One hundred clinicians and medical school faculty at one of the world's most prestigious universities have endorsed a blueprint for an international fund to provide antiretroviral therapy for up to 2 million Africans each year.
The blueprint closely follows a call for action issued at the Eighth Annual Retroviruses Conference in February by Jeffrey Sachs, Director of the Center for International Development at Harvard University.
"The HIV epidemic is a global catastrophe," said Dr. Bruce D. Walker, Professor of Medicine at Harvard Medical School, and one of the Statement's signatories. "It is compounded by tremendous inequalities in care that must be dealt with now, not only for moral and ethical reasons, but also because of political, social, and economic imperatives. It is time for a response, and this Statement is intended not only to intensify discussion of feasible solutions, but also to prompt immediate action."
The blueprint lists four major reasons why wealthy countries should support an international drug purchase fund:
- Humanitarian: 36 million individuals already infected will die unless they receive treatment
- Prevention: the growth of the epidemic could be controlled if a significant number of people receive treatment and thus become less infectious
- Global security: The loss of a generation could lead to huge poltical instability in Africa as the number of orphans grows (to an estimated 44 million by 2010 if the epidemic is not arrested)
- Economic: African nations are losing development gains and will suffer reduced growth and greater poverty for many years to come
The blueprint creates a target of having at least 1 million AIDS patients in Africa receiving antiretroviral therapy within three years, at a cost of about $1.1 billion per year. Additional costs of prevention programs and treatment other than antiretroviral therapy would require $3 billion per year, according to estimates of the UNAIDS international partnership, for an annual total of around $4.1 billion for both prevention and treatment. Assuming that three million people in Africa are brought under treatment by the fifth year, total costs for prevention and treatment would rise to around $6.3 billion per year.
"In 2001, the prices of medications have continued to fall rapidly," said Jeffrey Sachs. "Even though antiretroviral drug prices have declined to around $500 per year, this is still far above what poor countries can afford without donor assistance. Considering the combined $25 trillion gross national products of the high-income nations, the proposed donor support for treatment is a modest sum that will produce enormous economic, social, and political benefits for the world's poor countries hard hit by the pandemic."
The statement proposes not only a more widespread treatment approach, but also calls for carefully designed clinical trials to determine the best practices for delivering HIV therapy in resource poor settings.
"There is no question that HIV therapy is cost-effective in wealthy countries" said Dr. Kenneth A. Freedberg of Harvard Medical School, "and it can clearly save lives in poor countries in a cost-effective manner if administered properly. With this Statement, we propose a series of scientifically sound clinical trials to answer the most important questions facing us in this endeavor, including issues related to drug delivery, efficacy, monitoring, and the development of antiretroviral drug resistance." The plan also proposes designing targeted pilot programs that contribute directly to preventing the spread of infection, such as the inclusion of HIV-infected pregnant women and other groups with high risk of transmission.
The document also proposes that treatment should be administered by Directly Observed Therapy, and should integrate DOT tuberculosis treatment. Dual nucleoside analogue treatment, argued by some to be affordable and practical, should not be administered because it is a sub-optimal form of therapy.
"This document has the potential for enormous impact on global health policy," says Richard Marlink, executive director of the Harvard AIDS Institute. "As a result of widespread discussions within our academic community and with our African partners, individual faculty members involved in the HIV epidemic have decided to speak with one voice in addressing the increasing global need for AIDS treatment. The varied roles of the signatories in the struggle against AIDS - physicians, virologists, immunologists, epidemiologists, economists, human rights experts, and others -- contributes to the strength of the document and the chances of success of the proposed plans."
The Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries can be viewed online at: