Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

how and infrastructure. Local production, combined with bulk purchases of imported
antiretrovirals, led to significant decreases in the programme's drug costs. The
annual cost of double therapy with nucleoside analogues decreased on average by
80% between 1996 and 2000, from US$ 3812 to US$ 763. For triple therapy with two
nucleosides and one protease inhibitor, the cost reduction was 36% over the same
period (from US$ 7342 to US$ 4717) and for triple therapy with two nucleosides and
one non-nucleoside it was 34% (from US$ 4584 to US$ 3009).
The programme's annual drug costs were approximately R$ 611 million (US$ 339
million) in 1999, and are expected to rise to R$ 831 million (US$ 462 million) for the
year 2000, taking into account both a higher proportion of patients on triple therapy
and a larger overall number of patients. Between 1997 and 1999, approximately
146 000 AIDS-related hospitalizations were averted, resulting in savings of approximately R$ 521 million (US$ 289 million); this has partly offset the high cost of antiretroviral therapy. At the same time, condom sales increased by nearly half (from 216
million to 320 million pieces) between 1996 and 1999, and demand for voluntary HIV
counselling and testing rose 35% between 1996 and 1998.
Yet another approach is to utilize a safeguard incorporated into the Agreement on
Trade-Related Aspects of Intellectual Property Rights (TRIPS), an international treaty
that protects patent rights, including those for drugs. Patent protection provides an
important incentive for innovative research and development of new HIV/AIDS drugs
and, hopefully, the discovery of HIV vaccines, in particular, vaccines suitable for use
in developing countries (see Box 14, page 68).
The TRIPS agreement sets out minimum standards in relation to intellectual property
for Member States of the World Trade Organization (WTO). Countries that wish to be
members of WTO must comply with the TRIPS standards, where necessary by
changing their national laws and regulations. In practice, for many developing countries, this will mean giving patent protection for the first time to pharmaceutical
inventions (both products and processes). Under TRIPS, patent protection must be
available for a minimum period of 20 years. However, the TRIPS agreement also
foresees that in certain circumstances, such as national emergencies, governments
may grant third parties the right to produce and sell a patented product even without the consent of the patent holder, according to carefully prescribed conditions.
This safeguard, known as "compulsory licensing", was incorporated into the TRIPS
agreement through negotiations by developing countries. Its maintenance as part of
TRIPS has been vigorously defended by nongovernmental organizations and activist
groups, such as Act Up, the Consumer Project on Technology and M~decins Sans
Frontieres, who have conducted international campaigns for improved drug access.
These organizations have also sought to obtain compulsory licences on drugs of
interest to people with HIV/AIDS in South Africa and Thailand. The campaigns did
not result in the issuing of compulsory licences. However, access to the target drugs

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