UNAIDS: The First 10 Years

UNAIDS The First 10 Years76outcomes with antiretrovirals in low-income countries. So the myth that antiretroviraltherapy was too difficult [to be provided in poor countries] had been slashed”.Reflecting on the initiative’s success, three experts wrote in 2007: ‘The Drug AccessInitiative was a milestone towards the now well-accepted principle of differential pricingfor medicines for developing countries at a time when there were few generic suppliers ofantiretroviral drugs’ 8 .In 1999, when the generic companies began to enter the market in a more significant way,some nongovernmental organizations and activists criticized UNAIDS for engaging onlywith the big pharmaceutical companies. Perriëns explained: “The main source of criticismwas from the anti-globalization activists who thought that we had made ourselves hostage tothe research-based pharmaceutical industry and their intellectual property agenda”.Initially, UNAIDS had concerns about introducing generic drugs into the Drug AccessInitiative. The quality of generic drugs was not internationally recognized and there was asyet no legal framework, as the Doha Agreement would provide some years later. ‘But thenin Uganda, one of the treatment centres involved in the initiative started sourcing genericsfrom the Chemical, Industrial and Pharmaceutical Laboratories (CIPLA) in India, and theDrug Access Initiative in Côte d’Ivoire began sourcing Zidovudine from Combino Pharmin Spain. The experience of the Brazilian AIDS control programme with local production ofantiretrovirals at lower cost added to evidence of efficacy of generic drugs 9 .From its earliest days, the UNAIDS Secretariat was criticized by activists and some membersof cosponsoring agencies for engaging with brand-name pharmaceutical companies. Butbroad-ranging partnerships have always been an essential part of UNAIDS’ strategy.Building partnershipsUNAIDS’ intensive partnership-building (including with pharmaceutical companies) over thefirst two years was beginning to reap results, resulting in alliances with nongovernmentalorganizations, people living with HIV and the private sector. Partnership with experts inepidemiology was perhaps the most productive.Bernhard Schwartländer, former Chief of the UNAIDS epidemiology unit and now Directorfor Performance Evaluation and Policy at the Global Fund to Fight AIDS, Tuberculosis andMalaria, spoke about the value of partnerships to UNAIDS’ work: “UNAIDS is only as goodas the partnerships it can engage in … Partnership pushes our work to the highest possible8Schwartländer B, Grubb I, Perriëns J (2007). ‘The 10-year struggle to provide antiretroviral treatment to peoplewith HIV in developing countries’. The Lancet, 368.9Ibid.