“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa:

On the occasion of the World Health Assembly 2003
Edited proceedings of:
“Successes and Challenges in Scaling-up Treatment
for HIV/AIDS in Sub-Saharan Africa:
A Role for Public/Private Partnerships”
Friday, 23 May 2003, 12:30 to 14:30
Salon GenPve, Restaurant des Délégués,
Restaurant des Délégués,
8 Floor, Elevators 12A and 29
Building A, Palais des Nations Unies
Global Alliance for Women’s Health® (GAWH)
The Permanent Mission of Niger to the United Nations
The Permanent Mission of the Republic of Angola to the UN
The Permanent Mission of the Republic of Angola in Geneva
in partnership with the corporate members of the
Accelerating Access Initiative (AAI)
Abbott Laboratories Inc., Boehringer Ingelheim GmbH, Bristol-Myers Squibb,
GlaxoSmithKline, F. Hoffmann-LaRoche, Ltd., Merck & Co., Inc.
Support for this roundtable and web site posting was made possible by a grant from the
corporate members of the Accelerating Access Initiative (AAI)
Edited by: Alice Shiller
Part I
Welcome and Introduction
Co-Chair and Moderator: Elaine M. Wolfson, Ph.D.
Keynote Remarks
Co-Chair: H.E. Mr. Ousmane Moutari
Part II
Speakers in order of presentation:
• Chris Murray
Director, Pharma International, F. Hoffmann-LaRoche, Ltd.
• Christophe Longuet
MD, MPH, Medical Manager Africa HIV/AIDS, Merck Sharp & Dohme Interpharma
• Didier Delavelle, MD
Director of HIV Programs, Boehringer-Ingelheim GmbH
• H.E. Anna M. Abdallah, MP
Minister for Health, United Republic of Tanzania
• H.E. Albert Mabri, MD
Minister of Health and Populations, Côte d’Ivoire
• H.E. M. Phooko
MD, Minister of Health, Kingdom of Lesotho
• Julian Fleet, JD
Acting Chief, Policy & Coordination Unit, UNAIDS
• Jos Perriens
Director of CARE, Department of HIV/AIDS Care and Support, World Health Organization
• Ndola Prata, MD, MSc
School of Public Health, University of California, Berkeley
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
H.E. Anna M. Abdallah, MP
Minister for Health
United Republic of Tanzania
Biography not available.
Didier Delavelle, M.D.
Director of HIV/AIDS Programs, Africa
Boehringer-Ingelheim, GmbH
Dr. Delavelle is in charge of the implementation, coordination and support of the Viramune
donation program in Francophone Africa (Sénégal, Côte d’Ivoire, Bénin, Burkina Faso, etc.). He
is also a volunteer counselor to the France Red Cross on Preventing Mother to Child Transmission
(PMTCT) programs. His role in this public-private partnership is very instrumental.
Between 1985 and 1991, Dr. Delavelle was a general physician. He joined the pharmaceutical
industry in 1991.
Julian Fleet, JD
Acting Chief, Policy & Coordination Unit
Julian Fleet has experience and training in public health and law. He began his career in
community-based health planning in Boston and then served for three years as health planning
adviser in the Ministry of Health, Government of Swaziland. After practicing law in a large law firm
in the United States, in 1989 Julian joined the Office of the UN High Commissioner for Refugees
(UNHCR) where he held various field and headquarters posts including staff assistant in the
Executive Office of the High Commissioner; Deputy Representative and Head of the legal section,
Washington, DC; legal officer, Es Showak, Sudan; and emergency team officer in Kisangani,
Democratic Republic of Congo.
Since joining UNAIDS in 1998, Julian has served as senior adviser for human rights, law and ethics,
senior policy advisor in the Office of the Executive Director, and in his present position as senior
advisor, care and public policy.
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
Christophe Longuet, MD, MPH
Medical Manager Africa HIV/AIDS
Merck Sharp & Dohme Interpharma
Christophe Longuet joined Merck Sharp & Dohme on March 1998 as Medical Manager Africa HIV/
AIDS. He is currently in charge of the implementation of Accelerating Access Initiative for Merck in
Sub-Saharan Africa.
His previous experience in the medical field includes vaccination and tropical pathologies at
Bichat Hospital in Paris, where he participated in protocols on clinical and therapeutic studies
on HIV/AIDS and therapeutic programs on malaria. He has also been a physician in Pointe-BPitre Hospital in Guadeloupe, and in the Commonwealth of Dominica. He has written several
publications on HIV/AIDS and tropical diseases.
Mr. Longuet holds a Medical Degree from Reims University in France, a Degree in Tropical
Diseases form Marseille University in France, a Master of Public Health from UCL, Brussels, Belgium,
a Degree of AIDS/STD at the Xavier Bichat Medical School at Paris University, and finally a Post
Master of Health Economics from the Paris University.
H.E. Ousmane Moutari
Ambassador, Permanent Representative
Permanent Mission of Niger to the United Nations
Ambassador Moutari has worked in the diplomatic field since 1979. He was Niger’s Ambassador
to the Soviet Union (1990-1993). Six years later and after holding a number of important positions
at the international and national levels, he came to New York as Niger’s Ambassador to the
United Nations.
His previous experiences in Niger include two years as a diplomatic advisor to the Office of the
President (1998-1999) and Permanent Secretary at the Ministry of African Integration (1997-1998).
