Disagreements abound over drug safety, trade rules, funding and the sincerity of U.S. government efforts, but there are signs of progress.
Stephen Lewis, the United Nations special envoy for HIV/AIDS in Africa, told The Associated Press that major changes in the past six months - especially new trade agreements and a World Health Organization initiative - have produced "the largest quotient of hope we've had in a long, long time."
Dr. German Velasquez, coordinator of WHO's drug action program, said he was not optimistic about the trade agreement but sees steps forward in China, Latin America and South Africa, the country with the most HIV-infected people.
Some 40 million people worldwide are infected with HIV/AIDS - two thirds of them in sub-Saharan Africa; 30 million have died of AIDS-related causes, according to U.N. reports.
Recent developments include:
Lewis said there is "a potential breakthrough coming in 2004, 2005" if WHO gets the $200 million it needs to train people in developing countries and organize supply lines. So far, wealthy countries have contributed little, he noted.
"We can't pretend there's been a huge increase in the last six months in the availability of drugs at low cost. We seem to be right on the threshold of a dramatic increase," he said. "The WTO agreement makes it possible."
Velasquez said, however, that efforts to implement the WTO agreement are "totally stuck." The U.S. initiative, and pharmaceutical companies' promises to offer patented medicines free or at cost, are "big announcements ... in big industrialized countries" that have yet to make a big difference in drug availability in Africa, he said.
The U.S. initiative has critics, including Doctors Without Borders, which charges that the government will only allow the funds to be spent on patented medicines - which means they'll reach fewer people because patented drugs are much more expensive than those made by generics manufacturers - and that it creates doubts about the safety of anti-AIDS medicines recommended by the WHO.
"There are very clear signals that the U.S. government does not support ... the use of fixed-dose combinations" made by foreign generics manufacturers, Ellen 't Hoen of the group's Campaign for Access to Essential Medicines said.
"We are very worried that these arguments about the safety of the medicines ... will lead to loss of confidence in the products," she said.
The U.S. Global AIDS Coordinator's office denies the charges.
Its deputy chief medical officer, Dr. Mark Dybul, told the AP that "we will buy any drug that has proven to be of high quality, safe and effective, and at the lowest cost possible."
Dybul said the government wants to be certain not to contribute to the virus' drug resistance through widespread but inappropriate drug distribution.
"We could lose a whole continent," he warned.
U.S. officials, WHO, the Joint U.N. Program on HIV/AIDS and the Southern Africa Development Council will meet in Botswana on March 29-30 to work out principles for drug approval.
The five-year U.S. program, which aims to treat 2 million people in poor countries, includes $9 billion for 15 countries hard hit by AIDS, $5 billion for 100 other countries and $1 billion for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
By Barbara Borst