The price of treating AIDS

Christian Century, Oct 20, 1999

THE HIGH COST of drugs and treatment for people with HIV/AIDS is a matter about which the Southern African Catholic Bishops' Conference (SACBC) is "gravely concerned." South Africa has approximately 1,500 new HIV infections daily. About 10 percent of the country's population of 43 million are affected by HIV/AIDS, according to Robert Shell, head of the population research unit at the East London campus of Rhodes University. South Africa's Department of Health says about 65 percent of all new infections are among young people between the ages of 15 and 25.

A month's supply of the antiviral drug AZT costs $80, while the more effective "cocktail" of a combination of three protease inhibitor drugs which suppress the spread of the HIV virus in the body costs about $334 a month--far beyond the reach of the majority of South Africans. Sixty percent of South Africa's population live on a monthly income ranging from $80 to $550, reports Molefe Tsele, director of the Ecumenical Service for Socio-Economic Transformation.

The statement from the bishops comes against the background of a legal tug-of-war between South Africa and the U.S. about the global pricing system of AIDS drugs. According to this system, drug companies have divided the world into different price zones, based on what the average middle-class patient can pay. Only about 5 percent of white South Africans are believed to be infected with HIV/AIDS, but their high average income has placed South Africa in the category of the rich countries that pay premium prices for the drugs.

South Africa's department of health has tried to break out of this pricing system, wanting to import drugs more cheaply from poorer countries which have been allocated a lower price. South Africa could also manufacture the drugs itself, but if it did so it would be forced under patent licensing protocols to set prices close to those of the developed world.

Bart Cox, coordinator of the HIV Programme of the Anglican Church in the Johannesburg archdiocese, said that in 1997 the South African government began the process of passing legislation to allow it to manufacture AIDS drugs and ignore patents. But local subsidiaries of U.S. pharmaceutical companies started legal action against the government. "The U.S. government meanwhile has withdrawn objections, but the local pharmaceutical companies only suspended their court action," Cox noted.

In its statement, which was released on September 22, the SACBC said it was "gravely concerned about the inordinate delay in making affordable drugs and treatment available to those infected with serious illnesses, in particular HIV/AIDS." Added the SACBC: "In recent months, many leading governmental, commercial, community and religious agencies have declared their concern about the plight of people with AIDS. What remains is for these expressions of concern to be translated into action."

The bishops also called on the relevant pharmaceutical companies and government departments to give practical assistance to all in need of health care, especially the very poor. The SACBC'S general secretary, Richard Menatsi, commented that at this point he does hot want to accuse drug companies of getting rich at the expense of people living with AIDS in South Africa.

"The position of the bishops is not to condemn but, at this stage, to care for the poor and work out how to reduce HIV infections and AIDS deaths," Menatsi said. "We are not in attacking mode yet, but if the pharmaceutical industry remains intransigent, we will go on the offensive."

The bishops' statement came in response to a call for churches to back the Treatment Action Campaign, launched last year by the National Association for People Living with AIDS. According to the statement, the Catholic Church supported the campaign to the extent that it was "working to ensure that people with AIDS have access to quality treatment that can be afforded; that new infections are prevented or at least minimised by change of behaviour and that the state makes quality and affordable health care available to all." Menatsi emphasized the reference to a change in sexual behavior, saying the bishops were concerned about the "ethical dimension." The Catholic Church continues to reject the use of condoms.

The SACBC, based in Pretoria, South Africa, also encompasses Botswana and Swaziland. AIDS infection rates in southern Africa range from 8 to 25 per cent of the adult population, researchers say. In sub-Saharan Africa as a whole, approximately 34 million people have been infected with the HIV virus. Of these, 11.5 million have died, and about one-quarter of the deaths have been among children. More than 80 percent of all AIDS deaths have occurred in this region. Most of the region's governments have yet to acknowledge publicly that the epidemic even exists.