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INTERESTING TIMES

The old Chinese proverb 'May you live
in interesting times' has surely never
been mOre apt than in the current
HIVlAIDS arena in South Africa.
Last month the Pharmaceutical
Manufacturers Association, on
behalf of 39 drug companies,
unconditionally withdrew its
challenge to legislation - passed in
1997 but not yet implemented - that
allows the government to make or
buy cheaper drugs. The drug
companies, which include giants
Merck, Bristol-Myers Squibb,
GlaxoSmithKline and Boehringer
Ingelheim, had claimed that a section
of the 1997 law that allows South
Africa to import or make cheaper
drugs overrode their patent rights.
The patents are necessary, they said,
to encourage drug research. The
Health Minister, Manto Tshabalala-
Msiman9, is however quoted as
saying that the victory allowed South
Africa to pursue policies that she
believes are critical to securing
medicines at affordable rates and
exercising 'wise control' over them.

South Africa must still reconcile the
1997 law with its commitment to
honour international trade agree-
ments and patent rules. The Health
Minister said that the government
has invited members of the
pharmaceuticai industry and the
public to help draft the regulations goveming the law. Mirryena
Deeb, Chief Executive of the Pharmaceutical Manufacturers
Association, termed it 'a partnership, a settlement based on trust'.

Mark Heywood of Treatment Action Campaign believes that the
court case will embolden people in developing countries around the
world to stand up for medicines that are affordable.
GlaxoSmithKline's South African head, John Kearney, has said that
the ball is now in South Africa's court to deliver AIDS drugs to its
people. This is an awesome challenge, and not a moment too late.
With 4.7 million South Africans (approximately 10% of the
population) living with HIV infection, development of an
infrastructure that will allow those afficted access to life-saving
drugs is a matter of extreme urgency. Even when the drugs are
affordable we will need to sort out the operational issues that will
enable them to be delivered to people in need. This will require
concerted efforts from government as well as non-government and
private structures to work together to really tackle our country's
AIDS crisis.

Jean-Pierre Garnier, GlaxoSmith-
Kline Chief Executive, summed things
up well in a statement following the
court case, saying 'this settlement
meets the objectives of both the
South African government and the
pharmaceutical industry, but it is my
fervent hope that the real winners will
be patients'. We couldn't agree more.

As pressure for drug access shifts
slightly from those who manufacture
and price the drugs to those who
deliver, such as government and
medical aids, the country's wealthiest
medical aid scheme, Discovery, came
under some flack recently. It would
appear that the brochures and
information used to lure clients to
join offer anti-H IV drugs in a
misleading way. People have
discovered to their horror after
joining that the promised
'antiretroviral cover' amounts to little
more than supportive counselling.

While Discovery is aggressively
marketing itself to young
professionals, and emphasising and
rewarding healthy lifestyle, it has not
taken into consideration that young
people are the group most at risk of
HIVIAIDS, and appears to have
chosen not to reimburse for
treatment for this disease.

Other medical aids in this country,
such as Medscheme, which have had

an antiretroviral treatment policy for at least 2 years, already have
compelling data to show that the intervention is cosHonstraining
and will be even more so as drug prices continue to fall.

In a recent press article Discovery Health's general manager
claimed that the misleading brochure was currently under revision
and that independent brokers misinforming the pubiic would be
dealt with. We hope so.

There is no doubt that all the changes in the HIVlAIDS arena in
recent months have made for interesting and exciting times. The
onus is now very much on us to grasp the opportunities, to bring
ourselves up to speed on treatment issues, and as quickly, safely and
effectively as possible to translate this into benefits to our HIV-
infected population.

L1NDA-GAIL BEKKER
Managing Editor

THE SOUTHERN AfRICAN JOURNAL O~ HIV MEDICINE ------------ MA 200 I 11