Part 8: Use What You Have

Treating AIDS Without Money

Of Patents and Pills

If David Sekirevu didn't have well-connected friends who could procure drugs, he would be dead. He contracted cryptococcal meningitis—one of the most feared AIDS-related illnesses—and the drug that fights it, fluconazole, is far too expensive for Sekirevu and the vast majority of Ugandans. But does it have to be?

Elly Katabira has been treating people with HIV since the beginning of the epidemic. He copes by blocking out everything except "that patient sitting in front of me."
photo: Mark Schoofs
Elly Katabira has been treating people with HIV since the beginning of the epidemic. He copes by blocking out everything except "that patient sitting in front of me."

AIDS activists say no, and point to Thailand. When pharmaceutical giant Pfizer had a fluconazole monopoly there, the price of a daily dose was $14. But when local companies started manufacturing generic versions, the price tumbled to about 70 cents, a 95 percent drop. Thai companies also make generic AZT; the price of that AIDS drug has fallen by almost three-quarters.

Activists want the United States and world trade bodies to allow poor countries to manufacture more life-saving drugs or import them at lower prices. When countries such as South Africa moved to do so, the U.S. threatened trade sanctions. But after ACT UP dogged Vice President Gore, the U.S. backed off.

The fight over drugs called antiretrovirals, which target HIV directly, has generated the most publicity. One company under fire is Bristol-Myers Squibb, which makes the AIDS drug ddI. For a United Nations pilot program in Uganda, Bristol sells the drug for less than $160 a month, a discount from First World prices but still astronomically expensive for most Africans. Activists argue that, because the U.S. government funded the development of ddI, its price should be much lower. Bristol retorts that it purchased the patent from the government and invested in clinical trials, so it deserves to control the price. More broadly, the pharmaceutical industry argues that profits feed new research.

Bristol also points to its AIDS charitable program, launched this year, which will donate $100 million to several African countries. But critics point out that Bristol CEO Charles Heimbold Jr. took home a 1998 pay package of more than $56 million and retained about $200 million in stock options.

Relaxing patent laws is no panacea. Patents for many of the compounds on the United Nations essential drug list have expired, yet distribution remains spotty. In much of rural Africa, only half of children get vaccinations, and only 30 percent have clean water.

The experience of tuberculosis is sobering. Though the disease can be fully cured with relatively cheap drugs, African TB programs have been hobbled by such basic problems as lack of electricity to run diagnostic tests. The continent's crushing poverty breeds "theft of drugs at every point in the distribution system," as veteran researcher Susan Allen recently wrote. Patients, for example, sell their pills as soon as they feel better, even though they are not yet cured. AIDS cannot be cured, and HIV drugs must be taken for life, which means that treating AIDS will have even more pitfalls.

Finally, for many Africans with HIV, the first need is not medicine but food. Elhadj Sy of the United Nations AIDS Program calls the push for cheap antiretrovirals "commendable," but adds, "For people in the West, going hungry is very abstract. They don't know what it is." He draws an analogy to a major effort by the UN years ago to build hygienic latrines in rural Africa. "I remember in one of the villages an old man asked a very simple question. 'My children,' he said, 'don't you think you are trying to solve the problem from the wrong end?' "

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