He also held posts in Rabat, Morocco, as Special Representative of the Secretary General of
the Islamic Conference (1995-1997) and in Jeddah, Saudi Arabia, as Director of Cabinet to the
Secretary General of the Islamic Conference.
Ambassador Moutari received a Bachelor of Arts, International Public Law, and the Maitrise in
International Relations from the University of Cameroon, Faculty of Law and Economics, also the
Institute Professional Degree from the International Institute for Public Administration in Paris. Last
year, he was awarded the Master of Public Administration degree from the Robert F. Wagner
Graduate School of Public Service at New York University.
Chris Murray
Director, Pharma International
F. Hoffmann-LaRoche, Ldt.
Born in Beckenham, England in 1947, Christopher Murray was awarded a Higher National Diploma
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
in Business Studies form Bournemouth College of Technology in 1967. Opting for a career in the
Far East, he worked for the American Optical Corporation and Dynatech Corporation in Hong
Kong and Singapore, before joining Roche in Hong Kong in 1976.
Subsequently, he has been the Pharma Manager and General Manager of Roche Hong Kong
and the General Manager in Indonesia and Dubai, before moving on to the Pharmaceutical
Division in Roche’s headquarters in Basel, Switzerland. Throughout his 27-year career with Roche,
he has been committed to resolving issues and problems relating to healthcare delivery in
developing countries in Asia and Africa.
Chris has been a driving force in defining and implementing a number of programs to increase
the availability of anti-malarials, and treatment for HIV/AIDS. His extensive experience and
knowledge of the barriers to healthcare in developing regions has enabled Roche to develop
strong partnerships with local governments and NGOs, to help provide sustainable access to care
and HIV therapy.
As the responsible person for the Divisions’ activities in Africa, he is directly involved in the fight
against AIDS. He is also the Roche principal representative to the Accelerated Access Initiative,
the collaboration formed in May 2000 between five United Nations organizations and six
research-based pharmaceutical companies, committed to increasing access to anti-retroviral in
countries most affected by HIV/AIDS.
He has twice represented the industry as President of the research-based pharmaceutical
association—the Hong Kong Association of the Pharmaceutical Industry (1982) and the
International Pharmaceutical Manufacturers Association of Indonesia (1989).
Jos Perriens
Director of CARE
Department of HIV/AIDS Care and Support
World Health Organization
Biography not available.
Ndola Prata, MD, MSc
School of Public Health
University of California at Berkeley
Dr. Prata is an Angolan Medical Doctor and demographer, lecturer at the School of Public
Health, University of California, Berkeley. She is coordinator of the Bay Area Group (BIG), Institute
of Human Development and School of Public Health, UC-Berkeley. Dr. Prata manages, supervises
and conducts research on issues of reproductive health and family planning in developing
countries. In addition, she writes grant proposals and is responsible for programme evaluation
of collaborating agencies. Other duties include a special assignment a the Centers for Disease
Control and Prevention (CDC) in Atlanta, Division of Reproductive Health and Global AIDS
Global Alliance for Women’s Health — Edited Proceedings of
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Program, providing: technical expertise for survey design and data collection to CDC and to
other agencies in developing countries and several other duties.
Ms. Prata became a Doctor of Medicine at the Faculty of Medicine of the University of Angola.
She then received a Diploma in Demographic Analysis for Development in Costa Rica, a
certificate in “Using Demographic and Health Data for Health Sector Reform” at the Harvard
School of Public Health in Boston, a certificate in “Population Projections and Demographic
Methods” at the University Catholic de Louvain in Belgium, and an MSc Medical Demography at
the London School of Hygiene & Tropical Medicine, University of London. Dr. Prata has written and
delivered more than 30 papers and presentations on issues such as reproductive health, war,
peace and health, demographics and health and development.
Her participation was made possible by a grant from the University of California Berkeley, Bixby
Chair of Population and Family Planning.
H.E. Albert Toikeusse Mabri, MD
Minister of Health and Population
Côte d’Ivoire
Biography not available.
H.E. M. Phooko, MD
Minister of Health
Kingdom of Lesotho
Biography not available.
Elaine M. Wolfson, Ph.D.
Founder and President
Global Alliance for Women’s Health (GAWH)
A political scientist and academic since 1967, Dr. Wolfson became a representative of a
non-governmental organization at the United Nations in 1991. As a result of her research in the
formation of social policy, more than two decades of work on women’s health policy, and her
experience at the United Nations, she noted the consistent under attention and inadequate
information available about all stages of women’s health throughout the world. She founded
Global Alliance for Women’s Health (GAWH), a non-governmental organization, in 1994 in order to
help address these shortcomings through women’s health advocacy, education and promotion
Dr. Wolfson was educated at Smith College (BA) and New York University (MA and Ph.D.) and the
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
Wharton School of the University of Pennsylvania (certificate). She has taught at New York University,
the State University of New York, Long Island University, Rutgers University and the City University of
New York, and she has held an adjunct appointment at the Columbia University School of Public
Health. She has lectured on women’s health at international seminars in Spain, Italy and Korea,
and has consulted on women’s health with UNDP and WHO. Her publications on women’s health
include articles, monographs and edited compilations.
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
About Accelerating Access Initiative (AAI)
The Accelerating Access Initiative (AAI) started in May 2000 and is a cooperative public-private
partnership of UNAIDS, the World Bank, and six research-based pharmaceutical companies: Abbott
Laboratories, Boehringer-Ingelheim GmbH, Bristol-Myers Squibb, F. Hoffmann-LaRoche, Merck & Co.,
Inc. and GlaxoSmithKline.
