By Steve Weinstein
By Devon Maloney
By Tessa Stuart
By Alison Flowers
By Albert Samaha
By Jesse Jarnow
By Eric Tsetsi
By Raillan Brooks
But when Glaxo announced that price cut in May, Jeffrey Sturchio of rival company Merck remembers that "Congressman Jim McDermott was on CNN, rattling his saber and saying, 'If you can lower prices over there, why not right here in the U.S.?' " Such pressure, which threatens the very heart of the pharmaceutical market, scares the drug companies.
Of course, Western activist groups, such as ACT UP, frequently push for lower drug prices in America and Europe. "With friends like these," quips Bernard Hirschel, the scientist who chaired the previous world AIDS conference in Geneva, "developing countries don't need enemies." For global access to medicine, he says, the new deal is simple: Rich countries must "pay more so that others may pay less."
If the industrialized nations accept differential pricing, Joseph Perriens of UNAIDS says, the cost of the AIDS cocktail could tumble from its current discount price of $7000 a year to $2000. What's more, a new and cheap test would allow doctors to monitor the effect of the drugs on the immune system much more easily. He predicts that the combination of such advances and price cuts will allow AIDS treatments to spread from big hospitals in capital cities out "to the district level." He says, "I thought for a long time that antiretrovirals for developing countries would not be possible. But now I think there really is something in it."
AIDS counselor Jesús Agüais remembers the woman who somehow found her way from Latin America into his office in New York City. "She had sold all her property to come to the U.S., and what she wanted was medicine for her son and daughter, who were dying from AIDS. I had some drugs in my drawer, and when I put them in her hand it was as if she had seen God. Right then I knew I had to do it on a larger scale."
Agüais, who calls ACT UP "my kindergarten," founded an organization called Aid for AIDS. Like Lee Wildes's group in San Francisco, it sends drugs to people with HIV in poor countries. Now, many such programs have joined under the umbrella of the newly formed AIDS Empowerment and Treatment International. It has a clear goal: to keep AIDS activists alive. "If they don't stay alive," says Agüais, "who will make the changes?"
One activist sustained by drugs from Agüais is Jose Fernando Sanchez Romero. Working in the Peruvian port city of El Callao, which has the highest rate of HIV in that South American country, Romero runs a support group for infected sex workers and another for HIV-positive mothers. He has also convinced two banks to fund all school expenses, from books to uniforms, for children with HIV.
But those programs might never have been born. Three years ago, Romero had tuberculosis, pneumocystis pneumonia, and a fungal infection called thrush in his mouth and esophagus. This combination of diseases signals end-stage AIDS; without treatment patients usually die quickly. But on the Internet, Romero found Aid for AIDS, and his latest project has been to help launch Peru's first national network of people with HIV.
Such groups are crucial, because for the most part, governments in developing countries have not done nearly enough to fight AIDS. Many countries impose tariffs on medicine, adding to their cost. Most countries, even the hardest hit, devote only a tiny sliver of their budget to AIDSalmost never more than one percent. Yet medical infrastructure, from trained staff to basic laboratory equipment, is often lacking. "We need more beds," says Kenyan doctor Christopher Ouma, who works with the Nobel Prize-winning group Médecins Sans Frontières. He says that patients sleep two or even three to a bed in his Nairobi hospital, and that drug shortages are common. "If my patients were able to get food, that would be a major improvement."
At the moment, though, the lion's share of attention is on the most expensive drugs, the antiretrovirals that attack HIV directly. But most Africans survive on less than two dollars a day, and they lack even basic care. For example, an antibiotic called cotrimoxazole prevents a variety of diseases, including pneumonia and malaria, and last year UNAIDS recommended its use in developing countries. But even though the drug is cheap, only a handful of poor people get it. Meanwhile, in Uganda, researchers are about to test an even more basic way to prevent opportunistic infections: providing chlorine tablets and special jugs to ensure clean water.
But before such tangible changes can be made, there needs to be a change in the mind. "We prefer not to tell patients the drugs exist," says Ouma, because doing so would be a "cruel joke." Even Guzha, who is taking the drugs Wildes sends her, agonizes over whether to tell her clients about antiretrovirals. "They start thinking they can't get better without them," she says, "and so they lose hope and don't do the things they could do."
That's "paternalism in the worst sense," charges Zackie Achmat, a founder of South Africa's Treatment Action Campaign. "You know something and you're taking out of that person's hands their own despair or hope." Learning the facts, he says, might stir "outrage and action."