Care and support for people living with HIV/AIDS

Care and support for people living with HIV/AIDSimproved when the pharmaceutical companies involved donated the drug free ofcharge to some patients (as was the case for fluconazole in South Africa), or agreedto a significant price reduction around the same time that non-patented alternativeformulations were put on the market (as was the case for didanosine in Thailand).The fact that pharmaceutical companies have not yet decreased their prices enoughto make their products affordable to the majority of people in developing countriesdoes not preclude future progress. To achieve prices even lower than those availablefrom small suppliers of generic drugs, it will be necessary to pursue discussion andcollaboration with the pharmaceutical companies that developed the products.“Differential pricing” of HIV/AIDS drugs and other pharmaceutical products is gainingincreasing acceptance in industry and should help in making these productsaffordable in countries with limited local purchasing power.At the same time, governments should increase access to drugs by reducing importduties, customs and taxes on HIV-related goods and lowering their cost, and byremoving unduly restrictive regulations that impede drug availability. More broadly,at a time when the epidemic is increasing the demand for health services, governmentsand donor agencies should improve the affordability of drugs by giving higherpriority and greater financial support to the health sector.Box 19. Lessons from the UNAIDS Drug Access InitiativeThe Drug Access Initiative enrolled its first patients in Uganda and Côte d’Ivoire in1998. In Chile and Viet Nam, the initiative became operational in early 2000. The initiativeaims to evaluate ways of overcoming obstacles to the provision of drugs, usingaccess to antiretrovirals as an entry point for wider access to a comprehensive packageof HIV care in developing countries.Some important lessons have already been learnt about the operational aspects ofthe initiative from the experience of Côte d’Ivoire and Uganda, where currently about600 and 900 patients respectively are receiving antiretroviral therapy.Rational drug selection and drug useAdvisory boards in both countries defined treatment policy, and training efforts weresuccessful in ensuring physician compliance with the proposed treatment guidelinesin the referral centres participating in the initiative. The guidelines and training took acomprehensive approach to the management of patients with HIV, including theiropportunistic infections and diseases. However, the procurement guidelines focusedalmost exclusively on antiretroviral therapy until 1999. Since then, at the insistenceof UNAIDS, both countries have shown a greater interest in the management ofopportunistic diseases. Anticipating the March 2000 consultation on cotrimoxazoleprophylaxis (see Box 20, page 106), Côte d’Ivoire and Uganda adopted guidelines onusing this drug combination for the prevention of opportunistic infections in peoplewith HIV. The increased emphasis on drugs for opportunistic infections will make the–––>103