“The price of the newer medicines we need is set to go through the roof, just as donors decided to retreat from their commitment to expand AIDS treatment,” says Dr. Gilles van Cutsem, MSF’s medical coordinator for South Africa and Lesotho.  “As doctors trying to treat people with HIV/AIDS, we feel like our hands are being tied behind our backs.”

Lesotho © Zethu Mlobeli/MSF
MSF nurse Patricia Nyoni examines baby Relebohile, who is co-infected with HIV and tuberculosis.

The World Health Organization’s (WHO) latest recommendations for AIDS include treating people with better tolerated drugs, and treating earlier. The revised strategy calls for treating people before they become ill from opportunistic infections such as tuberculosis.  Data just published from MSF’s project in Lesotho shows the value of this new strategy: providing people with treatment earlier led to a 68 per cent reduction in deaths, a 27 per cent reduction in new diseases, a 63 per cent reduction in hospitalization, and a 39 per cent reduction in people defaulting from care.

This “treat early” strategy has a benefit to individuals, but also to society, as it makes people with HIV less infectious and hence less likely to transmit the virus.  Research in Africa has shown that treating AIDS can reduce heterosexual transmission of the virus by 92 per cent.

“The evidence of what we need to do in order to turn the tide of the epidemic is mounting,” says Dr. van Cutsem. “But just as we’re seeing the promise of the latest treatment recommendations, the money that donors are allocating to HIV/AIDS is stagnating. Even South Africa, a middle-income country with the largest ART [antiretroviral therapy] program in the world, will struggle to implement the full WHO recommendations if its Round 10 proposal to the Global Fund is not approved.”

Lesotho © Zethu Mlobeli
Children playing with MSF counsellors as part of a support meeting for kids with HIV.

The Global Fund recently received only $11.7 billion in pledges, compared to the $20 billion it has said it needed. The U.S.-funded President’s Emergency Plan for AIDS Relief, which supports at least half of all people on HIV/AIDS treatment in developing countries, is flat-lining funding for the third year in a row.

At the same time, rich countries are working to give unfair advantages to companies that make patented products, limiting access to generic medicines and raising prices.  Eighty per cent of the AIDS medicines MSF uses to treat 160,000 people come from generic producers in India, the so-called ‘pharmacy of the developing world,’ as do more than 80 per cent of donor-funded AIDS medicines on a global scale.  India’s position as key producer of affordable medicines has already been compromised by World Trade Organization rules that obligate the country to grant patents on medicines.

Yet India has a patent law that imposes strict limits on what can and cannot be patented, in the interest of public health.  Multinational pharmaceutical companies have tried and failed to have this law overturned, and now the European Union is taking up their fight. As a part of free trade agreement negotiations with India, Europe is pushing for policies such as ‘data exclusivity,’ which would act to restrict even further generic producers’ ability to put more affordable generic medicines on the market.  If Europe wins, access to affordable generic versions of newer medicines needed to tackle HIV/AIDS will be severely compromised.

“We can’t afford to simply watch rich countries chip away at our ability to treat people living with HIV/AIDS,” says Dr. Tido von Schoen-Angerer, executive director of MSF’s Campaign for Access to Essential Medicines.  “We urge people to take a stand and say they do not support the European Commission doing the bidding of drug companies.”

MSF has been providing antiretroviral therapy since 2000 and today treats more than 160,000 people living with HIV/AIDS. Five million people are on treatment in developing countries today.  This represents important progress, but ten million people are still waiting in line and will die within the next several years if left untreated.