The objective of the AAI is to reduce the treatment gap between countries in the use of antiretroviral
(ARV) therapy for HIV/AIDS. All of the partners are committed to working with governments, international
organizations, and other stakeholders to find ways to broaden access while ensuring rational,
affordable, sage and effective use of drugs.
While it is widely recognized that affordability is just one of the many obstacles to access, the
companies, individually, have offered to substantially improve access to, and the availability of, range
of medicines by providing more affordable prices in developing countries.
By early 2003:
• 80 countries had expressed an interest in participation, of whom 39 had submitted national
• 19 countries in Africa, Eastern Europe, Latin America and the Caribbean have negotiated
ARV prices, concluded supply agreements, and begun to waive import duties and taxes
• Prices have been as low as 10%-20% of those in industrialized countries (the price of a firstline ARV regimen fell from US$10,000pa to $350pa within two years)
• Almost 36,000 additional patients now have access to ARVs in Africa
• The Economic Community of Western African States (ECOWAS) and the Caribbean
Community (CARICOM) joined together in negotiations with the AAI partners and agreements
were concluded in July 2002
The AAI has transformed the environment for the treatment of HIV/AIDS, and with the assistance of
new global funding sources, has brought treatment within the reach of more and more of the least
developed countries. It has served to put the spotlight on shortfalls in diagnostics and healthcare
infrastructures. It has firmly demonstrated what can be achieved through willing partnership between
stakeholders, to ensure that all of the essential conditions for sustained success are in place.
Countries wishing to participate in the AAI must meet the following conditions:
1. Political commitment by governments
2. Strengthened national health care capacity
3. Engagement of all sectors in facilitating access
4. Efficient, reliable and secure distribution systems
5. Significant additional national and international funding
6. Continued investment in R&D, with strong IP protection
It is hoped that quarterly updates on the achievements of the AAI will provide an ongoing demonstration
of the success of partnership, and further encourage its expansion and adoption.
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
About the Global Alliance for Women’s Health
The Global Alliance for Women’s Health (GAWH) is committed to advancing women’s health in all
stages of life and at all policy levels through health promotion, education, advocacy and program
implementation. We believe that long-term initiatives and commitments are needed and that
partnering with non-governmental organizations, the private sector and academic institutions is
necessary to provide effective health care and research for women.
GAWH’s outreach extends to more than 110 countries and we have approximately 70,000 visitors to our
website each year, students and scholars from 600 colleges and graduate schools visit the GAWH website regularly. Our
website is ranked six among “the top 100 women’s health web sites”.1 GAWH has held seminars, panels and caucuses,
and briefings on women’s health in all regions of the world, including Geneva, Copenhagen, Vienna, Istanbul, Lima, Dakar,
Jakarta, Beijing and Seoul.
The Global Alliance for Women’s
Health has:
Created world wide women’s health networks on several issues including tobacco and trachoma
Campaigned successfully among member states at the United Nations to include provisions for
women’s health throughout the life span in four of the platforms of the world conferences of the
Developed partnerships across the public and private sectors in all regions of the world to advance
women’s health
Developed donation programs for Meningitis vaccine and palliative treatment for oral thrush for
persons living with HIV/AIDS.
From: http://www.top100sites.com/health-women.htm.
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
Geneva Roundtable Participants
Representatives of Governments at the World Health Assembly
Adelaide de Carvalho, National Director of Public Health, Ministry of Health
Sofia Pegado, Counsellor, Permanent Mission of the Republic of Angola to Geneva
Sandra Thirad, Assistant, Permanent Mission of the Republic of Angola to Geneva
H.E. Dr. Y.C. Seignon, Minister of Public Health, Ministry of Health
Burkina Faso
Dr. Ghislaine Conombo, Director of Family Health, Ministry of Health
Awa Ndeye Ouedraogo, Technical Counsellor, Ministry of Promotion of Human Rights
Côte d’Ivoire
Prof. Djeha Djokouehi, Delegate, Ministry of Health
Prof. C. Gahoussou, Technical Counsellor, Ministry of Fight against AIDS
H.E. Dr. Albert Mabri, Minister of Health, Ministry of Health and Population
Jerome Weya, Charge d’Affaires, Permanent Mission of Côte d’Ivoire in Geneva
Jallene Amensisa, Health Service Team Leader, Ministry of Health
Dr. Tesfanesh Belay, Head of Family Health, Ministry of Health
Dr. N. Letsie, Head of Family Health Services, Ministry of Health
H.E. Dr. M. Phooko, Minister of Health, Ministry of Health
R. Dania, General Secretary, Ministry of Health
H.E. Ousmane Moutari, Ambassador, Permanent Mission of Niger to the UN
H.E. M. Sourghia, Minister of Health, Ministry of Health
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
Lars Lien, Head of Unit, NORAD
Cheickh Fall, Director of Prevention, Ministry of Health
M.K. Fall, Chef de Cabinet, Ministry of Health
United Republic of Tanzania
H.E. Anna Abdallah, Minister for Health, Ministry of Health
Dr. Ali A. Mzige, Director, Prevention Services, Ministry of Health
United States of America
Barbara Blackney, President, American Nurses Association
Dr. B. Chriwa, Director General, Center Board of Health
Alexander Mangwiro, Director, Environmental Health
Representatives of Governmental and
Intergovernmental Organizations
World Health Organization
Dr. Fabrizio Bassani, Executive Director, New York Office
Tom Loftus, Advisor
Dr. H. Mambu-ma-disu, Representative (Cameroon)
Dr. Mike Mbizvo, Senior Scientist
Craig McClure, Manager, International HIV Treatment Access Coalition
Nelle Temple Brown, Ph.D., External Relations Officer
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
Representatives from Civil Society
American Nurses Association
Barbara Blackney, President
Associated Country Women of the World
Joanna Koch, UN Representative
Boehringer-Ingelheim GmbH
Dr. Didier Delavelle, Director of HIV Programs
Bristol-Myers Squibb
James Laubner, Associate Director, International Policy
Commonwealth Regional Health Community Section
Olive Munjanja, Coordinator Human Resources Development
Zoonach Nguesya, Administrative Secretary
Dr. Steven Shongwe, Regional Secretary
Consumer Information Network
Samuel Ochieng, Chief Executive
F. Hoffmann-LaRoche
Christopher Murray, Director
Maria Vigneau, Director, External Affairs
Jon Pender, Director, External Relations, Global Access Issues
Global Alliance for Women’s Health
Mirian Barrientos, Global Affairs & Government Relations Officer
Ghislaine Ouedraogo, Senior Program Officer
Dr. Elaine Wolfson, President
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
International Federation of Pharmaceutical Manufacturers’ Associations
Boris Azais, Director of External Policy
Dr. Eric Noehremberg, Director
International Health Cooperation Organization
Mats Ahnlund, Special UN Representative
Merck & Co.
