INDICES> UN session - urges action on War on AIDS (long email)

[Leela McCullough <leela@healthnet.org>]

Subject:  FORUM URGES ACTION IN WAR ON AIDS (long email)

UN session tackling African pandemic seeks to aid access

By John Donnelly, Globe Staff, 9/23/2003
Reprinted with permission

NAIROBI -- The world's fight against the AIDS pandemic has remained 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 Botswana, less
than 1 percent of HIV-infected pregnant women in heavily affected countries
received treatment to prevent transmission 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 clinics in 10
countries, the group found that competition among generic drugmakers will
reduce prices and that doctors can simplify treatment -- two critical
factors in rapidly expanding access 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 nonprofit group
Partners in Health, means there could be less reliance on laboratory
results, removing a potential obstacle for many poor rural areas that offer
only basic health care.

In another positive finding disclosed yesterday, HIV-infected patients 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 director, Andrew
S. Natsios, expressed strong doubt in a Globe interview 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 manufacturers. 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 infrequently 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 medicines.

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 people 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 million 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 providing
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 programs 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 promises 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 received services
to prevent the transmission of the HIV virus to their children. But
elsewhere in Africa, no other heavily infected 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: +617-926-9400    Fax: +617-926-1212
Email: leela@usa.healthnet.org
Web: http://www.healthnet.org

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