Report on the Global HIV/AIDS epidemic

Care and support for people living with HIV/AIDS

improved when the pharmaceutical companies involved donated the drug free of
charge to some patients (as was the case for fluconazole in South Africa), or agreed
to a significant price reduction around the same time that non-patented alternative
formulations were put on the market (as was the case for didanosine in Thailand).
The fact that pharmaceutical companies have not yet decreased their prices enough
to make their products affordable to the majority of people in developing countries
does not preclude future progress. To achieve prices even lower than those available
from small suppliers of generic drugs, it will be necessary to pursue discussion and
collaboration with the pharmaceutical companies that developed the products.
"Differential pricing" of HIV/AIDS drugs and other pharmaceutical products is gaining increasing acceptance in industry and should help in making these products
affordable in countries with limited local purchasing power.
At the same time, governments should increase access to drugs by reducing import
duties, customs and taxes on HIV-related goods and lowering their cost, and by
removing unduly restrictive regulations that impede drug availability. More broadly,
at a time when the epidemic is increasing the demand for health services, governments and donor agencies should improve the affordability of drugs by giving higher
priority and greater financial support to the health sector.
Box 19. Lessons from the UNAIDS Drug Access Initiative
The Drug Access Initiative enrolled its first patients in Uganda and C6te d'lvoire in
1998. In Chile and Viet Nam, the initiative became operational in early 2000. The initiative aims to evaluate ways of overcoming obstacles to the provision of drugs, using
access to antiretrovirals as an entry point for wider access to a comprehensive package of HIV care in developing countries.
Some important lessons have already been learnt about the operational aspects of
the initiative from the experience of C6te d'lvoire and Uganda, where currently about
600 and 900 patients respectively are receiving antiretroviral therapy.
Rational drug selection and drug use
Advisory boards in both countries defined treatment policy, and training efforts were
successful in ensuring physician compliance with the proposed treatment guidelines
in the referral centres participating in the initiative. The guidelines and training took a
comprehensive approach to the management of patients with HIV, including their
opportunistic infections and diseases. However, the procurement guidelines focused
almost exclusively on antiretroviral therapy until 1999. Since then, at the insistence
of UNAIDS, both countries have shown a greater interest in the management of
opportunistic diseases. Anticipating the March 2000 consultation on cotrimoxazole
prophylaxis (see Box 20, page 106), Ccte d'lvoire and Uganda adopted guidelines on
using this drug combination for the prevention of opportunistic infections in people
with HIV. The increased emphasis on drugs for opportunistic infections will make the

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