Susan Crowley, Director, International Organization Relations
Dr. Christophe Longuet, Medical Manager Africa HIV/AIDS
University of California, Berkeley
Dr. Ndola Prata, Lecturer, Researcher
University of Geneva
Armand-Michel Broux, Researcher
Zambia Consumers Association
Muyunda Ililonga, Executive Secretary
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“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
Edited Proceedings Of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role
for Public/Private Partnerships”
Elaine Wolfson, Ph.D., President, Global Alliance for Women’s Health: Thank you health ministers from
5 countries and senior officials from 12 countries for coming to our roundtable today dealing with
successes and challenges in scaling-up treatment for HIV/AIDS in Sub-Saharan Africa and the role of
public-private partnerships. We are very pleased to be a public part of a partnership for several years
now and working with many private sector people. The Global Alliance for Women’s Health (GAWH) is
a non-governmental organization that is registered in the United States as a charity and as a not-forprofit with the Internal Revenue Service.
Since GAWH started nine years ago, we have been working to advance women’s health
throughout the life cycle, at all stages of life. Through programs such as this; panels at the UN; programs in Beijing, Istanbul, Copenhagen, and New York, we have been advocating for the need to
address women’s issues throughout the lifespan throughout the world. We have embarked on this
long-range effort because we know that in many places of the world attention to women’s health
and services available to women have not been adequate.
In the United States, up until two or three decades ago, women felt that their health needs
were undeserved. Since then, there have been significant improvements in health research and
services for women in the US, though not in much of the rest of the world. While GAWH has been producing programs on depression, osteoporosis, arthritis and heart disease, we have also been keeping an eye on the progression of HIV/AIDS. Regrettably, HIV/AIDS increasingly is becoming a women’s
health problem.
The numbers as well as the proportion of infected women is growing alarmingly in the United
States and in Western Europe. We know that of all the people living with HIV/AIDS in Africa, 58% are
women. Consequently, in the past two years we have focused our attention intensively on this aspect
of women’s health to see if we could help women not only in Africa but also all over the world. We
know that with HIV/AIDS we cannot just address the concerns of women. So, we do indeed advocate
advancing health services for all people – women, men, and children.
Today we are not going to focus exclusively on women and HIV/AIDS, we are just going to talk
about treatment. But, I must tell you that in the future we will come back to you to ask you to make
sure that if treatment is expedited, if access to treatment is expanded, then at least 50% of patients
treated be women.
At this roundtable we are going to talk about how we can achieve this better access to treatment, this expansion, this acceleration. We want to focus on a public-private partnership model, one
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
led by national agencies, international agencies, and the corporate sector of multinational pharmaceuticals. And we are very pleased that corporate members of the Accelerating Access Initiative—called AAI —have agreed to partner with us on our campaign. We are very pleased, too, that
a number of African countries have agreed to co-sponsor our efforts in advocating the expediting of
access to women’s health services. Indeed, what you do and what we are doing today is part of a
campaign that GAWH started last month at the United Nations when, with eight African countries as
co-sponsors, we held a meeting addressing the challenges involved in accelerating access to treatment.
Today is our second meeting, and next week in Ethiopia at the Economic Commission for
Africa, we will be holding our third meeting. The Accelerating Access Initiative is our partner for these
last two meetings.
At this gathering we want to encourage discussion. Fortunately very illustrious people have
agreed to participate. After my welcoming remarks, Ambassador Ousmane Moutari of Niger will give
the keynote address and then we will have comments focusing on issues of success and issues of
challenge. We hope that what is said here will engender discussion and encourage questions. We
also hope that this will foster serious interaction between governments, industry, NGOs, and agencies. If we can facilitate such interaction, we will have considered our efforts to be successful.
Now I would like to give the floor to Ambassador Moutari.
H.E. Ousmane Moutari, Ambassador, Permanent Mission of Niger to United Nations: I would like first
of all to thank the Global Alliance for Women’s Health and its president, Dr. Elaine Wolfson, for convening this meeting to address such an important issue and for affording me the opportunity to
speak here.
