIV-infected children, it needs to prepare for a substantial numbers of orphans if the infected mothers die.

Bate said he generally agrees with the IOM on the problem, but he has a different -- and admittedly minority -- view of the solution. He said encouraging developing countries to adopt democracy is a better long-term strategy. Democracy tends to create a more stable social-economic infrastructure, through which HIV/AIDS programs can function more effectively.

"It doesn't matter how much money you throw at a country if they don't set up a (structure) that can use it," he said. "You can't divorce a health issue from the political issues."

Developing nations also often hurt their own cause by imposing taxes or tariffs on incoming prescription drugs. Bate said some nations have made exceptions to remove tariffs on HIV/AIDS medicines, but they do not represent the norm.

What is not the problem, Bate wrote in a policy analysis released by AEI this week, is pharmaceutical patents. He noted, however, that South Africa is an exception because it has imposed patents hat limit drug distribution.

"The argument that drug patents and drug company profits are blocking access to drugs is an appealing and simple one, but the reality is somewhat different," he wrote in the analysis. "Research into the actual extent of drug patenting of ARV therapy in Africa and of essential drugs in most poor countries shows that (drug patent-related restrictions) rarely exist."

Bate said out of 795 possible patents for AIDS drugs, only 172 are in force and there is no relationship between the number of patents a country has for these drugs and drug access.
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