UNAIDS HIV Drug Access Initiative: Providing Wider Access to HIV-related Drugs in Developing Countries, Pilot Phase

drugs such as ARVs and sophisticated OI drugs, and non-expensive and
essential drugs. With this respect, programmes to make available basic drugs
for Ols should be integrated with essential drugs programmes.
Addressing Expectations
SIt is clear that the announcement of the Initiative created high expectations,
Swhich could not be met by the programme. Despite the clear statement that
this was a pilot phase, small-scale effort, many believed the Initiative would
solve the issue of access to drugs. Furthermore, while Initiative
communications addressed both ARV and OI aspects of the programme, the
ARV aspects received the most attention. A number of factors help to explain
this tendency:
* Since the reports presented in 1996 at the international AIDS conference
in Vancouver, ARVs have been widely perceived as life-saving drugs. This
perception has been reinforced by dramatic improvements in morbidity
and mortality rates in developed countries.
* As a result of these dramatic effects, access to ARVs became a very
visible political issue taken up by politicians as well as by people living with
HIV/AIDS. This created a bias in reporting on the ARV component. On
the positive side, however, the visibility of the issue has served to highlight
discrepancies in drug access between developed and developing
countries more generally.
* The Initiative was one of few international actions, however limited, that
proposed to address this discrepancy. It therefore received
disproportionate attention. The negative consequences of this, given the
reality of its small scale and pilot nature, have been partly offset by the
impression that at least "something can and is being done".
The Advisory Board
The advisory boards have played a crucial role in decision-making and in the
implementation of the Initiative.
In the initial model, the advisory board was designed to include political
stakeholders as well as members who have technical expertise. However, in
the countries in which advisory boards are operational, the board members
appointed are usually top executives in their areas and are influential at the
political level. A number of subcommittees have then been formed to address
specific technical issues such as policy and pricing, clinical care and
counselling, and evaluation. Within this set up, the board has both the
expertise to make recommendations on technical issues, and the influence to
have most recommendations approved and transformed into policy.

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