Differential Access to Antiretroviral Drugs in the Third World: PEPFAR as a Mitigating Agent

The Acquired Immune Deficiency Syndrome (AIDS) caused by HIV is a scourge that is ravaging humanity. A 2005 global epidemic update by UNAIDS puts the total number of people living with HIV at 40.3 million (adults: 38 million; women: 17.5 million; children under 15 years: 2.3 million). The total number of deaths due to AIDS in 2005 was 3.1 million people (children under 15 years: 570,000). There are about 13 million AIDS orphans worldwide-over 90% of these orphans are in Africa. The number of AIDS orphans is projected to reach 25 million in 2010.
Most of the people living with HIV/AIDS live in the developing world.
Access to antiretroviral drugs and HIV care as a whole has been very difficult in the third world. Earlier on, we grappled with the problem of inadequate capacity. There was only a limited understanding about the dynamics of the disease. Many health facilities lacked the capacity to carry out even simple diagnostic procedures such as the rapid antibody tests. And when eventually this capacity was acquired, those who were positive were not able to procure the antiretroviral drugs that were just coming to the third world. The costs were prohibitive. At that time, in Nigeria, for instance, it cost the equivalent of four months salary to procure a month’s worth of antiretroviral drugs. Apart from the fact that many died from AIDS since they could not afford these drugs, it was difficult to carry out quality assurance on these drugs. Those bent on surviving the scourge got involved in some practices such as monotherapy, skipping doses, sharing medications with relatives and so on, laying a good foundation for multidrug resistance.
The third world is a complex place which has defied conventional economic theories. Poverty and disease exist alongside so much wealth. There is a very deep and wide gulf between the rich and the poor. The rich did not have much trouble procuring their antiretroviral drugs. Ofcourse, the rich also acquire HIV!
The WHO has been instrumental in ensuring universal access to antiretroviral drugs. There was the 3 by 5 campaign and recently again, the urgent call to scale up antiretroviral drug access especially to resource-constrained settings. In response, international donors have taken up the challenge almost in a fevered pitch. And in frenzy, many health facilities have opened up their doors, some stopping short of alluring donors.
PEPFAR (President’s Emergency Plan for AIDS Relief), a US government initiative, has served as a mitigating agent for some time in alleviating differential access to antiretroviral drugs in the third world. I am not about to sing the praises of PEPFAR but I simply submit that this program has achieved quite some. PEPFAR serves the center where I work. VCT (voluntary counseling and testing), laboratory investigations, antiretroviral drugs, contact tracing and home-based care, capacity building in terms of health personnel training, facility development and so on are all provided by PEPFAR.
And we have seen results. The patients directly benefit. Their follow-up indices gladden our hearts.
We still have a long way to go. The uptake of antiretroviral drugs in the third world is still unacceptably low considering the burden of the disease.
And it is time governments in the third world (as in Botswana) began to put in place the necessary framework to sustain HIV care when the donors have gone: the donors will not be here forever.