Aids Research In Africa: What Can The Un Do To Help?

Bombs can be dropped in many forms all over the world, it does not have to take the shape of a nuclear cloud or a blast from a fighter plane-it can take the form of a disease which to date has claimed more lives than any single war in history. Seventy percent of the world’s AIDS population lives in sub-Saharan Africa. (Weissman)

More than seventy percent of the world’s AIDS population lives in sub-Saharan Africa.

The news is sobering. In fact it is down right frightening. A report from the United Nations says that AIDS will kill half of all fifteen year olds in Zimbabwe, Botswana, and South Africa by 2012 if something is not done soon. The report goes on to say that about twenty-four million people in Sub-Sahara Africa are living with HIV. So why is the epidemic raging out of control in Africa and other undeveloped countries? Several factors are contributing to this tragedy. Although HIV transmission has not been eradicated, these measures have helped dramatically. Unfortunately, for those living in sub-Saharan Africa, the availability of these important prevention techniques is rare. Without HIV education, the people of Africa continue to lack the tools necessary to change behaviors and halt the spread of the disease. Without condoms, heterosexual transmission continues to soar. Consider this: in some African nations, one in three adults are infected with HIV. (Weissman) The majority of sexual contact is unprotected, making transmission more likely and more widespread. And finally, widespread testing and counseling is just not available. Of the 24 million people or so with HIV, a large number of them do not know they are infected. Because of this, heterosexual contact becomes a major transmission route of young adults in Africa. The combination of not knowing their HIV status and the lack of available condoms, allows unprotected sexual transmission to

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continue. In the western world, the fight against HIV has been bolstered by the emergence of HIV medications. Unfortunately, the lack of available health care dollars in the countries hardest hit has made medications scarce in those regions. Medications have been proven to slow the progression of HIV infection to AIDS, thus allowing people to live longer, more productive lives. Without the benefit of these medications, the people of Africa continue to fall victim to AIDS at alarming rates. Medications such as Myambutol and Zithromax and other new treatments called anti-retrovirals significantly decrease the virus' replication speed, allowing patients to live much longer, fuller lives and hampering the spread of the virus. Treatment comes with a price tag - a very large one. An anti-HIV regimen of drugs for one patient at US prices costs $15,000 annually. In South Africa, treating all 4.2 million patients would cost $63 billion - more than twenty percent of the nation's gross domestic product. (Awkuke) Because of these prices, only .001 percent of Africa's AIDS patients receive anti-retroviral treatment. Nongovernmental organizations and AIDS activists are calling on Western pharmaceutical companies to drastically reduce the prices of AIDS medication in the developing world. The countries maintain that drug companies - who make only one percent of their profit on the African continent - can afford lower prices in the name of extinguishing this coming plague.

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Drug companies, until a recent legal and public relations struggle, had been unwilling to make good faith efforts to reduce prices. They believe one percent of revenue is necessary for researching possible vaccines and cures for the disease. They

also assert their intellectual property rights and patents, which until recently were rarely respected in the developing world. Since the World Trade Organization (WTO) was created in 1995, member nations have had to respect twenty year patents on file with other members - including the pharmaceutical companies patents on AIDS medications. The WTO TRIPS agreement (Trade-Related Aspects of Intellectual Property Rights) codifies standards for adequate protection of patents (UNAIDS)

The TRIPS agreement also allows two special practices that countries can use to lower the price of pharmaceuticals - compulsory licensing and parallel importing. Compulsory licensing gives the government the right to grant a license to a domestic manufacturer of a generic drug, provided that they pay royalties to the patent holder. The introduction of competition often drastically lowers prices, while both companies still turn a profit. Price reductions have been as high as eighty-two percent. (WHO) Parallel importing allows countries to "comparison-shop" for the world's best market price of a drug and import quantities for sale in the domestic market. Drug companies are particularly concerned that such practices, although legal under TRIPS and authorized by South Africa's 1997 Medicines Act, will alert consumers in the West of the actual low prices of pharmaceuticals, thereby cutting into profits in the developed world. They have

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lobbied persistently the U.S. government to apply bilateral pressure to prevent compulsory licensing and parallel importing and have thus far been successful in the U.S.

The South African government won a major legal victory when the suit filed against it by thirty-nine Western pharmaceutical companies was withdrawn. Companies sued the government to question the constitutionality of beginning parallel importing and compulsory licensing measures. Facing increased public outrage in the West (and the shaky legal ground of their claim), the companies withdrew their case in late April, paving the way for alternative ways of bringing in generic drugs. (Note: From a legal standpoint, the TRIPS agreement does indeed allow for parallel importing and compulsory licensing when public health or other national emergencies arrive.

The often-unheard side of the story comes from the medical community. Scientists also question the prudence of allowing cheap AIDS drugs into the South African market. For anti-retrovirals to be effective, the regimen must be monitored strictly and requires a developed medical infrastructure that South Africa does not have. Official U.S. policy also supports development of the infrastructure over reducing prices.

Why is the infrastructure so important? When dosages are skipped, low levels of the HIV virus can continue to reproduce in the body. Through natural selection, the viruses that have survived and reproduced