Feb. 24, 2000
Six Steps Can Ease the AIDS Epidemic in Sub-Saharan Africa
Public Citizen Expert Testifies Before Congress
WASHINGTON, D.C. — Reducing the transmission of HIV from mothers to infants, facilitating the lowering of drug prices, providing debt relief to sub-Saharan African nations and expanding the U.S.?s financial role could greatly ease the AIDS epidemic in Africa, a Public Citizen expert told Congress today.
Dr. Peter Lurie, deputy director of Public Citizen?s Health Research Group, on Thursday testified before the Senate Subcommittee on African Affairs, part of the Committee on Foreign Relations, and outlined a comprehensive plan for
addressing the epidemic.
“My purpose today is to describe the details of a straightforward six-point plan to address the HIV epidemic in sub-Saharan Africa,” Lurie said. “Certainly there is much more that can and ought to be done, but, in my opinion, these are the highest priority elements of any plan that seeks to reduce the terrible suffering wrought by this disease. Many of these elements have been shown to be extremely cost-effective, and others would cost the U.S. government nothing to implement.”
Lurie suggested the following:
1) Prevention of mother-to-infant transmission of HIV. Recent data from U.S. government-funded studies demonstrate conclusively that short courses of antiretroviral drugs that cost as little as four dollars per mother can reduce mother-to-infant HIV transmission by up to 50 percent. In areas where a substantial proportion of women are infected with HIV, it would probably be cost-effective to simply treat all pregnant women, without even testing for HIV. If just one thing was done to address the epidemic, this would be it, Lurie said.
2) Treatment of sexually transmitted diseases. It is well-known that sexually transmitted diseases (STDs) increase the transmission of HIV infection and that ensuring a regular supply of medications for STDs and the infrastructure to deliver them can reduce the spread of HIV. Unfortunately, a huge gap exists between science and policy, largely for economic reasons, Lurie said. Large parts of sub-Saharan Africa do not enjoy a stable supply of pharmaceuticals. Efforts should be concentrated among those most at risk for infection, such as sex workers, migrants and adolescents.
3) Compulsory licensing and parallel importing of drugs. The pharmaceutical industry has argued that the possible development of HIV strains resistant to the current antiretroviral drugs, due to difficulty complying with the often-complex drug regimens, might actually leave patients worse off if they were treated. This argument is without scientific merit or moral basis,
Lurie said. Many patients who are not fully adherent with anti-HIV therapy do not develop drug resistance. There is evidence that drug-resistant strains may actually be less aggressive.
Compulsory licensing and parallel import proposals do not require any country to engage in these practices. Rather, countries are left to decide for themselves if they wish to use these legal mechanisms. But preventing compulsory licensing and parallel imports in blanket fashion robs developing countries of that choice. For the pharmaceutical industry to argue that people in sub-Saharan Africa are best protected by us from the dangers of these drugs is paternalistic in the extreme, Lurie said. Furthermore, compulsory licensing and parallel importing can be implemented at no cost to the U.S. government.
4) Treatment of opportunistic infections. It is not usually HIV itself that kills people with AIDS, but rather a series of infections and cancers that take advantage of the AIDS patient?s weakened immune system, Lurie said Some of these opportunistic infections can either be treated or prevented using existing drugs such as fluconazole, isoniazid and trimethoprim-sulfamethoxazole that are either currently inexpensive or could be made so by compulsory licensing or parallel importing.
5) Debt relief. Much attention has been focused upon the economic and social impact of the HIV/AIDS epidemic on African economies, but very little attention has been focused on the notion that specific economic policies may have contributed to the severity of the epidemic, Lurie said. In exchange for loans from the World Bank and the IMF, these institutions have imposed structural adjustment policies on developing countries: export-oriented economic models that also undermine the public sector in ways that are detrimental to controlling HIV/AIDS. Debt relief is therefore a necessary component of any
strategy addressing HIV/AIDS.
6) Expanded U.S. government role. Several of the elements of this six-point plan can be implemented with little cost, particularly to the U.S. government, but expanded funding is needed. Even the president?s increased budget for international HIV/AIDS efforts is a decidedly anemic response to the magnitude of the problem, amounting to under $10 per person currently living with HIV/AIDS, Lurie said.
“If we are truly interested in stemming this terrible epidemic, the contribution of the world?s richest country will have to go beyond mere words of support to encompass the kinds of concrete actions described in this testimony,” Lurie said.