Microscopic image of human white blood cell

The sheer size of the just concluded international AIDS conference in Toronto showed that the HIV/AIDS pandemic still poses a daunting challenge. It might be reasonable to infer that the challenge is to turn existing knowledge and experience into practical treatment and prevention programmes: unfortunately, we can only expect more of same - more money for more drugs that cannot reach the victims but little thought about prevention, the only cure that exists.

Hundreds of scientists, political leaders, AIDS activists and international dignitaries arrived in Canada for the 16th International AIDS Conference. This year's theme "Time to Deliver," follows the failure of World Health Organization's plan to treat three million people by 2005. There are myriad problems facing victims today in African countries. On the one hand is lack of access to antiretroviral drugs, worsened by lack of prevention policies. On the other hand are the AIDS activists who see pharmaceutical companies as villains who place profits above human lives. AIDS activists continue to claim that high prices explain why many do not have access to the antiretroviral drugs that slow down but cannot cure the effects of HIV/AIDS. In fact, even if the drugs were free, they would still not reach the majority of patients or be administered effectively.

Lack of political will among political leaders in the continent is one of the major contributory factors. The WHO's 3 X 5 initiative failed because of the lackluster response of some governments notably Nigeria, South Africa and Zimbabwe. President Thabo Mbeki, who has some unorthodox views about HIV as the cause of AIDS, has done little to expedite treatment to South African's 5.5 million people living with the virus, despite government pledges to provide access to anti-retroviral (ARV) drugs.

Unfortunately, we can only expect more of same - more money for more drugs that cannot reach the victims but little thought about prevention, the only cure that exists.

According to the United Nations Joint Program on HIV/AIDS, out of 6.5 million people who need ARV drugs to survive, the medicine is available to only one in five of them. Access is hindered because the health systems needed to distribute and administer the drugs do not exist. This is not caused by drug companies but by lack of economic development, itself in turn caused by the lack of economic freedoms. The victims of course are the poor, women and children.

There is a growing acknowledgement that efforts to bring AIDS drugs to the victims in Africa are limited by decayed health-care infrastructures that cannot provide even simple and cheap hydration to infants dying of diarrhea and malaria. Years of massive aid injections from NGOs, the World Bank and UNICEF to make medicines and health care services available to the continent's growing population have failed. These efforts attracted wide publicity and much fanfare but have not actually translated into expected result: the WHO estimates that roughly 270 million people in Africa lack regular access to even the most essential medicines.

The reasons are obvious. In many African countries public health sector systems are plagued by inadequate financing, weak management systems, lack of accountability, and a devastating reduction in the healthcare workforce and low morale among workforces on poor pay. There is little effective communication between pharmacists and doctors over availability of drugs.

According to the United Nations Joint Program on HIV/AIDS, out of 6.5 million people who need ARV drugs to survive, the medicine is available to only one in five of them.

Distribution is so poor that drugs in government stores have been known to expire. In addition, private sector health service is limited to urban areas. Many private health providers are simply avoiding villages for lack of good road networks and power supplies. New drugs that could represent a major breakthrough for AIDS treatment in the Africa are not available because erratic power supply makes drug refrigeration impossible. Even in Uganda, which represents the most ambitious HIV/AIDS program in Africa, about half the 148,000 people who need ARV drugs to survive have no access to them. In some areas, faith-based and other non-governmental organizations step in to provide health care services where government is failing. However, the capacity of NGOs, even though hospitals are well run, is less than 20% of any country's pharmaceutical market.

There is the need to urgently close the huge gap in access to HIV/AIDS drugs in Africa. Policy makers, health officials, and other stakeholders concerned with improving health in Africa must find new solutions. Part of the solution is policies that economically empower the people. Property rights must be adequately protected so that individuals can use their property to secure loans either to start business or engage in farming. Governments must allow people to trade freely both internally and with neighboring countries. The advantage for this is two-fold: they would get cheaper goods and would make more money to buy medicines with.

Governments must allow people to trade freely both internally and with neighboring countries. The advantage for this is two-fold: they would get cheaper goods and would make more money to buy medicines with.

In all this, the pharmaceutical industries should be seen as the heroes in the fight against HIV/AIDS and not villains who place profits over human suffering. The ability of the pharmaceutical companies to find new cures depends on the expected returns on products into which huge amount of money have been sunk. Unless there is guarantee for strong intellectual property protection to give them incentives to engage in high-risk investments, investors' confidence to invest in discoveries for diseases that affect people in Africa cannot survive.

Ultimately there is the need for a total overhaul of policy, financing and regulation; a realignment of responsibilities between public and private sectors; and the forging of genuine public-private relationships to help implement the supply of ARVs and other essential medicines and, above all, to work hard on prevention. The current UN emphasis on access to drugs obscures the central fact that no amount of ARVs can cure HIV/AIDS: at best, they can prolong lives a few years -- at worst they can help create new strains.

The only way to reduce the numbers is by prevention - or death.




Contributed by Thompson Ayodele, the Executive Director for Public Policy Analysis, a think tank based in Lagos, Nigeria, promoting the institutions of free society. Reprinted with permission from Enterprise Africa.

To read another Global Envision article about anti-retroviral (ARV) drugs, see ARVs Still Scarce Years After WTO Declaration.



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