UNAIDS: The First 10 Years

Chapter 6By the end of theAAI, perceptionshad changed.Providing largescalecare andtreatment wasnow shown tobe feasible in thedeveloping world.Not everyone would be so unreservedly enthusiastic about the results. According to JamieLove, Director of Consumer Project on Technology: “Accelerating Access Initiative (AAI)played a negative role because it was an attempt to undercut the real important workthat was to be on generics. It was a public relations mechanism; it was a way of tryingto force developing countries to buy premium, high-priced products which undercut theeconomies of scale of the generics market. So it was really designed to keep prices higherfor AIDS patients instead of lower. It was really the wrong thing to do”.By the end of the AAI, perceptions had changed. Providing large-scale care and treatmentwas now shown to be feasible in the developing world. The inclusion of the possibility ofpurchasing antiretroviral drugs within the scope of the Global Fund and the availability ofWorld Bank financing for care and treatment were further evidence of the changed attitudeof donors to financing the purchase of antiretrovirals 25 . ‘Globally, governments, the UNsystem, bilateral donors, the Global Fund, and civil society increasingly were focusing ontreatment and care as part of their commitment to scaling up the global AIDS response’ 26 .This was all preparing the way for a far more ambitious project the following year.165There were mounting demands for access to treatment in low- and middle-income countriesand increasing evidence that antiretroviral therapy could be provided effectively in placeswithout Western-style health services – examples include Médecins Sans Frontières clinicsin South Africa, the work of Partners in Health in Haiti and UNAIDS’ two initiatives onDrug Access and Accelerating Access. The evaluation of the Drug Access Initiatives inCôte d’Ivoire, Senegal and Uganda 27 clearly establishes that antiretroviral therapy can besuccessful in Africa. ‘Virologic and immunologic outcomes, adverse events, and estimatedsurvival are similar among patients in African DAIs [Drug Access Initiatives] and ART[antiretroviral therapy]-treated patients in Europe and the USA’.Support from other donors was urgently needed to ensure technical support forprogrammes, sustainability rather than a project approach to treatment, and to strengthenhealth systems.But until late 2002, the donors, with the exception of France and Luxembourg, werereluctant to talk about treatment financing for people with HIV in developing countries.The “3 by 5” goal was received very critically by the donors in 2003.25Ibid.26UNAIDS (2004). Global Report 2004. Geneva, UNAIDS.27Katzenstein D, Laga M, Moatti J-P (2003). ‘The evaluation of the HIV/AIDS Drug Access Initiatives in Côte d’Ivoire,Senegal and Uganda: how access to antiretroviral treatment can become feasible in Africa’. AIDS, 17, July.