South Africa’s HIV/AIDS Strategy Must Address Treatment Access and Primary Care Delivery Issues
Now that South African President Thabo Mbeki has admitted that HIV-positive senior government officials receive antiretroviral drugs while HIV-positive pregnant women and rape victims are denied the treatments, there should be a "clear path to a coherent anti-AIDS strategy in South Africa," Richard Horton writes in a Lancet op-ed. However, Horton writes that the question remains, "How can these drugs be made available to those who need them most?" He notes that a recent Voluntary Service Overseas position paper cites the Trade-Related Intellectual Property Rights agreement as an obstacle to affordable drugs in developing countries. The TRIPS agreement, which has set patent protection for 20 years, aims to "standardize patent law across nations" and is "supposed to safeguard public health." Already implemented in "richer" countries, TRIPS "came into force" in developing countries this year, and "least-developing nations must comply by 2006." Horton notes that the TRIPS agreement will be "one more hurdle preventing the production or importation of widely needed drugs into regions with high burdens of HIV/AIDS." He adds that the agreement "could actually diminish the availability of copy generics." Therefore, Horton calls for the inclusion of "exemption legislation" in national laws -- otherwise "there will be no means for countries to override patent protection." Horton cites the U.N. Development Program's 2000 report, which also calls attention to TRIPS, saying that it "tightens patent copyright protection, favoring those who develop and market technology rather than society's interest in liberal diffusion of new technology." However, Horton acknowledges that even if AIDS therapies were made available in poorer countries, "the almost insuperable difficulties facing health care systems ... can hardly begin to administer drug regimens safely and effectively even if those drugs were freely available." As such, Horton notes that the VSO recommends governments "carefully monitor" TRIPS' impact on medication prices, health care and pharmaceutical firms in developing countries, and "promote a review of TRIPS to ensure developing countries' health care needs are met." Horton concludes, "Although pressure should be maintained to restrain the damaging effects of the TRIPS process, drug provision alone is not the simple solution for patients with HIV/AIDS that some critics suggest. An equal ... concern must remain the creation of sustainable primary care services combined with clear guidelines for treatment. Without this basic framework, the provision of antiretroviral drugs will produce chaos, not control" (Horton, Lancet, 11/4).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.