An AIDS-free generation is in sight but action is needed now
Mohga Kamal Yanni Senior Health and HIV Policy Adviser
1st Dec 2012
On World AIDS Day, Mohga Kamal-Yanni outlines the four main challenges facing all countries that are dealing with HIV and AIDS.
In 2001, I stood in front of a huge picture in the UN building in New York. It showed an African woman on her death bed with another woman hold her hand. It said: "You must not die alone". I screamed: "You must not die full stop! There is treatment!"
My friends in the UK were living and working thanks to treatment provided free through the public health system, so why not this lady?
There are challenges facing all countries dealing with HIV: funding, health systems, medicines
Today, interviewers ask me: "What are the major challenges for HIV in country X?" My response is that there are four challenges facing all countries dealing with HIV: funding, health systems, medicines and prejudice.
AIDS has uncovered many ills in the world: donors' lack of long term commitment, weak health systems and flawed drug research and pricing. Not to mention deep-rooted stigma, prejudice and discrimination against marginalised including women, men who have sex with men, drug users, and sex workers.
Achieving the goal of an AIDS-free generation and the control of HIV is in sight but action is needed now.
1. Donors dragging their feet
Firstly, donors are dragging their feet from supporting the Global Fund which provides grants to countries to finance effective prevention, treatment and care programmes. Clearly donors need to re-think their reluctance. The more people we treat now and the more infections we prevent, the less costly the AIDS response will be in the near future and the more lives will be saved. The opposite is also true: ignore scaling up of prevention and treatment now and pay later not only in terms of lives lost but also in terms of money needed to contain an escalating epidemic.
2. Drug companies - part of the problem as well as the solution
Second, drug companies! They are a big part of both the problem and the solution. Thanks to Indian generic companies' competition, the price of first line antiretrovirals dropped from £10,000 per patient per year to under $100. But now patients need more effective medicines and some need new ones which are still under patent. To avoid the patent block, civil society organisations and others supported UNITAID, the international drug purchasing facility, to establish the Medicine Patent Pool. MPP
acts as a one stop shop where the big international pharmaceutical companies license their medicines to the pool and then generic medicine manufacturers can make the needed combinations - paying royalties on sales in countries that have patent on those drugs.
Yet so far, the big companies are dragging their feet or refusing to join. Only Gilead issued a license, which represents a good start but still needs to be improved. ViiV Healthcare (created by GSK and Pfizer), Boehringer Ingelheim, Bristol-Myers Squibb, Roche and Bristol Myers Squib are taking a long, long time to negotiate with MPP. I am not sure when they will conclude these negotiations with decent licenses. We cannot wait forever!
Other companies - notably Johnson & Johnson, Merck and Abbott - refused to join. Instead, they are trying hard to polish their public image by cutting separate deals with generic medicine manufacturers but the terms of the licenses are not transparent and they exclude patients in many countries. For example, the latest J&J deal on the drug "darunavir" excludes the West Bank and Gaza where the drug is sold at USD 5900 per patient per year!
When will drug companies put patients' lives before making huge profits?
3. A critical need to invest in public health systems
The need for treatment programmes highlights once again the fact that investing in public health systems must be a priority for all governments and donors. Without qualified health workers (including managers, planners, pharmacists, etc) infrastructure, health information systems, and medical supplies, we will not be able to scale up treatment to reach all who need it. Yet some government donors still see investing in public health system as a remote goal to dream about rather than an urgent action to be performed now. A decade of increased funding for HIV response and most countries
still face bottle necks in the drug supply chain - because of a lack of investment.
4. Addressing discrimination
Last but not least, all governments, community and societal leaders must address the deep-rooted discrimination in their societies. Countries cannot continue to ignore the rights of women, girls and marginalised groups under the cover of culture, religion or any other banner. In this age where young people across the world are communicating and sharing views and ideas about rights, it is not possible to continue with discriminatory laws and rules.
For a start, access to prevention, treatment and care is a right for all.