Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

Drug Access Initiative more relevant to clients who cannot afford antiretroviral drugs,
and to follow-up centres where antiretrovirals are not prescribed.
Efforts to increase drug affordability
SDrug price negotiations led to a significant decrease in the price of antiretroviral
drugs in the region, both within the Drug Access Initiative and beyond. However, a
comparison of these prices with those obtained by Brazil or Thailand (see Table 2)
makes it clear that further price reductions should be possible to achieve, if need be
through the introduction of generic competition.
Uganda, a relatively poor country, opted not to use any public funds to subsidize
antiretrovirals supplied through the initiative (the cost being borne by the patients). In
C6te d'lvoire, a richer country, the Government committed itself to shoulder part of
the cost for selected patients; however, the allocation of treatment subsidies was
very slow. While an in-depth analysis of the use of antiretrovirals outside the initiative
was not conducted, the fact remains that the programme in C6te d'lvoire attracted
fewer clients than that in Uganda.
Strengthening the health sector
The educational efforts of the initiative were assessed as positive in both countries.
In Uganda, laboratory follow-up was strengthened by the donation of CD4 counting
equipment. The growing interest of the countries' advisory boards in opportunistic
disease management has resulted in more operational follow-up centres.
Three challenges to be met in the months ahead are: integrating the advisory boards'
guidance on HIV management into national treatment guidelines; regulating antiretrovirals and advanced drugs for the treatment of opportunistic infections as part
of the countries' national drug management policy; and preparing to make the initiative sustainable after UNAIDS reduces its subsidy.
S.ocietal impact
7 in both countries, the presence of the initiative galvanized people with HIV and AIDS
by holding out some hope for them, and led to a wide mobilization of health sector
staff around HIV and AIDS. It also resulted in a great deal of discussion of AIDS in
the media - not only about the cost of HIV treatment but also HIV prevention. By raising the visibility of the epidemic, this level of discussion may enhance prevention
efforts and yield significant benefits that extend beyond the clients and health care
providers of the initiative.
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