AFRO-NETS> Kaiser Daily HIV/AIDS Report - Wed, 17 Oct 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Wed, 17 Oct 2001
-----------------------------------------------

* Rep. Barbara Lee Calls For $1 Billion in Emergency Funding for
  Global HIV/AIDS Fund
* Forty Percent of South African Adult Deaths Last Year Were AIDS-
  Related, Medical Research Council Report States
* HIV/AIDS Will 'Postpone' Africa's Chances for Food Production Self-
  Sufficiency
* Patents on Antiretroviral Medicines Are Not Barriers to Access in
  African Countries, Researchers Write


--
Rep. Barbara Lee Calls For $1 Billion in Emergency Funding for Global 
HIV/AIDS Fund

Rep. Barbara Lee (D-Calif.), a "vocal advocate" for international 
HIV/AIDS funding, on Thursday began circulating a letter asking her 
congressional colleagues to call on President Bush to approve an ad-
ditional $1 billion in emergency funding for the U.N. Global AIDS and 
Health Fund, Reuters Health reports (Zwillich, Reuters Health, 
10/12). The letter, signed by Lee and four other members of the 
House, including Connie Morella (R-Md.), James Leach (R-Iowa), John 
Conyers (D-Mich.) and Jerrold Nadler (D-N.Y.), acknowledges that al-
though the world's attention and federal budgetary planning is "ap-
propriately focused on combatting international terrorism," the gov-
ernment cannot "ignore" HIV/AIDS, a "public health crisis" that 
"clearly warrants an emergency designation." The United States has 
already pledged $200 million to the fund, which is estimated to need 
between $7 billion and $10 billion a year to fight HIV/AIDS, malaria 
and tuberculosis in the developing world. However, only $1.7 billion 
has been received from international donors so far and an "emergency 
appropriation of $1 billion for FY02 is essential so that additional 
investments from both public and private sources can be leveraged," 
the letter states. The letter asks members of Congress to send by 
Friday an attached "bipartisan" letter to Bush supporting the funding 
allocation (Lee letter, 10/11). The letter to Bush states that the 
U.S. Agency for International Development should have control over 
the funds until the U.N. fund is operational. It also states that the 
funds should go toward supporting a "wide range of interventions" 
such as education, prevention and the "procurement of HIV/AIDS/TB-
related drugs and commodities" (Letter to Bush, 10/17). U.S. offi-
cials have been resistant to the notion of using money from the 
global fund to provide treatment, arguing that the money would be 
better spent on prevention efforts (Kaiser Daily HIV/AIDS Report, 
7/20)


--
Forty Percent of South African Adult Deaths Last Year Were AIDS-
Related, Medical Research Council Report States

AIDS is the leading cause of death among South Africans, particularly 
young adults, according to a mortality report released yesterday by 
the Medical Research Council, South Africa's top medical body, the 
New York Times reports. The report, which examined mortality data as 
far back as 1985, said that AIDS-related illnesses were responsible 
for 40% of South African adult deaths last year (approximately 
150,000) and could kill a cumulative total of five million to seven 
million people by 2010, with about 780,000 adult AIDS-related deaths 
expected in 2010. According to the report, from July 1999 to June 
2000 there were more reported deaths among women in their mid-20s 
than women in their 60s, a "unique phenomenon in biology." The actual 
figures could be even more disparate because deaths are often under-
reported. "There is no precedent for this in our history. You have a 
situation where the younger females who are supposed to be healthy 
and productive are dying in greater numbers than their mothers," MRC 
President Dr. Malegaparu Makgoba said (Swarns, New York Times, 
10/17). The report also predicted that South African life expectancy 
would decrease from 54 years to 41 years by the end of the decade.

