The World Health Organisation (WHO) has asked in its new guidelines that anybody with HIV get anti-retroviral drugs. The guidelines are being heralded as a significant announcement which “cannot be overstated” according to Tari Hanneman, the Deputy Director of the Health and Ageing Programme and the HRC Foundation.
These new guidelines mean that all 37 million people worldwide suffering from AIDS will be on ARSs. This will have the effect of preventing 28 million new infections and 21 million AIDS death by 2030. This is excellent news, but one wonders how the guidelines will apply on the ground. If in the western world, ARVs are routinely offered to at-risk populations, things are a little more tricky in Africa.
Africa is the continent the most impacted by the HIV virus. It is estimated that 69% of the HIV-positive people worldwide live in Africa. 91% of the world’s HIV-positive children live in Africa. More than one million adults and children die every year in Africa from HIV/AIDS. Saying that the situation is alarming and something needs to be done is an understatement.
The biggest obstacle is cost. To alleviate that, the World Trade Organisation (WTO) allowed in 2003 developing countries to import less costly copies of patented drugs. That allowed prices to drop, thanks to the Indian generics manufacturers making use of that law. But even that compromise was flawed. Strict WTO’s patent rules now only allowing countries to issue compulsory licences for domestic use means that many African countries without local pharmaceutical-manufacturing industries cannot give their citizens cheap ARVs. That’s 37 African countries.
Then, there is the reality of the culture which must not be overlooked. Being diagnosed HIV-positive is synonymous with a death sentence for many Africans who choose then not to know their HIV status.
While the guidelines are good and might provide a tool for lobbying, although how effective a tool remains the billion-dollar question. Mandeep Dhalival, the head of the UN Development Programme HIV/AIDS Human Rights and Gender division worries that “re-opening the agreement at the WTO may not be the strategic thing to do. We could end up with a worse agreement than we have now.” So there we have it where cheap generic drugs are concerned.
In the meantime however, one way African governments could entice their populations to know their HIV status might be to better train their health workers on confidentiality matters. Women at antenatal consultations in Côte d’Ivoire routinely complain of the result of their HIV test being divulged within earshot of patients and other health workers. Lowering the voice in a roomful of other patients does not make effective confidentiality practices.
While the who ambition to “expand access to treatment being at the heart of a new set of targets set for 2030 with the aim to end the aids epidemic by 2030 “ is a noble one, there are many issues that still need to be addressed for that ambition to become a reality.