I am privileged to join Dr. Wolfson in welcoming our guests and in thanking the pharmaceutical company representatives who are here with us today. Their presence is most highly appreciated,
as it demonstrates the full commitment of their companies to contribute to the international partnership against HIV/AIDS in Africa.
Ladies and gentlemen, according to the AIDS epidemic update of December 2002 released
by the World Health Organization (WHO), there are 42 million people living with HIV/AIDS worldwide,
with nearly 30 million living with HIV/AIDS in Sub-Saharan Africa. Our region has the highest number of
HIV-positive people in the world. It is estimated that more than 4 million of those infected have a sufficiently advanced stage of the disease to warrant antiretroviral (ARV) treatment. But only 50,000 are
actually receiving it.
Really, nothing can more vividly describe the emergency situation created by the HIV/AIDS
epidemic in Africa than the extraordinary proliferation of AIDS orphans. Their numbers have reached
11 million. By 2010, 20 million African children will have lost one or both of their parents to HIV/AIDS.
In industrial countries, antiretroviral drugs have greatly improved the prognosis for people living with
HIV/AIDS. However, 95 percent of people with HIV/AIDS live in developing countries, most of them in
Sub-Saharan Africa where access to these medicines remains limited.
As new resources are becoming available to provide HIV/AIDS treatment and care, both at
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
bilateral and multilateral levels, major opportunities now exist to greatly expand coverage. But challenges remain and they must be overcome if we are to implement national treatment programs.
We are grateful to those international pharmaceutical companies which are responding to
calls to the private sector to engage in partnership with African governments for expanding the response to HIV/AIDS. Our roundtable today is part of those efforts undertaken to explore practical and
specific ways of working more closely with the private sector to accelerate access to HIV/AIDS care
and treatment in Sub-Saharan Africa.
This public-private cooperation should be based on principles which reflect a common vision
of how the HIV/AIDS epidemic can now be tackled more effectively in developing countries. Among
those principles are the following: unequivocal and ongoing political commitment by national governments; strengthened national capacity; engagement of all sectors of society at the national level
and the local community; efficient, reliable, and secure distribution systems for medical supplies;
significant additional funding from national and international sources for long-term success; and
continued investment in research and development by the pharmaceutical industry.
For those among the pharmaceutical companies who have been pioneering initiatives to
increase the standard of care for HIV/AIDS patients in different parts of the world, please feel free to
share with us your experience of the best practices worth replicating in Africa. We know, of course,
that even with the cost of medicine removed, there is a barrier to access. To successfully fight HIV/
AIDS in the poorest regions of the world requires collaborative efforts from NGOs, government health
institutions, private foundations, and competent international organizations.
We would be very glad to hear today from our private partners as to what they see as the
obstacles confronting them as they work to carry out their commitment to accelerate access to HIV
care, support, and treatment and how they believe our respective governments might help.
I think I will not take more time. Thank you very much.
Dr. Wolfson: Thank you very much, Ambassador Moutari, and special thanks to you and your mission
for co-sponsoring our event here and in New York, and for all of the wonderful help that we have gotten from the African missions at the United Nations.
Now, I would like to introduce all of the roundtable speakers:
• H.E. Albert Toikeusse Mabri, MD, MPH, Minister of Health and Population, Cote d’Ivoire;
• Julian Fleet, JD, Acting Chief, Policy & Coordination Unit, UNAIDS, Geneva;
• Jos Perriens, Director for Care, Department of HIV/AIDS Care and Support, World Health Organization, Geneva;
• Ndola Prata, MD, MSc, School of Public Health, University of California. Originally from Angola, Dr.
Prata is now working at UC as a lecturer and researcher;
• Christophe Longuet, MD, MPH, Merck Sharp & Dohme, Medical Manager Africa HIV/AIDS, in
charge of implementing the Accelerating Access Initiative;
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
• Anna Abdallah, MP, Minister of Health, Republic of Tanzania;
• Christopher Murray, Pharma International, Hoffman-LaRoche, Director of the Pharmaceudical
Division of Hoffmann-LaRoche in Basel, Switzerland. The Roche principal to the Accelerating Access
Initiative, he is speaking today both on behalf of the members of the Accelerating Access Initiative
and Hoffmann-LaRoche;
• Didier Delavelle, MD, Director of HIV Programs, Boehringer-Ingelheim GmbH;
• Dr. M Phooko, Minister of Health, Kingdom of Lesotho.
Dr. Wolfson: Thank you all very much for coming. We are now going to turn our attention to successes. Chris Murray, would you begin please.
Mr. Murray: Thank you very much. As a point of information, there are two Christopher Murrays in
Geneva. One of them is in WHO, and the other is me, with Roche. Please, if you send me an E-mail,
it should go to roche.com, not who.org. I believe my namesake gets a number of E-mails for me.
Now to the Accelerating Access Initiative. It was established exactly three years ago this
month. The objective set for the AAI is expansion of the global response to HIV/AIDS. To do this we are
exploring ways to accelerate and improve the provision of HIV/AIDS-related care and treatment in
developing countries. We are working to alleviate the devastating impact that the AIDS epidemic is
having, particularly in Sub-Saharan Africa.
The Initiative began with a membership of five pharmaceutical company. We are now six:
Abbott joined last year. All the industry partners are totally committed to working with governments,
international organizations, non-governmental organizations, and other stakeholders to find ways to
broaden access while ensuring rational, safe, effective, and sustainable use of HIV drugs. By early
2003, more than 20 countries in Africa have concluded antiretroviral (ARV) supply agreements individually with our companies, and some of these countries have begun to waive import duties and
taxes on these medicines. We believe that is a very positive step forward.
