HIV AIDS

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HIV / AIDS Pharmaceutical Issues

• Richard Laing
• Department of International Health, School of
  Public Health Boston University

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Global Burden of Disease(Selected Diseases)
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Key Facts about HIV and AIDS

• Incubation time from HIV to AIDS about 8 years
• The present AIDS situation in countries reflects
  the HIV situation of 8 years ago
• For most African countries the HIV situation has
  stabilized with some countries having rates over
  25 of adults
• Except for Uganda and Senegal, the AIDS situation
  will get worse for at least the next 5 to 10
  years and maybe longer

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Demographic Effect of HIV /AIDS

• Leading to negative population growth in some
  countries
• Women affected at younger age causing a missing
  care generation
• More adults in their 60s and 70s in Botswana in
  20 years time than there will be adults in their
  40s and 50s

http//www.unaids.org/epidemic_update/report/Epi_r
eport_chap_devastation.htm
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Population Impact

• Washington, 22 May 2001 (RFE/RL) -- Paul Delay,
  the director of HIV/AIDS programs for the USAID,
  said the deaths of women early in their
  childbearing years is causing negative population
  growth in at least three African countries --
  Botswana, South Africa, and Zimbabwe.

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Impact on Children
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Risk of Death
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http//www.unaids.org/epidemic_update/report/Epi_r
eport_chap_devastation.htm
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Impact of HIV/AIDS on countries

• Orphans 11 million in Africa and counting
• Mortality rates rocketing (In Zimbabwe 14-45 CDR
  increased from 7 to 30/1000
• Social Impacts on all members of society
• Economic Impacts on disposable income,
  productivity, training costs etc
• Health system Impacts on demand, supply of
  services and staff morale and numbers

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HIV/AIDS and TB in context

• The present HIV/AIDS and TB epidemic in Africa is
  the worst public health disaster since the Great
  Plague of 1347-1351 in Europe!

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Branded AIDS drug price vary greatly (2000 prices)
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Brazils success story

• Brazil aims to treat all AIDS patients
• Now treating about 85,000 of 120,000 eligible
  patients with good outcomes
• Producing or importing drugs at good prices. Have
  threatened CL to drive prices down
• Willing to help other countries

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Uganda and Cote dIvoire Drug Access Experience

• UNAIDS and Drug Industry combined to provide
  reduced cost drugs for those who could afford
  500 to 750 per month
• Outcomes variable with nearly 50 one year
  mortality but many received dual therapy and
  costs to patients were a barrier
• MTCT with Neverapine appears to reduce
  transmission from about 25 to 12-13 at cost of
  4 but breastfeeding and cost of screening issue
  a problem

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Recent Developments in Improving Drug Access in
Africa

• Drug Companies attacked by John Le Carre, WSJ,
  NYT, and activists
• Withdrew from SA court case
• Donations and low cost offers
• Issue now of infrastructure
• Harvard Consensus statement
• Kofi Annan fund established
• Not clear what will actually happen???

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Drug Prices and Related Issues

• Prices now may be as low as 500 per year with
  probably 70-80 annual survival
• But who will receive?
• How will the drugs be monitored? CD4 and viral
  load testing
• Who will pay? Private sector? Employers? NGOs?
  Public Sector? No one?

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What I would like to see

• Effort to involve all sectors in responding
  private providers, employers and mission
  organizations with governments
• Multiple operational field trials of ARVs
• Maintain pressure on developed countries to
  support AIDS activities but not just for drugs
  but for all aspects of infrastructure

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Infrastructure - All sectors

• HUMAN RESOURCES highest priorityincl local,
  regional international training
• Rehab buildings
• Provide transport incl running costs
• Support PHC drug supply Management
• Assist with management incl MIS supervision

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Conclusion

• AIDS situation in Africa situation will get
  worse!
• How much worse depends on global response led by
  US
• Message for Asian countries. Take action to
  prevent now!
• In 1993, the HIV rate in Brazil and South Africa
  was 0.6. Today the rates are Brazil 0.5 and
  South Africa 30!!!!!