S. Africa AIDS case -- a hollow victory?
JOHANNESBURG, South Africa -- Africa's millions of AIDS sufferers may still not get the vital drugs they need, despite the decision by the pharmaceutical industry to withdraw its legal patent fight.
In the euphoria that followed the move on Thursday by 39 of the world's most powerful drugs companies, activists described it as offering a potential lifeline to Africa's 25 million HIV-positive people.
But South Africa, where the court action was fought, woke on Friday to face the realisation that cheap, generic AIDS medicines are unlikely to flood quickly into a country ravaged by the disease.
While South African health officials said Pretoria was committed to fighting AIDS through education, prevention and drugs that primarily treated diseases associated with AIDS -- such as pneumonia -- access to affordable key anti-retroviral drugs that suppress the replication of the virus may be no nearer.
"The use of anti-retrovirals would need a policy decision because of the cost implications," said health department spokeswoman Jo-Anne Collinge.
"Clearly even at the current prices on offer they are still not in the realms of what is possible.
"We are looking at how we can get the cheapest source of drugs to treat opportunistic diseases, but I wouldn't want to speculate on a timetable."
Several drug companies have offered Pretoria discounted prices on their anti-retrovirals but the government has rejected them on the grounds that they are still too expensive and that the necessary infrastructure to monitor their use is lacking.
The German firm Boehringer-Ingelheim has offered the drug free to Pretoria but the government wants ethical safeguards before the trials at 18 national sites begin.
A meeting between Pretoria and the drug firms involved in the case is scheduled for early next month to plan a way forward.
Health Minister Manto Tshabalala-Msimang, who hailed the drugs industry's withdrawal of legal action as a victory of South Africa, has since made it clear that cost and infrastructure remain steep obstacles to purchase large quantities of anti-retrovirals.
Treatment Action Campaign, a group that supported the South African government against the drug firms, has called on the health ministry to speed up implementation of the Medicines and Related Substances Control Act that allows South Africa to import cheap copies of patented drugs and which was at the heart of the court battle.
South Africa President Thabo Mbeki has ruled out the use of anti-retroviral drugs, which can also prevent mothers from passing the virus to their new-born babies, in the public health sector after questioning their efficacy and expense.
Mbeki's stance on AIDS caused controversy after he questioned the causal link between HIV and AIDS and appointed leading AIDS "dissidents" to his own advisory panel on the disease, many of whom argue that AIDS is caused by recreational drug use and anti-AIDS drugs.
Manto Tshabalala-Msimang is scheduled to visit India in the coming weeks. Indian firm Cipla has applied to Pretoria to supply generic AIDS drugs at a fraction of the cost of patented drugs.
But while cheap drugs would go a long way to relieving the suffering and diminishing the death toll from AIDS in poor nations, the United Nations says a two-pronged attack including prevention is needed to defeat the epidemic.
Mark Malloch Brown, administrator of the U.N. Development Programme (UNDP), said medicines were only half of the winning equation.
"The idea that somehow, in a region where healthcare spending is $10 a year, you can introduce medicines of this kind and expect that a treatment regime is going to solve the problem is totally implausible. It will only work if it is strongly tied to an effective prevention strategy," he said.
Brown said prevention and treatment went hand-in-hand because people were more likely to volunteer for HIV testing and to acknowledge their status if a treatment option was available.
Treatment alone, without a prevention strategy, would be a time bomb in society, he warned.
"People have got to change their behaviour and practise safe sex. It is not enough to give them a treatment to keep them alive, they have to change their own behaviour so they do not continue to infect partners."
He cited Botswana, which has the highest rate of HIV infection with an estimated 35.8 percent of all adults living with the disease, as an example where government intervention had made a difference.
"We've seen dramatic changes in Botswana in the last year where the president has personally led the charge," Brown said.
A U.N. Special Session on HIV/AIDS is to be held in New York on June 25-27.
AIDS drugs case adjourned
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