The number of people who have access to antiretrovirals in Africa has increased from less
than 10,000 to the number mentioned earlier. But we still have a very long way to go, and none of
us believes that we have been successful. But, we look toward success in the future. The Accelerating Access Initiative is transforming the environment for the treatment of HIV/AIDS and, with the assistance of new global funding sources, is bringing treatment within the reach of more and more
African and least-developed countries.
This demonstrates what can be achieved through willing partnerships between all stakeholders that ensure all essential conditions for sustained success are in place. The six key principles presented by Ambassador Ousmane Moutari reflect the common vision of how the HIV/AIDS epidemic
can be more effectively tackled in developing countries. I will not repeat them. Three years on, each
of these principles remains valued today and, as Dr. Wolfson has outlined, we all look forward to
specific discussions here on the current operational challenges which are restricting greater access
to therapy.
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I would just like to highlight a few top-line illustrations of achievements some of our individual
companies have made in some African countries. Abbott, in partnership with the government of Tanzania (that country’s Minister of Health is sitting on my right) is working to improve access to care for
people living with HIV, including access to antiretrovirals and drugs for opportunistic infections. Abbott
is also working with the government to build the capacity of the health care system which is critical
for expanding access to quality health care and treatment. This involves training of medical workers, and laboratory personnel in order to expand access to voluntary testing and counseling as well
as treatment. Another objective is to create a national reference and teaching center at Muhimbili
National Hospital which would provide high-level expertise in management and treatment of HIV that
could serve the whole country and be an example for the region.
My own company, Roche, together with the non-profit organization PharmAccess International, has sponsored a care program to develop local expertise, training and provision of HIV health
care and therapy across four African centers in Kenya, Uganda, Senegal, and Ivory Coast. Health
care professionals are being trained and equipped with the current international knowledge of HIV
management and how to deliver good clinical practice.
Successful implementation of these pilot programs may well lead to sustainable benefits
demonstrated in line with international standards and to the extension of this program to more people living with HIV. What we have learned from the Initiative has been used to assist individual private
organizations in the region to realize their desire to extend HIV care to their local employees. Our
colleagues in GlaxoSmithKline are supporting over 20 clinical trials in Africa, with more than 10,000
patients participating. They are helping provide access to both antiretrovirals and to products for
prevention of mother- to-child transmission. GSK has concluded over 55 agreements for the supply
of antiretrovirals at reduced prices with countries not just in Africa but across the world. Their positive
action program supports 25 individual programs in 32 different countries.
I made a comment previously that none of us can be happy with where we are with antiretroviral therapy and its availability throughout Africa. The Accelerating Access Initiative is one of the few
organizations able to demonstrate a sustained availability and an increase of treatment for people
in Africa. We are optimistic that with the help and support of the people in this room, we will be able
to move further. Thank you very much.
Dr. Wolfson: We will hear from some of the other private sector representatives, then move to WHO
and UNAIDS to be followed by the Minister of Health from Tanzania and the Minister of Health from
Cote d’Ivoire. We will stop after the first round for questions from the audience.
Dr. Longuet: I’m very pleased to be here today with you representing Merck. Indeed, it is a real
opportunity to share and to make sure that private-public partnerships are successes. First, I would
like to say that the fact that public-private partnerships exist is a success by itself. At Merck we have
experience with the Mectizan Donation Program. For more than 15 years we have been partnering
with WHO and with local governments through their Onchocerciasis Program. And together, we have
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been able to assure that 30 million people every year get access to a single dose of Mectizan. This
enables them to avoid river blindness which is a medical, economic, and social disaster for the affected populations. This is an example of very successful public-private partnership.
Dealing with HIV is much more difficult, as you know. It does not involve taking a single tablet once
a year. Our Accelerating Access Initiative is an unprecedented partnership of pharmaceutical companies that usually compete in the marketplace. For Africa, in regard to HIV, we sat down together
to discuss our efforts with the UN agencies, WHO, and the governments involved. The question we all
had to answer: what did we have to do and how did we have to do it to improve care and access
to care for the people most affected by HIV/AIDS?
Merck, a research-based pharmaceutical company, is best at discovering new drugs against
HIV that provide the most advanced treatment. We bring this ability to the AAI, and we provide these
drugs on a not-for-profit basis to the developing countries most affected by the HIV/AIDS epidemic.
Development of an HIV vaccine is currently one of the main vaccine research programs at
Merck. Hopefully, in a few years our HIV vaccine will become a reality, and I believe providing access
to it would also involve a public-private partnership.
Merck has a special history with Botswana. We initiated the development of a unique public-private partnership to address the HIV/AIDS epidemic in the country to help Botswana achieve its
vision of an AIDS-free generation. The partnership is known as the African Comprehensive HIV/AIDS
Partnership or ACHAP. This effort is showing early progress—it’s saving lives and helping a nation. The
hope is that it will serve as a model for other nations. And not one week passes without the president
of Botswana saying a word against HIV/AIDS.
An important point that I want to make here about the Accelerating Access Initiative, the
public-private partnership with WHO, with UNAIDS, UNICEF, all the UN agencies, is that the key factor
for success IS YOU! It is African governments. You can make this initiative become a real success,
become real for the patients.
