Abstrait

HIV drug policies and South markets: settling controversies

Daniele Dionisio, Claudio Fabbri and Daniela Messeri

Despite progress, antiretroviral therapy coverage in low- and middle-income countries remains poor: only 31% of HIV-infected people in need were receiving treatment in 2007. Obstacles include weak healthcare systems, a critical shortage of human resources and a lack of sustainable, long-term funding. Considering that health spending is still less than US$10 per person per year in most African countries, these obstacles act as key barriers in preventing poor people from obtaining life-saving drugs. Under this backcloth, out-ofreach prices still prevent HIV-infected people in most income-constrained countries from accessing brand antiretroviral drugs (ARVs). In the meantime, evolutionary strategies by governments and generic companies in emerging South markets look like they would place a risk of failure on the ARVs pricing policies of the multinational brand corporations. This article explores an attuned model to allow the brand and generic manufacturers to appropriately tackle evolutionary trends in the emerging markets, while securing the poorest expanded access to fairly priced ARVs, either for the present or the future. The potential of the model was investigated by examining: the current brand and generic company roles; the forecasts from government and drug trading directions of India, China, USA, Canada, Brazil and Thailand; the foreseeable implications of multiplying South–South partnerships; and the impact of the UNITAID–Clinton Foundation coalition. The highlighted model aims to reliably provide – through a combination of incentives, the WHO’s brokerage, fairly used differential pricing and the World Trade Organization’s flexibilities – several opportunities to the brand and generic enterprises, while cutting prices and promoting equitable access to ARVs.