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Access to HIV/AIDS drugs in the developing world

The AIDS epidemic is often considered the most serious we have ever faced. Since its
beginning in the 1970s HIV/AIDS has spread all over the world. In 2007 it was
estimated that approximately 33 million people were living with HIV, and in that year
alone over two million people died from the virus, while another 2.5 million people
were infected (World Health Organization & UNAIDS, 2007). While many of the
developed countries have been successful in slowing the spread of the disease, most
developing countries have seen it spin almost out of control. Only about 8% of the
world population live in sub-Saharan Africa and yet they suffer two-thirds of all
HIV/AIDS cases (Kalipeni et al., 2004). A global effort to inform and educate the
public on how to decrease the risk of infection has been largely successful, especially
in the developed world. It is essential to the fight against the epidemic to provide as
many people with treatment as possible, for many different reasons. This has been
incredibly difficult, especially in the developing world and only approximately 31%
of the people who need access to antiretroviral therapy in the world have it (World
Health Organization (WHO), 2008). People in the developing countries have had
problems accessing the drugs they need due to high prices set by pharmaceutical
companies, poverty and lack of efffective health care systems. In order to combat the
HIV/AIDS crisis in developing countries, cooperation from pharmeceutical
companies in order to provide greater and more cost effective access to antiretroviral
drugs, change in global trade rules, abolishion of structural adjustment programs, debt
relief, and the political will of the governments of those developing nations is
necessary.

Not everyone agrees on the best ways to adress the AIDS problem. Many claim that
prevention measures only should be the main focus of the battle and that antiretroviral
treatment is not cost effective in countries with limited budgets (Moatti et al, 2008).
Jefferis et al (2008) and Moatti et al (2008) argue that while preventative measures
are very important, providing treatment to as many people as possible is essential to
long term success. Infected people who have regular access to medication live longer,
they are able to work more and are less of a burden on the health care system.
Providing the medications necessary to prevent mothers from passing the disease on


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to their children has generally been considered a preventative measure, but Luo et al
(2000) argue that universal treatment is equally important, because while the children
do not get infected, they will be orphaned before long if their parents do not have
access to treatment. It would add further financial burdens on governments to take
care of all these orphans. Governments should therefore strive to combine prevention
and treatment in their efforts to tackle this epidemic. For example, Brazil has already
shown that this is not only economically feasible but also successful (Biehl, 2006).
While in 1998, the government had spent $300 million on antiretroviral drugs, they
saved $500 million in other areas. At the same time the number of reported AIDS
deaths fell by 35% and demand for treatment in hospitals fell by 40% (Biehl, 2006, p.
215).
Most developing countries have not been able to implement similar policies
because their access to antiretroviral medication has been limited. Generally the
problem is a question of cost. Most people in the developing world cannot afford to
pay for their own medication, and for the most part their governments consider
providing them with free access to be too expensive. Although prices have fallen in
recent years due to increased pressure by non-governmental organizations and public
outrage they are still prohibitively expensive (Craddock, 2004). The pharmaceutical
companies claim that their prices are so high because they are expensive to develop,
they need the money to finance more research, and the markets in most developing
countries are too small. However, Petryna et al. (2006) point out that much of the
research has been financed by the governments of the companies in question and that
the diseases afflicting the developing countries are neglected by them for the most
part.
The World Trade Organisation’s (WTO) many agreements includes the Agreement
on the Trade-Related Aspects of International Property Rights (TRIPS) which
provides companies with strict international property rights. This also applies to the
pharmaceutical companies. They can now place a 20 year long patent on their drugs
and put any price on them they like. The WTO did however add a clause which
allows governments to implement compulsory licencing and parallel imports in case
of a medical crisis (WHO, 2001). Several countries have already made use of this
loophole in order to produce patented AIDS drugs for their national markets and
import cheaper drugs from other countries (Craddock, 2004). The pharmaceutical
companies have not been pleased with how this development has forced them to


