Health Officials Question Impact Cheap Anti-AIDS Drugs Will Have on African Nations
Despite several major drug makers' announcements that they will cut prices of anti-AIDS drugs for numerous countries in sub-Sarahan Africa and U.N. Secretary General Kofi Annan's success in persuading six companies to cut their prices even further, some researchers and health officials question "how much of a difference the drugs could make" in light of the continent's infrastructure problems, the Los Angeles Times reports. Although some sub-Saharan African countries have "put in place a structure to cope with the impact of the disease," several others have "dire shortages of good roads, communications, medical facilities and trained doctors" necessary to fight the epidemic. For example, in many African nations, annual health budgets are less than $5 per person, hospitals lack equipment and medicine even for "basic ailments" and AIDS is "treated as a badge of shame," the Times reports. To improve infrastructure, nations would have to build roads to remote villages, construct laboratories, install refrigerators to store and analyze blood samples and devise an "intricate communications system" to ensure that stocks are kept up to date. To make such improvements, South Africa, for instance, would need more than $1.24 billion over the next 10 years to deal with an "infusion of antiretroviral drugs," according to Zweli Mkhize, health minister for the KwaZulu-Natal province. He said, "On its own, the question of drugs will certainly go a long way. But that is not the complete picture." Costa Gazi, director of the AIDS Babies Battling AIDS Trust, said, "If you don't tackle the infrastructure, you cannot tackle AIDS."
While improving infrastructure should be a priority, lack of infrastructure should not be "an excuse to delay bringing down [medication] prices," Nathan Geffen, spokesperson for the Treatment Action Campaign, a South African lobbying group that advocates better access to health care for the poor, said. He added, "With the cheaper drug prices, the pressure to improve the health care system would come. The cheaper drugs would be an incentive to get the infrastructure going." Other health officials and researchers say that beyond infrastructure, African countries would benefit from an infusion of "basic medicines" to treat tuberculosis, hypertension and diabetes, which many HIV/AIDS patients die from before their HIV infection progresses to AIDS. In addition, education campaigns are important to help end a "culture of denial about AIDS," Mkhize said, adding that the "understanding of the cause of the spread of HIV/AIDS is more potent that the availability of drugs. We should not say that the end of our problems would come with access to drugs."
Poverty and Compliance
High poverty levels in many African nations also will play a role in how effective the cheaper drugs will be, the Times reports, noting that many Africans "survive on less than a dollar a day." Tony Moll, senior doctor at the Church of Scotland Hospital in KwaZulu-Natal, said, "A lot of our patients cannot afford to pay the six rand (less than $1) to reach the hospital when they are desperately sick. You can forget about paying for antiretroviral drugs." Gazi added, "The government would have to make these cheap drugs available to the poor, and they would have to make them available for free because the poverty is so deep." Even if poor Africans do receive the drugs, there is the "question of compliance," the Times reports. Many anti-AIDS medications are supposed to be taken on a full stomach and with clean water, both of which are "hard to come by." Furthermore, it is difficult enough to ensure that people adhere to medication courses for illnesses like tuberculosis, "much less getting them to stick to a strict and often complex regimen of sophisticated antiretroviral drugs," the Times reports. Mkhize said, "You need very good supervision and monitoring of your patients. How do you say to somebody, 'You should take this medication at a certain time,' when they don't even have a watch?" If patients do not comply with treatment regimens, researchers warn that a "more resistant strain of HIV" could emerge (Simmons, Los Angeles Times, 4/8).