As Chris Murray said, we have achieved 19 agreements with 19African countries. In fact, more
than 19 African countries have gotten access to not-for-profit prices for antiretrovirals because we
have also worked in many other countries with NGOs and with international private companies. Actually, more than 40 countries in Africa benefit from the Accelerating Access Initiative today. I want to
say here that I am very impressed by the leadership I have seen from many, many presidents and
ministers of African countries. Several African presidents have said that HIV/AIDS is a national priority, a
national emergency. Prime ministers and ministers of health have said it too, and you are here today
as testimony to this outlook.
In Botswana and in other African countries the highest level of government has committed to
the fight against HIV. To me, that is the main success coming out of our public-private partnerships.
Thank you.
Dr. Didier Delavelle: Thank you, Elaine, for giving me the opportunity to briefly say a few words. It
is really an honor for me to represent Boehringer-Ingelheim, the pharmaceutical company which,
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two years ago, initiated a donation program in order to prevent mother-to-child HIV transmission. In
these HIV/AIDS crisis days, I would say it is very important to focus on partnership and on a multilateral
approach. The Accelerating Access Initiative is a unique example of, as Christophe Longuet said, a
collaboration of competitors to accelerate access to HIV drugs.
I have to say that all of us are not satisfied. We are not satisfied because only a small minority of women, of men, and of children, have access to HIV treatment. Further, we need your support
to convince the top managers of our companies that the decision they took three years ago was a
relevant decision. Let me assure you that in the private sector you have to continue to defend every
day the relevance of giving a drug for free or giving a drug, a product, at a non-profit price.
Once again, the message I would like to give to you is that we need to continue our efforts
and to do that we need your help. We need your concrete partnership. At today’s roundtable, we
have had an opportunity to discuss this with a representative of Ethiopia and of Angola, countries
where a running program is yet to be established. We are also pursuing partnerships with companies
such as Daimler which are involved in Africa and would like to provide HIV care to their employees.
Thank you.
H.E. Anna M. Abdallah: Madam President and moderator, dear colleagues, ladies and gentlemen. First of all, allow me to thank you, Madam President, for giving me this opportunity to address
this audience. Madam President, the world is witnessing a transformation in carrying out its business.
Globalization and the HIV/AIDS pandemic have forced different sectors, partners, and actors to work
together because individually they cannot do it alone.
A few years ago, the public sector was the main provider of health services in most developing countries. Objective analysis showed that in order to meet the health needs of communities,
governments in developing countries had to deploy all the resources available in their countries.
Therefore, governments had to incorporate and coordinate all health providers in order to complement each other. This includes private, both for-profit and not-for-profit, health providers, voluntary
agencies, non-governmental organizations, and the communities themselves. In order to cultivate
an effective public-private partnership, it is necessary to build trust and transparency, and to encourage dialogue between both sides as equal partners.
I have experience in dealing with private partners, especially the voluntary hospitals. Governments in Africa tend, in most cases, to act as big brothers. That should not be the case. Tanzania
is implementing health sector reform. An aim of the reform was to look at the effectiveness of our
health care delivery system and see how best we could improve it. One of the formal strategies we
adopted was improving public-private partnership. Since it was realized that public sector alone
could not provide health services, the health sector had to go into partnership with the private sector.
Tanzania, a developing country, has not been spared from the HIV/AIDS pandemic. The first
initiative taken by my government was to provide health education to the general public in order to
clarify the reasons for the spread of the disease. People were encouraged to take a voluntary HIV/
AIDS test in VCT centers. However, experience has shown that testing alone was not enough because
in most cases people would ask about the next step once they found they were already positive.
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But we had no answer because the government could neither provide the treatment nor care
for the sick due to financial constraints. We are grateful, however, for donations of antiretroviral drugs
to prevent mother-to-child transmission. Boehringer-Ingelheim is providing nevirapine without charge
to our mother-to-child transmission prevention program.
In order to introduce this program, we had to start with five hospitals which, apart from being
pilot centers, also served as the training ground for staff in preparation for including more hospitals.
A review of the program at the five hospitals showed that of the 22,000 pregnant mothers involved
in the pilot, 3,300 (15%) were HIV positive. The pilot is now ready for scaling-up. This year, the government will introduce the PMTCT program in 20 regional hospitals and eventually expand it to all district
hospitals in the country in order to cover about 1.5 million expected pregnant women.
The government has entered into an agreement with Pfizer, Inc., as you have heard, for the
company to donate drugs to Tanzania. Diflucan will be used by AIDS patients with opportunistic
infections. The drug is now available in a number of hospitals. Of course, we had to waive all taxes in
order for this drug to enter the country. That is true for all drugs donations. Availability and use of antiretrovirals require strong laboratory backing. Negotiations with the different collaborators are underway. These involve the government and private sector firms working together to capacitate laboratories in Tanzania so that blood safety will be ensured and antiretroviral drugs will be properly used.
Collaborators include the government of the Netherlands, Abbott Laboratories through AXIOS, the US
Centers for Disease Control (CDC), USAID, JAICA, and in Bern, Switzerland, the Best Blood Transfusion
Now, the challenges. Poverty, ignorance, and disease are among the major enemies of the
country, and I think that is true for all developing countries. The per capita income of a Tanzanian is
less than 200 US dollars per annum. The agreed negotiated price for some antiretroviral drugs is one
US dollar a day. Therefore, a person who is suffering from HIV/AIDS will need to spend about 360 US
dollars per year for medication. Mind you, this man and his whole family earn less than 200 US dollars
per year.
