E-drug: UN session tackling African pandemic seeks to aid access
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UN session tackling African pandemic seeks to aid access: Forum
Urges Action in War on Aids
John Donnelly, Globe Staff, 9/23/2003
NAIROBI -- The world's fight against the AIDS pandemic has
remained at a virtual standstill for two years and will fall far short of
goals set by 189 member states of the United Nations unless
countries take dramatic action, the UN reported yesterday.
The evidence of inaction was sobering: With the exception of
Botswana, less than 1 percent of HIV-infected pregnant women in
heavily affected countries received treatment to prevent transmission
of the virus to their children, though the drug is free; and 50,000
people at the end of 2002 had access to antiretroviral treatment in
Africa, where 4.1 million people need the life-extending medication.
"Today's reports are a dramatic wake-up call to the world," said Peter
Piot, UNAIDS executive director, in New York.
Yet as those findings were being released at a special UN session on
AIDS and here at the 13th International Conference on AIDS and
Sexually Transmitted Infections in Africa, the Nobel Prize-winning
group Doctors Without Borders reported that it has found reason to
hope that treatment for those suffering from AIDS can be expanded.
Drawing upon its experience over the last two years in AIDS clinics in
10 countries, the group found that competition among generic
drugmakers will reduce prices and that doctors can simplify treatment
-- two critical factors in rapidly expanding access to antiretroviral
drugs.
The group said nations have been able to lower the price of the drugs
to as low as $277 per patient annually -- antiretroviral treatment costs
up to $15,000 in the United States -- and that doctors can visually
diagnose a patient's progress with the drugs. The latter finding, which
is also supported by research in Haiti by the Cambridge-based
nonprofit group Partners in Health, means there could be less
reliance on laboratory results, removing a potential obstacle for many
poor rural areas that offer only basic health care.
In another positive finding disclosed yesterday, HIV-infected patients
in several African countries are taking their twice-a-day medicine as
directed, and in fact are adhering to doctors' orders at a higher rate
than Americans who are taking antiretrovirals.
Two years ago, the US Agency for International Development
director, Andrew S. Natsios, expressed strong doubt in a Globe
interview that Africans should take antiretroviral medicines because
he said few own watches and wouldn't know when to take the drugs.
The studies, however, showed that 95 percent of patients in Uganda
took their medicine properly, and 90 percent in Malawi. In Haiti,
adherence has also been reported at more than 90 percent. Roughly
75 percent of US patients take the medicine as directed, according to
the new studies.
Daniel Berman, coordinator of Doctors Without Borders' Access to
Essential Medicines project, said that many countries now need to set
up national systems to purchase drugs from generic manufacturers.
Since 2000, for example, Cameroon has set up a central purchasing
system, and the price has dropped to $277 annually for a patient,
according to a report on the project.
Berman said doctors in several clinics run by the groups infrequently
check a patient's CD4 count -- which measures the strength of the
immune system -- "and we are finding good results with a simplified
model." In Western countries, doctors regularly measure CD4 counts
to test a person's response to the harsh medicines.
Asked if that strategy was risky for the patient and the efforts to scale
up programs, Berman said, "We think it's dangerous not to simplify
care if we are serious about reaching 3 million people by 2005. You
have to be realistic. It doesn't mean we are just throwing drugs out
there. We are looking to simplify in a smart way."
The World Health Organization has set a goal of treating 3 million
people in the developing world with antiretroviral medicine by 2005.
Its new director, Jong-Wook Lee, pledged yesterday in New York to
deliver the antiretroviral drugs on a large scale. He said the failure to
do so thus far has created a "global health emergency." Lee pledged
that WHO would use the same skills shown in controlling the SARS
outbreak last year to fight AIDS, by providing emergency response
teams in highly affected countries to any government that asks for
help.
Here in the Kenyan capital, Badara Samb, WHO's head of AIDS
programs in Africa, said in an interview that his organization agreed
with the call by Doctors Without Borders to rapidly look for ways to
simplify treatment regimens. He noted that there was one new CD4
test that required only a microscope and chemicals and cost just 17
cents.
The new UN report, produced by UNAIDS as a way of measuring
promises made during a historic session before the General
Assembly in 2001, found several bright spots in Africa. But they were
mostly isolated, and the overall findings were extraordinarily grim --
especially concerning HIV-infected pregnant women. In Botswana --
now in the midst of a $100 million project run by the Bill & Melinda
Gates Foundation, Harvard University, and Merck, the drug
manufacturer -- 34 percent of HIV-infected women received services
to prevent the transmission of the HIV virus to their children. But
elsewhere in Africa, no other heavily infected country had treated
more than 1 percent.
John Donnelly can be reached at donnelly@globe.com.
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