AFRO-NETS> UN session tackling African pandemic seeks to aid access

[Leela McCullough <leela@healthnet.org>]

UN session tackling African pandemic seeks to aid access
--------------------------------------------------------
 
FORUM URGES ACTION IN WAR ON AIDS
 
By John Donnelly, Globe Staff, 9/23/2003
Reprinted with permission
 
NAIROBI -- The world's fight against the AIDS pandemic has re-
mained at a virtual standstill for two years and will fall far 
short of goals set by 189 member states of the United Nations 
unless countries take dramatic action, the UN reported yesterday.
 
The evidence of inaction was sobering: With the exception of Bot-
swana, less than 1 percent of HIV-infected pregnant women in 
heavily affected countries received treatment to prevent trans-
mission of the virus to their children, though the drug is free; 
and 50,000 people at the end of 2002 had access to antiretroviral 
treatment in Africa, where 4.1 million people need the life-
extending medication.
 
"Today's reports are a dramatic wake-up call to the world," said 
Peter Piot, UNAIDS executive director, in New York.
 
Yet as those findings were being released at a special UN session 
on AIDS and here at the 13th International Conference on AIDS and 
Sexually Transmitted Infections in Africa, the Nobel Prize-
winning group Doctors Without Borders reported that it has found 
reason to hope that treatment for those suffering from AIDS can 
be expanded.
 
Drawing upon its experience over the last two years in AIDS clin-
ics in 10 countries, the group found that competition among ge-
neric drug makers will reduce prices and that doctors can sim-
plify treatment -- two critical factors in rapidly expanding ac-
cess to antiretroviral drugs.
 
The group said nations have been able to lower the price of the 
drugs to as low as $277 per patient annually -- antiretroviral 
treatment costs up to $15,000 in the United States -- and that 
doctors can visually diagnose a patient's progress with the 
drugs. The latter finding, which is also supported by research in 
Haiti by the Cambridge-based non-profit group Partners in Health, 
means there could be less reliance on laboratory results, remov-
ing a potential obstacle for many poor rural areas that offer 
only basic health care.
 
In another positive finding disclosed yesterday, HIV-infected pa-
tients in several African countries are taking their twice-a-day 
medicine as directed, and in fact are adhering to doctors' orders 
at a higher rate than Americans who are taking antiretrovirals.
 
Two years ago, the US Agency for International Development direc-
tor, Andrew S. Natsios, expressed strong doubt in a Globe inter-
view that Africans should take antiretroviral medicines because 
he said few own watches and wouldn't know when to take the drugs. 
The studies, however, showed that 95 percent of patients in 
Uganda took their medicine properly, and 90 percent in Malawi. In 
Haiti, adherence has also been reported at more than 90 percent. 
Roughly 75 percent of US patients take the medicine as directed, 
according to the new studies.
 
Daniel Berman, coordinator of Doctors Without Borders' Access to 
Essential Medicines project, said that many countries now need to 
set up national systems to purchase drugs from generic manufac-
turers. Since 2000, for example, Cameroon has set up a central 
purchasing system, and the price has dropped to $277 annually for 
a patient, according to a report on the project.
 
Berman said doctors in several clinics run by the groups infre-
quently check a patient's CD4 count -- which measures the 
strength of the immune system -- "and we are finding good results 
with a simplified model." In Western countries, doctors regularly 
measure CD4 counts to test a person's response to the harsh medi-
cines.
 
Asked if that strategy was risky for the patient and the efforts 
to scale up programs, Berman said, "We think it's dangerous not 
to simplify care if we are serious about reaching 3 million peo-
ple by 2005. You have to be realistic. It doesn't mean we are 
just throwing drugs out there. We are looking to simplify in a 
smart way."
 
The World Health Organization has set a goal of treating 3 mil-
lion people in the developing world with antiretroviral medicine 
by 2005. Its new director, Jong-Wook Lee, pledged yesterday in 
New York to deliver the antiretroviral drugs on a large scale. He 
said the failure to do so thus far has created a "global health 
emergency." Lee pledged that WHO would use the same skills shown 
in controlling the SARS outbreak last year to fight AIDS, by pro-
viding emergency response teams in highly affected countries to 
any government that asks for help.
 
Here in the Kenyan capital, Badara Samb, WHO's head of AIDS pro-
grams in Africa, said in an interview that his organization 
agreed with the call by Doctors Without Borders to rapidly look 
for ways to simplify treatment regimens. He noted that there was 
one new CD4 test that required only a microscope and chemicals 
and cost just 17 cents.
 
The new UN report, produced by UNAIDS as a way of measuring prom-
ises made during a historic session before the General Assembly 
in 2001, found several bright spots in Africa. But they were 
mostly isolated, and the overall findings were extraordinarily 
grim -- especially concerning HIV-infected pregnant women. In 
Botswana -- now in the midst of a $100 million project run by the 
Bill & Melinda Gates Foundation, Harvard University, and Merck, 
the drug manufacturer -- 34 percent of HIV-infected women re-
ceived services to prevent the transmission of the HIV virus to 
their children. But elsewhere in Africa, no other heavily in-
fected country had treated more than 1 percent.
 
John Donnelly can be reached at donnelly@globe.com. 
© Copyright 2003 Globe Newspaper Company.
 
--
Dr. Leela McCullough
Director of Information Services
SATELLIFE
30 California Street, Watertown, MA 02472, USA
Tel: +1-617-926-9400 
Fax: +1-617-926-1212
mailto:leela@usa.healthnet.org
http://www.healthnet.org

--
To send a message to AFRO-NETS, write to: afro-nets@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe afro-nets OR unsubscribe afro-nets
To contact a person, send a message to: afro-nets-help@healthnet.org
Information and archives: http://www.afronets.org