More to AIDS obstacles than just cost

There is growing concern about the situation faced by HIV/AIDS patients in South Africa. A New York Times online story reported on the situation faced by the people of Hlabisa, KwaZulu-Natal, South Africa. There is one private doctor in this rural village - Dr. Smangaliso Hlengwa - and the notice on his clinic door reads, AIDS treatment available here on request from the doctor.

This 29 year old doctor knows all about the plummeting prices of these drugs and the hopes for better treatment of AIDS patients in Africa. But he is also aware that as the poor squeeze into his waiting room, they will leave empty-handed. Since February, five top drug companies have slashed the prices of their lifesaving AIDS drugs, bringing them within tantalizing reach of many Africans for the first time. 

In that same month, insurance companies in South Africa began to offer triple-therapy AIDS cocktails to thousands of employees enrolled in their benefits packages. In April, Doctors Without Borders plans to prescribe the drugs for free at a public clinic near Cape Town, in what appears to be the first pilot program of its kind in this country, health officials say. But while the price cuts are finally bringing some affordable medicines, the obstacles ahead for South Africa are plain in Hlabisa, where one of every three adults carries the deadly virus. Of the 40,000 people believed to be infected with H.I.V. in this community, only about 11 can currently afford the pills that could save their lives. The cheaper drugs are still too costly for South Africa to provide to the poor in public hospitals, even though it is better off than most countries in Africa.

According to some officials the national health system was neglected under apartheid, and still struggles to vaccinate children and track tuberculosis patients. It would be unprepared to distribute the drugs and monitor compliance outside of a few big city hospitals, even if the tablets were free. While much will change as a result of the recent price cuts, much will not unless prices keep falling and donors come forward to help pay for drugs and health system improvements, doctors and health officials say. According to a facilities survey conducted by the Health Systems Trust, 44 percent of the nation's clinics do not even offer H.I.V. testing.

Of the 25 million people infected with H.I.V. in sub-Saharan Africa at the end of 2000, 4.8 million are in need of treatment, the United Nations estimates. Of those 4.8 million, all but 30,000 could expect to die without the drug cocktails that have to some extent helped to improve the lives of  AIDS patients in the West.  In South Africa, where the United Nations estimates that 600,000 people need drug therapy, the price cuts in patented drugs will expand access for a small but growing number of insured working people. (South Africa cannot currently import generic copies of AIDS drugs, although it is exploring sections of its patent law that allow that option.)

Shaun Conway, executive director of the International Association of AIDS Physicians of Southern Africa, says that if lower prices are made more widely available to workers with health insurance here, the number of South Africans with access to antiretroviral therapy could increase from 10,000 to 100,000 within 12 months. It is major, major, said Colleen Pead, a supervisor for Aid for AIDS, South Africa's largest health plan of its sort. Falling prices will give nearly 5,000 employees access to an inexpensive version of triple-drug therapy for the first time. It's making triple therapy affordable to working people, she said.

But the government has little hope of extending that access to the masses in the future at least. To buy the cheapest patented drug combinations, which range from $800 to $1000 a year, the government would have to spend more than its entire budget for all medicines, which is about $250 million. This would not include the cost of laboratory tests or the cost of training doctors and nurses throughout the public sector, in cities large and small, who have no experience with the drugs and their side effects.

Source: Rachel L. Swarns, New York Times online March 29, 2001