Challenging the Findings

The government has disputed the MRC's findings and will release its 
own mortality report in December. It had tried to delay the release 
of the MRC report until then, but a partial copy was leaked to the 
media last month, prompting the government to permit its release. 
Statistics South Africa, which prepared the government report, called 
the MRC findings "badly flawed," adding that its samples were not 
representative and the HIV transmission rate it used in calculations 
was too high. A lower transmission rate would lower death estimates 
for 2010 to between one million and two million, according to the 
government agency. Rob Dorrington, one of the MRC report authors and 
a professor at the University of Cape Town's Center for Actuarial Re-
search, called Statistics SA's critique of the report "prime evidence 
of the little knowledge or experience they have in this area" (Cohen, 
AP/Newsday, 10/16). According to the MRC report, researchers "looked 
at alternative explanations for [the mortality] patterns and found 
none of them plausible." 

Changes Unlikely

Despite the MRC's findings, it appears "unlikely ... that the govern-
ment will take aggressive action" against HIV/AIDS, the Times reports 
(New York Times, 10/17). President Thabo Mbeki, citing a six-year-old 
World Health Organization report, has maintained that external causes 
such as violence are the country's leading causes of death (Kaiser 
Daily HIV/AIDS Report, 10/11). Health Minister Manto Tshabalala-
Msimang and Essop Pahad, Mbeki's "right-hand man," supported that po-
sition in a recent article in a Johannesburg Sunday newspaper, call-
ing the MRC report a "massive propaganda tool" for those who want the 
government to provide antiretroviral therapy to those with HIV/AIDS 
(McGreal, Guardian, 10/17). Yesterday, Tshabalala-Msimang told the 
National Council of Province's public service committee that although 
HIV/AIDS is a "huge problem," government officials "feel comfortable 
that what we are doing, and our responses, are appropriate" (Xinhua 
News Agency, 10/16).


--
HIV/AIDS Will 'Postpone' Africa's Chances for Food Production Self-
Sufficiency

The effects of HIV/AIDS pose a substantial threat to farming in Af-
rica and will "postpone" Africa's chance of becoming self-sufficient 
in food production, Marcela Villarreal, chief of the U.N. Food and 
Agriculture Organization's population program, said Monday at a 
Stockholm, Sweden, seminar, Reuters reports. FAO estimates that in 
the 25 African nations most affected by HIV/AIDS, seven million agri-
cultural workers have died from AIDS-related complications since 
1985. Those countries could lose an additional 16 million farm work-
ers to AIDS by 2020. FAO also estimated that Namibia will lose 26% of 
its agricultural labor force to AIDS between 1985 and 2020. During 
that same time period, Botswana and Zimbabwe will lose 23% of their 
farm workers, Mozambique and South Africa will lose 20% and Kenya 
will lose 17%. "AIDS has a huge toll on the agricultural labor force. 
Most affected countries (in sub-Saharan Africa) are basically agri-
cultural," Villarreal said. She noted that AIDS will not just impact 
food production, but will carry nutritional and economic implications 
as well. Farmers in sub-Saharan Africa are responding to the effects 
of HIV/AIDS by shifting to "less nutritious" crops because they are 
less "labor intensive," she said. Economically, Villarreal said that 
in Ethiopia, the average costs for AIDS treatment and time spent 
grieving exceed annual farm income. However, Villarreal said she "had 
not lost hope" that Africa would be self-sufficient in food produc-
tion, even if that day was "at least postponed" (Brough, Reuters, 
10/15).


--
Patents on Antiretroviral Medicines Are Not Barriers to Access in Af-
rican Countries, Researchers Write

It is "doubtful" that patents on antiretroviral drugs are blocking 
access to the treatments in most African nations, Amir Attaran of the 
Center for International Development at Harvard University and Lee 
Gillespie-White of the World Intellectual Property Organization write 
in a "special communication" to the Journal of the American Medical 
Association. The researchers asked the intellectual property divi-
sions of eight major pharmaceutical companies to disclose "each pat-
ent or similar legal right" they held on 15 antiretroviral drugs in 
53 African nations between October 2000 and March 2001. While some 
major drugs such as lamivudine, zidovudine, nevirapine and nelfinavir 
were patented in the majority of nations, most of the drugs were pat-
ented in a median of three African nations. The researchers note that 
it is unclear why the pharmaceutical companies did not pursue patents 
in all of the countries; some of the nations do not allow pharmaceu-
tical patents, but they are legal in most countries. According to At-
taran and Gillespie-White, the companies most likely abandoned some 
patent applications because of the time and cost involved and because 
most patents yield small financial returns in poor countries. Poor 
local enforcement may have also contributed to the companies' deci-
sions not to pursue patents. 

