At the July Gleneagles Summit, G8 leaders announced a goal of having an AIDS-free generation in Africa. To reach that goal, they aim to provide near universal access to treatment for all those who need it by the year 2010. However, one AIDS expert warns anti-retroviral treatment is complicated and expensive and only one part of what’s needed to stop the pandemic.
South African professor, Alan Whiteside, is among those who praise the G8 intentions, but he says: "While it is very important to put everyone on anti-retroviral therapy, we should not lose site of the importance of prevention. Because if we just treat the disease, then we are not addressing the root cause of it, which is people being infected. Having said that, I obviously applaud the initiative to make treatment widely available."
Professor Whiteside is the co-author of AIDS in the 21st Century and director of the Health Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal in Durban. He says the availability of anti-retroviral drugs, ARVs, should not lessen the importance of prevention.
"People have taken their eye off the ball of prevention and what they’re saying is ‘Oh, we can treat this disease.’ Not understanding A, how complex the treatment is and B, how very serious the disease is and C, that these drugs are not a walk in the park. You know, taking anti-retrovirals is not something you would aspire to. It’s something you do because the alternative is so much worse," he says.
He says many people may not understand the necessity of adhering to the ARV drug regimen. If a person stops taking them, HIV could develop a resistance to the drugs. Second, the drugs can have many side effects, some severe, which could cause a person to stop treatment. And third, for some people, the ARVs simply won’t work.
Professor Whiteside is one of the founders of the Free by Five campaign. The name is similar to the World Health Organization’s Three by Five campaign, which aimed to put three million people on anti-retrovirals by the end of 2005. However, the WHO says that target will not be met.
Professor Whiteside says, "The Free by Five initiative says if we are going to provide the drugs, if it is going to be done equitably, then people accessing the drugs in the public health sector must have free access. If you start putting in user fees or charging for tests, then it immediately means that many people will not be able to afford them. So, what we’re saying is we may not be able to roll it out as fast as we would like, but we must roll it out in a manner that it is free at point of delivery."
However, pharmaceutical companies say developing a new drug can cost hundreds of millions of dollars. Recouping their investment, they say, allows them to continue research and develop newer and better medicines.
The University of KwaZulu-Natal professor says that is something that must be considered.
"The choice of free and not free isn’t as simple as recovering the cost. I think what we’re talking about is sure you can charge in the developed markets for the drugs, but in the resource poor world, and my country would be considered resource poor, there is very little point in charging in the public health sector because the recovery is not going to be there. I’m not saying the drugs shouldn’t be purchased. The government should buy them or the donors should buy them or maybe the pharmaceutical companies want to provide some of the drugs free. But what we are saying is that at the point of delivery they should be free to the patient," he says.
At the Gleneagles Summit in Scotland, G8 leaders also announced they would increase investment in AIDS vaccine research. Yet, researchers agree a vaccine is at least 5 to 10 years away, an estimate that’s been used repeatedly over the years.
"Well, I think that is one of those moving targets. If you recall when President Reagan announced the discovery of the virus with Robert Gallo of Luc Montagnier he said ‘and we’ll have a vaccine very shortly.’ Now that was in 1983. Here we are 22 years later and we’re still hoping for a vaccine. But I think realistically despite the best efforts at IVAI (International AIDS Vaccine Initiative) and other organizations, we don’t have a vaccine available yet. Even when we do, we don’t know how effective it’s going to be and we don’t know how much it’s going to cost," he says.
Professor Whiteside says vaccine research must be done in parallel with prevention efforts, care and treatment and dealing with the effects of the pandemic, such as AIDS orphans and the loss of millions of farm workers to the disease. He says just spending more money won’t solve the problem.