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 toinfants, facilitating the lowering of drug prices, providing debt relief to sub-SaharanAfrican nations and expanding the U.S.s financial role could greatly ease the AIDSepidemic in Africa, a Public Citizen expert told Congress today.
Dr. Peter Lurie, deputy director of Public Citizens Health Research Group, onThursday testified before the Senate Subcommittee on African Affairs, part of theCommittee on Foreign Relations, and outlined a comprehensive plan for addressing theepidemic.
“My purpose today is to describe the details of astraightforward 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 myopinion, these are the highest priority elements of any plan that seeks to reduce theterrible suffering wrought by this disease. Many of these elements have been shown to beextremely cost-effective, and others would cost the U.S. government nothing toimplement.”
Lurie suggested the following:
1) Prevention of mother-to-infant transmission of HIV. Recentdata from U.S. government-funded studies demonstrate conclusively that short courses ofantiretroviral drugs that cost as little as four dollars per mother can reducemother-to-infant HIV transmission by up to 50 percent. In areas where a substantialproportion of women are infected with HIV, it would probably be cost-effective to simplytreat all pregnant women, without even testing for HIV. If just one thing was done toaddress the epidemic, this would be it, Lurie said.
2) Treatment of sexually transmitted diseases. It iswell-known that sexually transmitted diseases (STDs) increase the transmission of HIVinfection and that ensuring a regular supply of medications for STDs and theinfrastructure to deliver them can reduce the spread of HIV. Unfortunately, a huge gapexists between science and policy, largely for economic reasons, Lurie said. Large partsof sub-Saharan Africa do not enjoy a stable supply of pharmaceuticals. Efforts should beconcentrated among those most at risk for infection, such as sex workers, migrants andadolescents.
3) Compulsory licensing and parallel importing of drugs. Thepharmaceutical industry has argued that the possible development of HIV strains resistantto the current antiretroviral drugs, due to difficulty complying with the often-complexdrug regimens, might actually leave patients worse off if they were treated. This argumentis without scientific merit or moral basis, Lurie said. Many patients who are not fullyadherent with anti-HIV therapy do not develop drug resistance. There is evidence thatdrug-resistant strains may actually be less aggressive.
Compulsory licensing and parallel import proposals do not require any country toengage in these practices. Rather, countries are left to decide for themselves if theywish to use these legal mechanisms. But preventing compulsory licensing and parallelimports in blanket fashion robs developing countries of that choice. For thepharmaceutical industry to argue that people in sub-Saharan Africa are best protected byus 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 tothe U.S. government.
4) Treatment of opportunistic infections.
It is not usually HIVitself that kills people with AIDS, but rather a series of infections and cancers thattake advantage of the AIDS patients weakened immune system, Lurie said Some of theseopportunistic infections can either be treated or prevented using existing drugs such asfluconazole, isoniazid and trimethoprim-sulfamethoxazole that are either currentlyinexpensive or could be made so by compulsory licensing or parallel importing.
5) Debt relief.
Much attention has been focused upon theeconomic and social impact of the HIV/AIDS epidemic on African economies, but very littleattention has been focused on the notion that specific economic policies may havecontributed to the severity of the epidemic, Lurie said. In exchange for loans from theWorld Bank and the IMF, these institutions have imposed structural adjustment policies ondeveloping countries: export-oriented economic models that also undermine the publicsector in ways that are detrimental to controlling HIV/AIDS. Debt relief is therefore anecessary component of any strategy addressing HIV/AIDS.
Expanded U.S. government role. Several of the elementsof this six-point plan can be implemented with little cost, particularly to the U.S.government, but expanded funding is needed. Even the presidents increased budget forinternational HIV/AIDS efforts is a decidedly anemic response to the magnitude of theproblem, amounting to under $10 per person currently living with HIV/AIDS, Lurie said.
“If we are truly interested in stemming this terrible epidemic, the contributionof the worlds richest country will have to go beyond mere words of support toencompass the kinds of concrete actions described in this testimony,” Lurie said.