Money, Political Will Real Barriers

The researchers write that, as the majority of antiretroviral medica-
tions are not patented in African nations, patents are not responsi-
ble for poor drug access, a conclusion that "counters some of the 
sweeping policy arguments made for or against patents." The real bar-
riers to antiretroviral treatment are the high price of the drugs, a 
"lack of political will," poor health infrastructure and care, high 
tariffs and "inefficient drug regulatory procedures that exclude com-
peting products from the marketplace," the researchers write. They 
suggest that countries should respect patent laws, but that the phar-
maceutical companies that hold the patents should "reciprocally sup-
ply medicines to the global poor without profit, but also without 
loss." They cite several discount initiatives by Merck, Bristol-Myers 
Squibb, Abbott Laboratories and GlaxoSmithKline that should serve as 
models. In addition, Attaran and Gillespie-White say that the compa-
nies should consider licensing the rights to the drugs to "high-
quality generic manufacturers willing to supply the drugs at low 
prices." International financial aid to fund the purchase of the 
drugs is also "essential," they conclude (Attaran/Gillespie-White, 
JAMA, 10/17). 

Concurring Research

The report supports research by PhRMA, the U.S. pharmaceutical indus-
try association, that found that patent coverage in South Africa for 
the 16 antiretroviral drugs used to treat HIV/AIDS was below 20%. Out 
of 52 nations analyzed in the PhRMA study, only South Africa had 
"more or less across the board" patent protection with patents on 15 
of the 16 drugs. "For these drugs, Africa is a patent desert. Patents 
are simply not an obstacle to access in almost every sub-Saharan Af-
rican nation," the PhRMA report concluded. The report also cited pov-
erty and a lack of health infrastructure as reasons for poor drug ac-
cess. Most of the nations studied spend less than $10 per person per 
year on health.

Reaction From AIDS Activists

In a statement issued today, five health organizations, including Ox-
fam and Medecins Sans Frontieres, refuted the findings, saying the 
same data used in both studies show that patents remain a barrier to 
the "most practical and sought-after drug combination" used to treat 
HIV/AIDS (Lamont/Williams, Financial Times, 10/17). Jamie Love of the 
Consumer Project on Technology cited GlaxoSmithKline's 3TC and Boe-
hringer Ingelheim's nevirapine and two of the desired treatments that 
remain patented in most African nations. "Anything you could manufac-
ture for under $500 is patented," he said (Boseley, Guardian, 10/17). 
"If you know what's going on on the ground in Africa, [Attaran and 
Gillespie-White's report] is really an offensive piece ... that is 
attacking the interests of the most powerless people on earth now," 
he added (Donnelly, Boston Globe, 10/17). Richard Elliot, director of 
policy and research for the Canadian HIV/AIDS Legal Network, said the 
"blanket statement' made by the report "cannot be substantiated," 
adding that "[n]o one has ever said that patents are the only bar-
rier, and this research is condescendingly criticizing activists who 
have been pushing for changes on many levels." Attaran, in an inter-
view with the Toronto Globe and Mail, defended his conclusions, say-
ing it is "intellectually untenable to say that patents are the prob-
lem in Africa today. The whole continent is being deprived of treat-
ment because of a lack of money -- not because of patents" (Picard, 
Globe and Mail, 10/17).

--
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, 
a free service of The Henry J. Kaiser Family Foundation, by National 
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser 
Family Foundation. All rights reserved.

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