14th International AIDS Conference Barcelona, Spain - July 7-12, 2002

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrE1421)

Attaran A
Harvard University, Kennedy School of Government, Cambridge, United States

ISSUES: Recent research (Attaran et al, 2001, JAMA 286:1886-1892) has demonstrated that for low income countries, the barrier to antiretroviral treatment is not often the existence of patents. In a pairwise comparison of 53 African countries and 15 antiretroviral drugs, patents exist in only 21.6% of cases, such that 1 or more of the most "strongly recommended" HAART regimens is totally unpatented in up to 98% of countries. Thus in nearly all African countries (with the important exception of South Africa), there is often unrecognized latitude to use brand-name or generic drugs in AIDS treatment. The theory that patents block access to HAART in Africa, while not without validity, is thus easily overstated, and HAART is possible in nearly every African country now without patents as an impasse. However, where patents are not such a problem, finance absolutely is. Even using the cheapest generics, HAART costs several times the per capita health budget of even the wealthiest African country. Nor is international aid finance forthcoming: in 1999, the world's 23 richest countries contributed about $161 million as aid for AIDS in all low income countries globally (Attaran & Sachs, 2001, Lancet 357:57-61). This is about what it costs to build 10 kilometers of highway, and represents just $7 on every $1,000,000 of income in rich countries.

RECOMMENDATIONS: Effective advocacy requires two simultaneous strategies. The first must be to increase international aid funding for AIDS, by replicating the lobbying energy that was focussed on patent issues, to compel donor governments to meet their international obligations. The second must be to reach agreement on equitable access to medicines in the few cases where patents exist, by making use of existing concessions from pharmaceutical firms, and seeking similar arrangements for other urgent cases, such as for malaria, TB, and other diseases of the poor. A Global Fund for AIDS, TB and malaria can ease these steps.

020707
ThOrE1421

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