In the past, brand name drug companies were reluctant to lower the price of AIDS drugs, making the cost of treatment beyond the means of many of those in need. Now they have joined the campaign to fight HIV-AIDS , but experts say availability of cheaper drugs is only half the battle.
When UNAIDS launched its pilot program in Africa in 1998, the price of AIDS-fighting drugs averaged $12,000 per patient per year. Today, that cost has dropped to under $500 and in some cases to less than $150 per patient per year.
What happened?
Senior UNAIDS official Julian Fleet lists several reasons.
"First and foremost, a social movement has grown up around HIV and AIDS in contrast with other diseases in developing countries, in particular," he said. "People living with HIV have demanded their human rights to have access to treatment."
AIDS activists say major drug companies needed to repair their tarnished image as the world has focused attention on the global epidemic.
Increased competition from generic drug firms has also forced down prices.
"Money shouldn't determine who lives and who dies from AIDS", said former U.S. President Bill Clinton, speaking recently in China about the need to cut the cost of AIDS treatment.
The Clinton Foundation, for one, is currently working with three firms in India and one in South Africa to provide cheap generic anti-retroviral drugs for several African and Caribbean countries hard-hit by the epidemic.
AIDS Initiative Vice President Lynn Margherio says a team of business experts followed the production process from the purchase of raw materials to the final sale to see where costs could be cut while maintaining a reasonable profit margin for the manufacturers.
Ms. Margherio says the impact of lower annual drug rates is significant.
"At those price levels, countries will now be able to seriously consider putting in place comprehensive programs that can assure that patients both have access to life-saving drugs today," she said. "But also, and more importantly, that once the treatment has started, it can be continued."
Brazil has led the way in Latin America with the free distribution of AIDS drugs, half of them manufactured by local generic producers. But the cost of importing brand-name drugs Brazil does not produce accounts for more than half the program's $200 million budget.
Abbott Laboratories has been involved with AIDS programs since 1985. Reeta Roy, vice president for global citizenship and policy says the company has maintained its low prices despite the profit loss.
"We looked at the profound need and we looked at what it is we could do," she said. Many companies in our industry are also providing products. There's no material impact on our overall operation and our shareholders understand that. But our shareholders also appreciate the fact that we are being responsive and sensitive and doing the right thing."
Still, Ms. Roy recognizes that lowering the price of anti-retroviral drugs is not enough.
"Over the next five years, we will have invested something like $100 million just in our humanitarian programs in the developing world alone, just to fight AIDS," she said.
Abbott runs several programs that deal with different aspects of campaign to combat AIDS, from training health workers and donating thousands of AIDS tests to providing care for AIDS orphans. UNAIDS official Julian Fleet points to Africa as the hardest hit area for immediate action.
"We should consider that the challenge is daunting," said Julian Fleet. "We have some 40 million people in the world today living with HIV. Of those, six million in developing countries are in need of AIDS treatment today. Yet, only some five percent of those in need are actually getting it. In Africa where the burden epidemic is most severe, the situation is even more dire. Ninety-nine percent of Africans living with HIV and in need of treatment today don't have it."
The Nobel Peace laureate humanitarian group, Doctors Without Borders, has long lobbied for expanded access to AIDS treatment programs. Spokesman Sean Healy says lowering the price of AIDS medicine is only one element.
"For example, the way we treat AIDS has to be simplified and adapted to the real world conditions of resource-poor countries," he said. "It needs to be simpler to administer. We've started to switch to the use of the triple fixed dose combinations, which means three anti-retrovirals that patients get, they can get in one pill, twice a day. And those kinds of measures are also needed to make it easier to treat large numbers of people."
AIDS experts also stress the need for countries hard hit by the HIV-AIDS epidemic to improve the infrastructure of their health systems and strengthen the capacity of doctors, nurses and counselors to proscribe and monitor long-term AIDS treatment.