Why the Fight Against AIDS Is Not Over

Dec. 1, 2009 — -- During my visit to Zimbabwe at the beginning of this year, I had the chance to meet people infected with HIV and their families. I will never forget the old woman I met in Lower Gweru in rural Zimbabwe. She showed me her house and I met several young children from her family. The woman explained that she and her husband were the only adult survivors after all her children had died of AIDS.

Now she was caring for 16 grandchildren. The oldest, who was 13, had already tested HIV positive and was under treatment with anti-retroviral (ARV) drugs. She was very grateful for the support she got and the treatment provided for her children by Doctors Without Borders (MSF), but it was by far not all she needed.

At the time of my visit, the world was talking about the cholera outbreak in Zimbabwe. Although that outbreak was the largest ever recorded, in terms of human loss it lagged far behind the real medical problem of the country. Within the space of just two weeks, more people died of AIDS than during the whole six months of the cholera outbreak. Every day, 400 people in Zimbabwe die of the disease.

Dire Situation

Despite great gains in the treatment of AIDS, the situation of the vast majority of people infected with HIV in the world remains dire. The latest data on HIV/AIDS shows a small reduction in the number of new infections and deaths, but 2 million people still die of the disease every year -- thousands every day. For every person put on HIV treatment, there are three new infections. In the six worst-affected countries -- Swaziland, Botswana, Lesotho, Zimbabwe, Namibia and South Africa -- AIDS is the leading cause of death.

Doctors Without Borders has been treating people with anti-retroviral drugs against HIV/AIDS since the year 2000. We currently have more than 140,000 patients in over 30 countries receiving the life-prolonging treatment. Today more than 4 million people around the world have access to anti-retroviral therapies -- but more than 6 million are still in need of urgent treatment.

At the moment, it is clear that donors are starting to question the need for further efforts in the area of HIV funding. Initial reports suggest that countries are under pressure to cut back their spending on ARV therapy in order to reduce costs. The Global Fund, one of the major funding mechanisms for HIV/AIDS treatment, needs new funds to provide for new projects beyond 2010.

Additional problems also exist regarding HIV drugs, which are essential to treating the disease. Here we are facing a crisis that has the potential to overturn the current successes in HIV treatment. After a long period of decline, prices for medicines to treat HIV are increasing again, because doctors today need newer drugs to treat HIV/AIDS.

There are two reasons for the need to switch treatments. First, the virus develops resistance to existing drugs over time. Secondly, the side effects of some drugs can become unbearable.

These newer treatments are much more likely to be patented or subject to patent disputes, which means that there will be no cheap generic versions in the near future. The resulting dramatic increase in drug prices is a major threat to the sustainability of HIV treatment programs.

Declining Mortality

This comes at a moment when the results of concerted efforts have started to pay off. Mortality due to AIDS is declining in some countries, prevention programs mean that fewer newborns are infected, there is significantly better treatment of AIDS-related diseases and more and more people are gaining hope of continuing to live despite being diagnosed HIV-positive, which used to be the equivalent of a death sentence.

But the fight is not over, nor have we, the donor countries, done enough to reach the majority of people living with HIV and AIDS. Greater efforts are needed and more money must be invested in health care for the world's poor. It is not acceptable that the most vulnerable are once again those who have to suffer because of the financial crisis, expensive wars and the West's feeling that it has already done enough.

A first step toward improving the situation would be a so-called patent pool for anti-retroviral drugs. Such an entity would bring together the patent rights for HIV drugs in developing countries. Under the program, drug companies would still get their royalties and would share their patents with generic drug manufacturers and research institutions. These could then produce cheaper drugs, and even work on developing desperately needed pediatric formulations for ARVs to treat children living with HIV. Everyone would win.

The decision about such a patent pool currently lies with the pharmaceutical companies. Are they willing to give up some control over patents in developing countries? MSF believes there is no alternative. Life-saving drugs are different from Hollywood movies or music -- access to them must not be blocked by intellectual property rights. You can help by joining MSF's "Make It Happen" campaign and writing to drug companies to urge them to put patents in the pool.

Keeping Their Promise

In Germany, the new government has yet to demonstrate whether it is committed to fulfill the promises made at the G-8 summits in Germany and Japan in 2007 and 2008. The G-8 countries promised to significantly increase the financial efforts to reach the goal of universal access for treatment and care by 2010. During the G-8 summit 2007 in Heiligendamm, the German government alone pledged to provide €4 billion by 2015 to help treat infectious diseases including HIV/AIDS. But we are still very far away from this target.

We urge Chancellor Angela Merkel and Development Minister Dirk Niebel to keep Germany's promises, and to increase German spending on health care in developing countries to about €1 billion annually. It is time to deliver.

Frank Dörner is general director of the German office of Doctors Without Borders (Médecins Sans Frontières).