Can Africa handle Aids drugs?

By Patrick Jackson
BBC News Online

If President Bush meets his promise of $15bn and the EU follows his lead, this could be the year that real money is finally brought to bear in the battle against HIV/Aids.

Timing is all when treating babies born to infected mothers

Twenty years after HIV was discovered by scientists, the rich countries seem to have come around at last to the idea of funding a global campaign, and nowhere needs greater help than sub-Saharan Africa.

But a US pioneer of HIV/Aids research, Professor Robert Gallo, has suggested to the BBC that "throwing drugs" at that region could be a recipe for disaster.

The truth, it appears, is that bringing hope to the lives of the four million sufferers in urgent need of medicines there has as much to do with creating proper health care infrastructure as delivering the drugs.

I do understand the concerns of Dr Gallo but a country shouldn't have to choose between a better health infrastructure, which would take years to implement in most African countries, and the immediate delivery of the much needed antiretroviral drugs Banchi, Addis Ababa, Ethiopia Have your say: Is access to Aids drugs in Africa fair?

Doctor Gallo was speaking from Paris where he is attending the International Aids Society conference.

Dominating the 2003 conference is the issue of getting drugs to the poor - or "the challenges of expanding access to treatment in resource-limited settings", as the IAS puts it.

In one of the conference's keynote speeches, South African statesman Nelson Mandela called on European leaders to match the funding pledge made by the American president in January.

Mr Bush had, he said, "moved the debate from hundreds of millions of dollars to tens of billions of dollars".

Activists in the audience seized the attention of the media just after he spoke with a chant of "Where's the 10 billion?" - the estimated annual cost of treating the world's HIV/Aids sufferers.

But, in the words of Dr Gallo, "it's not just the money".

Short-term relief, long-term crisis

"It is absolutely true that we can't just throw the drugs," he told a BBC News Interactive forum.

It was not, he said, a case of declaring "Here, take the drugs, go take them to everybody, here's drugs for everyone in Africa".

Gallo is head of the US-based Human Virology Institute

Having studied the epidemic for 20 years, Dr Gallo warned against irresponsibly doling out antiretrovirals - the drugs which can prevent HIV developing into Aids.

Through uncontrolled deliveries to a region lacking in health infrastructure, he argued, donors would be courting the risk of creating new strains.

"We will have a lot of happy people for two, three, four, five years," he said, "but, if the infrastructure is not there, we are going to create multi-drug-resistant mutants.

"So at the same time that we have the drugs for developing nations we've got to help build their infrastructure. This is vital."

Oxfam, the UK-based development organisation campaigning for free HIV/Aids drugs, agrees that the two things go together.

Having a health care system and the right drugs is "like the chicken and the egg", spokeswoman Amy Barry told BBC News Online.

Field test

The Boehringer Ingelheim corporation, Germany's leading privately held pharmaceuticals company, agrees that its antiretrovirals must not fall into the wrong hands.

When a doctor is applying its nevirapine drug for HIV-positive mothers, proper timing is vital to a healthy birth, spokeswoman Julia Kleinmann told BBC News Online.

AIDS WORLDWIDE 42m people have HIV/Aids 5m became HIV+ in 2002 3.2m died from Aids in 2002 SOURCE: UNAids 2002 Aids around the world

Boehringer Ingelheim offers nevirapine (under the trade name Viramune) free of charge to all developing countries and so far 44 worldwide - including many in sub-Saharan Africa - have taken up the offer.

In addition to its antiretroviral work, it is part of the Accelerating Access Initiative with the United Nations' Aids body (UNAids) which is aimed at cutting the cost of drugs to treat actual Aids in developing countries.

From Congo to South Africa, the corporation mainly uses non-government organisations (NGOs) such as Medecins Sans Frontieres (MSF) as its distributors.

Each NGO must, Ms Kleinmann stresses, must demonstrate that it can run a viable health care programme.

"To give away a drug is one thing - taking care of the administrative side is another," she says.

"You can't just send a drug to an airfield with nobody to take further care of it."

Huge demand

The German company says it is open to any body which can guarantee the proper application of its medicines and finds it convenient to operate through NGOs.

Whilst most sub-Saharan states lack the kind of formal health care systems which Robert Gallo and other HIV/Aids doctors are used to operating through, the NGOs are managing to provide some relief with the aid of donors like Boehringer Ingelheim.

But, according to UNAids, of the four million people in the region in need of antiretrovirals, a mere 50,000 have access to them.

With Aids claiming up to 1,000 lives a day in some countries, the case has never been stronger for mass - but proper - treatment.