Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date. 
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Voice of America - April 9, 2004
Joe De Capua
Washington
This week, the Senate sub-committee on Africa was told of the need to supply more anti-retroviral drugs to fight HIV/AIDS on the continent. The testimony comes on the heels of an agreement to provide quality, low cost generic AIDS drugs to developing countries. But word of the agreement did not come from the Bush administration.
The need for anti-retroviral drugs in Africa is clear. Of the more than 40 million people infected with the AIDS virus, 30 million live on the continent. This past week, the Clinton Foundation announced that it had negotiated low prices for generic drugs manufactured in India and South Africa. The drugs were approved under the World Health Organization’s Pre-Qualification Project. The cost of treating a patient could be as low as $140 a year.
The announcement came shortly after the Bush administration said it was concerned about the pre-qualification process – that it did not satisfy the administration’s “significant questions” of a drug’s safety and effectiveness. The administration has been fending off accusations that it opposes the use of generic drugs.
Randall Tobias, the US Global AIDS Coordinator, defended the administration’s position before the Senate sub-committee.
He said, "I have said from the beginning that our policy is and will be to buy the lowest cost drugs that we can find that we can demonstrate are safe and effective."
Mr. Tobias also expressed concern about relying on the WHO’s pre-qualification process for drugs that the United States will purchase.
"In the same way that we would not rely on and do not rely on the regulatory authorities in another country to review the dossier for a new drug application and then automatically take their evaluation and introduce that drug in the United States market – so, too, I believe do we need some stringent international standards and principles that can be used to evaluate these drugs," he says.
He says with the first round of funding from the President’s Emergency Plan for AIDS Relief, an additional 50-thousand people will begin anti-retroviral treatment in sub-Saharan Africa.
Also testifying before the Senate panel was Dr. Jonathan Mermin, country director in Uganda for the US Centers for Disease Control and Prevention.
He says low cost, simple methods are being used to help those infected with HIV. For example, a common antibiotic has sharply has sharply reduced the death rate from opportunistic infections. Treating water with diluted chlorine can greatly reduce cases of diarrhea. While insecticide treated bed nets can help prevent malaria, which, he says, is more common among HIV patients. But he says while effective, these treatments are not enough.
Dr. Mermin says,"Although these simple interventions can be rapidly implemented, their impact is modest when compared to anti-retroviral therapy, which dramatically reduces mortality."
Also calling for increased ARV treatment was Dr. Lulu Oguda of Doctors Without Borders, who cared for AIDS patients in Malawi.
"Before ARV treatment arrived in Chiradzulu, there was an atmosphere of despair. People with HIV had no hope. They simply waited for death. In the district hospital, wards were so crowded; you would have two to three patients assigned to one bed. So you’d find the patients in the bed and under the bed. I’ll never forget seeing my patients like that. If you’ve not witnessed such a scene, you simply can’t imagine it," she says.
Dr. Oguda says all that changed in 2001 with the arrival of anti-retroviral drugs.
"We saw farmers going back to their fields; teachers started to go back to school. Families were going back to churches. Generally the spirit of the community was uplifted."
Dr. Oguda urged the United States to support Fixed-dose Combinations of drugs, which allow several medications to be given in a single pill. She says this makes it easier for patients to adhere to their treatment regimen – and less likely to build up a resistance to the drugs.
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