Hobson’s choice
Yet again targets set up to the save the lives of people with HIV around the
world are going to be missed. So says the World Health Organisation (WHO),
a body that really knows about these things. Progress is still far too slow,
they say, to get life- prolonging drugs to all those in need by 2010.
At the current pace, only half of the estimated ten million who need HIV drugs
will get them. In human terms of course this means over the next three years
hundreds of thousands will suffer terrible yet utterly preventable deaths
from TB, meningitis, cancer and PCP…
Access to HIV treatment has expanded in recent years. In sub-Saharan Africa
some 1.34 million were receiving treatment at the end of 2006 compared with
100,000 in 2003. Botswana, Namibia and Rwanda report achieving more than 70
per cent coverage. But elsewhere the picture is truly bleak. Russia and India,
which combined have seven million people living with HIV, lag massively behind
at just 15 per cent. And even in ‘richer’ countries like South
Africa activists at the forefront of the struggle are still dying lonely and
painful deaths (see PN letters: Sister Soldier Mourned).
And the figures clearly show life-saving drugs are reaching HIV positive children
much slower than adults. The problems are many: creaking and collapsing health
systems, lack of political will and charges levied on HIV drugs deterring
the poorest families who end up sharing HIV meds to make them go further.
And as if that isn’t enough, another big problem is looming.
Many lucky enough to have access to ARVs now find their first-line therapies
are failing with nothing to replace them with. In the prosperous West people
with HIV have up to 20 plus potent and effective drugs to choose from.
But elsewhere it’s Hobson’s choice and when Hobson stops working,
people once again have to look death in the face. Second-line regimens are
extremely expensive in many countries. And it is this which is fast becoming
the next battle ground between treatment activist and big pharma desperate
to protect their patents.
Both Thailand and Brazil have taken the bold step of issuing compulsory licenses
to enable them to make and import second-line generic medications. But this
has set them on a collision course with drug companies and the US who claim
they are violating international trade rules. How this battle will play out
remains to be seen but WHO is clear: unless prices fall significantly treatment
programmes will face budgetary constraints that could lead to their demise.
The repercussions of that don’t even bear thinking about.
Amanda Elliot, managing editor
