War on AIDS: Money nightmare seems set to return

AFP, MEXICO CITY - "Save someone's life and you have a burden for life," goes the proverb, and its truth seems horribly apt for the campaign against AIDS.
After years of battling for funds and anti-HIV drugs for needy people in poor countries, activists are finally making headway.
But the 17th International AIDS Conference that ended here Friday has highlighted the dilemma of this success: the more lives you save, the more the bill goes up.With no cure or vaccine in sight, and with the lifeline comprising a regimen of powerful drugs that must be taken daily, the money crunch is doomed to return -- and with a vengeance."It is extremely improbable that we will have the structure and financial ability to take on all the people who require ART [antiretroviral therapy] and then treat them for life," Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), warned on Wednesday.In 2007, 8.1 billion dollars were mustered to fight HIV/AIDS in the developing world, home to 90 percent of the 33 million people with the human immunodeficiency virus (HIV), according to the UN agency UNAIDS.That effort is already a Herculean advance compared with the start of the decade, yet even so, less than a third of the 9.7 million poor people whose immune systems are so impaired by HIV that they urgently need the drugs have access to them.At the current pace of scaleup, 22 billion dollars will be needed in 2015 just to get antiretrovirals to eight million infected people.And that's just the minimum.If the world is serious about achieving universal AIDS drug and care access by 2010, a goal enshrined by the UN General Assembly in 2006 and endorsed by the Group of Eight (G8), the bill rises almost exponentially.The cost of universal access would be 42.2 billion dollars in 2010, five times 2007's expenditure -- and in 2015 it would be a whopping 54 billion dollars, to keep 21.9 million infected people alive."If you add the current 35 billion that is being spent in the developed world, you're talking at that time [about annually needing] almost 90 billion dollars, in a continuous fashion," Seth Berkley, head of the New York-based International AIDS Vaccine Initiative (IAVI), told AFP."And that doesn't even take into account complications with secondary resistance to drugs and other issues."With no cure in sight, the pendulum of debate is swinging from treatment to prevention to stop the tally of infections from rising further.One of the big focuses of the conference was on how to reinvigorate grassroots work.This often-overlooked business involves promoting safe sex among young people, ending coercive sex for women and easing stigma against gays, intravenous drug users, sex workers and other groups where the virus finds fertile ground for leaping into the wider population.By far the brightest news from the conference was about male circumcision.Surgical removal of the foreskin decreases the risk of contracting HIV by 65 percent, according to the latest data from a US-led study in Kenya.Those findings, three and a half years after the project began, compared favorably with 60 percent protection measured at the two-year mark.This extraordinary evidence will put pressure to launch a broad campaign of circumcision among men in sub-Saharan Africa, where two-thirds of the world's HIV population resides.Experts warn, though, that such a campaign has to be thoroughly prepared and financed, as botched operations and cultural or religious resistance could cause the whole strategy to backfire disastrously.Veteran AIDS campaigners, questioned at the conference by AFP, agreed that there seemed to be a lull in a war that has claimed more than 25 million lives since the disease emerged in 1981.Stephen Lewis, former UN special envoy for AIDS in Africa, attacked what he called "a kind of curious passivity among the international AIDS establishment" after the achievements in money-raising and drug access over the past two or three years.He believed that "generational change" would come, as younger people would take the baton handed on by the men and women in their fifties and sixties who had been fighting AIDS for two decades or more -- a sign indeed that the world is in for the long haul in combating this peril.

Special Notes :1)

Aids prevention startegies involve curative and preventive steps. Money will never be sufficient for all cases of HIV/AIDS. The emphaisis on spending funds only for drugs may have to be changed to spending funds on preventive interventions, and developing vaccine. Money falls short of providing drugs for 2nd line tretament. It fell short in the campaign 2 by 5 intiative, and will be short in any future such startegies. Available funds will never catch up the requirement, therefore higher percentage may be spent on preventive strategies, in future.

Special Notes :2)

I feel pesimistic about the future. Rich countries are experienced financial crisis. Low resources setting are expanding the ARV coverage in areas where infraestructure is not good yet as to provide monitoring. As a consecuence, patients are failing several months or year before to change to second line, and at this time the virus usually is multidrug resistant. It is difficult to afford second line regimens because all drugs are protected by patents. Mexico declared that in 6 year will be difficult to warranty universal coverage with the current HIV drug prices, this situation will be enormeously worse in low resource settings. Viral load monitoring and price reductions are need to expand the second line treatment to everyone. Brazil provide an example in how to negotiate ARV prices, but is is not enough for most places in the world. In any way. Pharmaceutical industry in never loossing monew by price reductions. Don be confused. MONEY IS NOT THE MAIN PROBLEM. THE PROBLEM IS DISTRIBUTION. IN A WORLD WHERE SOMEBODY IS SPENDING IN TOURIST FLIGHT INTO THE SPACE THE SAME AMOUNT OF MONEY THAT COULD COVER 1.500 YEARS OF ARV ANYBODE CAN TELL THAT THERE ARE NO MONEY. We need to define priorities (pharmaceutical profits or lives), strategies (which first line and second line), escential standar of care (takin HIV as an excuse to improve Health access), and operational strategies (favouring the drug manufractur in most affected countries)Other proposals includes MSF patent pool, one interesting mechanism where the patents of several drugs are bought to the Pharmaceutical industry and then negotiated in pool. Regional mechanism of price reductions are also need. We need to reduce the poverty, increase the quality of health care in order to fight against HIV.