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lower their prices to keep up with the market. They have made several attempts to
stop other countries, such as South Africa, from being able to do this, with lawsuits
and threats of trade restrictions. However, public outrage has often been successful in
thwarting these attempts (Bond, 1999). In Brazil good progress has been made in
providing infected people with medicines. Brazil has managed to create a large
pharmaceutical industry and develop many of their own medicines with compulsory
licencing of US patented drugs. As a result, the US tried to put trade restrictions on
them, though eventually the two countries reached an agreement. Brazil is now unable
to export these much cheaper alternative drugs out of the country, so other developing
countries can not make use of their lower prices (Biehl, 2006).
The high prices set up by the pharmaceutical industry is only one side of a very
complicated issue. In the 1980s the International Monetary Fund (IMF) and the World
Bank started giving out loans to developing countries to help them deal with the
financial crisis that developed after the price of oil rose. These loans were not given
unless these countries agreed to follow Structural Adjustment Programmes (SAP)
designed by the IMF and the World Bank. The conditions they were forced to meet
included paving the way for foreign investments, trade liberalization, focus on export
industries, currency devaluation, tax increases and reductions in government
spending (Lurie et al, 2004, 206). Most of the countries who took up these SAPs did
not experience Increased poverty and unemployment followed and, due to cut backs
in government spending on health, life expectancy fell, infant mortality rates rose, and
infection rates of many diseases increased. As a consequence the AIDS epidemic
became almost impossible for these countries to handle (Lurie et al. 2004). The
majority of the developing world is still having economic troubles today, so that even
if they wanted to provide their people with free or less expensive access to
antiretrovirals, they are not be able to do so easily. The problem, therefore is a
combination of lack of money and high prices.
Providing access to antiretrovirals has not been wholly impossible. The
government of Botswana decided that health care was an important part of their road
to development and they began their national antiretroviral therapy programme in
2002. As of 2005 close to 56,000 people were receiving therapy, out of the estimated
84,000 who needed it (WHO, 2005). Botswana is a very poor country and the
proportion of the nation living with HIV/AIDS is estimated to be between 25 and


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30% (WHO 2008). It is clear that with enough political will it is possible for even the
poorer nations to react to this epidemic and make a change.
Despite the success the programme has not been perfectly executed. While the
government has purchased the medication and has the will to deliver it to those in
need, the country‘s lack of infrastructure often makes this task difficult. There is a
considerable lack of doctors, with only about 40 per every 100,000 people, and many
people are forced to travel long distances distances for consultations and their
perscriptions (Miles et al, 2007). This is a common problem in many developing
countries, since economic structural problems have led to uneven access to primary
health care, lack of qualified health care professionals, and insufficient distribution
systems for drugs (Moatti et al, 2008, S64).
In order to encourage governments to go down this road there also needs to be
social mobilization. Prevention measures include education and spread of knowledge
about the disease and how to prevent it. This has been successful in many countries.
However, in some countries information on treatment has been lacking. If the people
do not know that proper treatment exists they are not likely to demand that they
recieve it. Therefore, in order to create social mobility and demand, imparting the
information to the people is crucial.
There are undoubtedly many possibly solutions to consider. First and foremost
there has to be a will to change, both within individual governments and on a global
scale. A big step to take would be to ease the poverty of the developing nations. SAPs
need to be adjusted to fit better within the cultures and economic situations of each
country, if not abolished all together. Debt relief or adjustment would go a long way
to increase government budgets so that more can be spent on health care, education
and other basic needs. That would free up a great deal of financial resources so that
free or inexpensive antiretrovirals could be provided. The trade rules of the WTO
need to be adjusted so that they benefit the developing world more. Increased pressure
on the pharmaceutical companies to develop more ethical practices and lower prices
is also important.
Even if all these changes were to take place, they still may not help unless there is
the political will within the nations to direct their efforts at HIV/AIDS prevention and
treatment. Governments must take the steps necessary to implement improved health
care programmes and provide better access to these programmes. Eradication of the
prejudice and stigma often associated with HIV is essential, and should be a part of all


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efforts to battle the epidemic. This could be combined with an education programme
aimed at disease prevention and providing information on how to obtain treatment for
those who are infected.

The many problems and issues mentioned here above are not insurmountable. With a
global effort and cooperation between nations and non-governmental organizations,
many of the problems faced by developing countries today could be addressed. With
cooperation between the developing nations, the WTO and the IMF, agreements could
be made that would alleviate their poverty and allow them to improve their health
care systems. A focus on the AIDS crisis should play a large role in such efforts. The
WHO could provide the pharmaceutical companies with incentive to lower their
prices and increase research into tropical diseases, by for example offering to help
with financing. To sum up, it is clear that whatever steps will be taken in the future
must involve cooperation between the WTO, the WHO, the IMF, the pharmaceutical
companies, and the nations of both the developing and the developed world.


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