Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector

Last week the United Nations, UNAIDS, and WHO launched a new report focusing on access to treatment for people living with HIV/AIDS in low and middle income countries. The findings were mixed: although treatment in these countries increased 54 percent over 2005, coverage in general is patchy and inadequate. And the UN's stated goal of achieving universal access by 2010 is now only 3 years away.

Indeed, the numbers reflecting need are alarming. The report, appropriately named Towards Universal Access, shows that:

• last year only 11 percent of HIV-positive pregnant women were receiving treatment to prevent transmission to their children;
• only 15 percent of children in need of treatment had access to it;
• there are 5 million people in low- and middle- income countries who still need treatment.

The report pitches a few recommendations to overcome these statistics. Some examples:

• More attention to mothers and children;
• More attention injecting drug users, an emerging problem in Africa;
• Control of sexually transmitted diseases to prevent HIV transmission.

Toward Universal Access also lingered on the cost of drugs; the report comes at a time of heated debate between Abbott Laboratories and Thailand’s Ministry of Health. In early 2007, Thailand issued a compulsory license for Kaletra, prohibiting its patent. Abbott tried to assuage the government by offering Kaletra at a reduced price. When Thailand maintained its compulsory license, Abbott retaliated by offering a different version of the drug, Aluvia, to other developing countries at a reduced price. Just yesterday and after much criticism, Abbott changed its stance and agreed to offer Aluvia in Thailand at a reduced price, approximately $1000/person/year.

This concession has the potential to embolden other developing countries to take advantage of the compulsory license option of the TRIPS agreement and obtain second-line ARVs at a more affordable price.

As Toward Univeral Access states:

“With some exceptions in certain low-income countries the average prices paid for second-line regimens remain unaffordably high in low- and middle-income countries, where few or no prequalified generic alternatives are available.”

It further points out that access to second-line drugs in developing countries is completely disproportional to their financial abilities:

“…An average price of US$ 1600 per person per year is paid by South Africa for tenofovir + abacavir + lopinavir/ritonavir, whereas El Salvador pays US$ 7613 per person per year for the same regimen.”

The Abbott Laboratories/Thailand story was a small victory towards increasing access. But, as Lancet pointed out last week, it was achieved only after advocacy groups heavily pressured the WHO to be more aggressive with Abbott. Reliance on case-by-case advocacy efforts is not sufficient, either to convince pharmaceuticals to lower their prices or to empower governments to take advantage of their right to provide generic drugs.

To this end, Towards Universal Access issues a warning:

“Unless prices for second-line regimens fall significantly, countries will soon be confronted with budgetary constraints that may put treatment programmes at risk. It is vital to achieve further reductions in the prices of second-line drugs and to obtain more second-line generic alternatives.

Lancet offers a first step: "WHO can do more. Developing a robust plan on access to second-line drugs in collaboration with its partners...would be a good start. Such a move would show that WHO is serious about defending the interests of patients with HIV/AIDS."