Given the poverty levels and the prices of antiretroviral drugs, the majority of those in need
have no access to the drugs. HIV/AIDS is more prevalent in poor communities, where the majority of
these affected are women. The program of prevention of mother-to-child transmission will reduce
the transmission of HIV/AIDS to newborn babies. While we are citing the successes of preventing the
babies from being infected with HIV/AIDS, the mother, who is vital to the very survival of the child,
seems to be neglected.
There is a need, an objective need, to extend treatment to mothers after delivery. Otherwise,
these babies are going to be orphans. We have proved that most of the transmission occurs because many people do not know their HIV status and, hence, are transmitting the virus unknowingly.
Even for those who are willing to test, we have yet to answer the question, “what is next, after testing?”
The only answer is to provide treatment and care to all of those found HIV positive. As countries, we
need to forge more partnerships and make our systems more transparent, accountable, and targeted to the needy ones.
Developing countries are the worst afflicted by the HIV/AIDS pandemic. As such, each one of
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us has to have a clear vision on HIV/AIDS prevention strategies. This will allow clear identification of
areas that need support from partners in the private sector. Both the private sector and the public
sector need each other. We will win the battle together, or we will fail and perish together. The choice
is ours. We have to make the right choice. Madam President, dear colleagues, ladies and gentlemen, I thank you for listening.
H.E. Albert Mabri, MD, Ph.D.: [Dr. Mabri made his presentation in French. What follows is the English translation.]
It is truly a pleasure to be able to speak here, in front of this assembly, to share Côte d’Ivoire’s
experience. Before continuing, I would like to thank the Global Alliance for Women’s Health for their
initiative in the realm of women’s health and also thank everyone assisting their effort, particularly
those in the private sector.
Having said this, I would like to agree with my colleague from Tanzania, who earlier had
mentioned that poverty was at the root of the AIDS epidemic on our continent. I am happy that the
private sector understands that one cannot make profit from those who are ill on a daily basis and
so must to be absent from their jobs or are forced to spend money their family needs on their own
In Cote d’Ivoire, the HIV/AIDS initiative concerning the prevention of mother-to-child transmission has a history. In 1985 the first HIV case was discovered in our country; two years later, with the
support of GPA/OMS (that is what UNAIDS was known as then) we established a national program,
Fight Against AIDS. At that time, the program aimed mainly at prevention and awareness of it by
the public at large, particularly women of childbearing age and sex workers. Despite important efforts made by the government and our program’s partners, HIV positive numbers rose until in 1999
it reached a level of 10% of our approximately 15 million population. In order to determine the HIV
prevalence rate we started with women who sought prenatal care. We tested those we could for HIV
and were able to extrapolate from those figures.
Then the targets of our efforts became young people, women, sex workers and immigrants.
Cote d’Ivoire is an important crossroads because of its port and its road infrastructure. All of West
Africa passes through this zone. Musical artists generally come to Abidjan to promote new CDs or
cassettes. You can imagine how many of their fans follow them. Cote d’Ivoire has about 16 to 17
million people today. Almost a third come from other countries of the sub-region because our industries’ employment opportunities lure people.
Today we have about 600,000 children who are AIDS orphans. While the magnitude of this
pandemic puts a major break on the development of our country, we have the political willingness
to address the human and financial costs of the problem. This was expressed at the highest levels by
the creation of a ministry that is in charge of Fight Against HIV/AIDS. At this point, I would like offer excuses for my colleague who is in charge of Fight Against AIDS. She could not be here because she is
attending the Global Fund’s lunch.
In addition to addressing and studying the impact of the pandemic on the different sectors
of activity in the country, the new ministry is in charge of elaborating a national strategy to respond
to the pandemic and to plan for the mobilization of resources, both financial and human. We are
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now reorganizing the national program, Fight Against AIDS, which is still dependent on the Ministry
of Health, to which I am appointed. The Ministry of the Fight Against AIDS will begin its efforts with the
prevention stage and take on responsibility for the cases, volunteers, counseling and all the care that
we can give at this level. The Ministry of Social Affairs will intervene and back us up by taking care of
AIDS orphans.
We have a number of initiatives planned at the national level. However, as you all know, we
are coming out of an armed conflict that has drained resources and displaced a significant number
of people. Also, as you all know, in Africa armed conflict means sexual violence on women. They are
abused and arrive at the refugee camps with sexually transmitted diseases as well as pregnancies.
An EFNEAP study showed that of a sample of women who sought medical care in war displacement camps, 71% had a sexually transmittable infection and 23% were pregnant. Therefore, we are
trying to set up kits to help deal with these sexual violence problems. If a woman seeks care quickly
enough, we will be able to test her and find out her HIV status. Then, depending on the result, we will
automatically give her medicine or take the necessary cautions in pregnancy cases so that HIV is
not transmitted to the baby. That is our main concern. However, we do have budget concerns. Our
country spends about 750 million FCFA, about 1.2 million US, on antiretrovirals. This is not enough
considering the HIV-positive rates affecting our people.
We salute the Global Alliance for Women’s Health, and we want you to know that Cote d’Ivoire
is ready to support all of your actions and will be by your side in hopes that you will be able to affect positively the issues relating to women’s health, particularly those concerning HIV/AIDS as well as
those related to malaria which we also face.
In Africa, in the rural areas, in 80% of cases women are the breadwinners. Therefore, when
a woman becomes ill and is no longer operational, she can no longer be responsible for going to
the market to do business and bring home money to support her family. The result: the whole family
structure collapses.
I would like to finish by thanking all those who are associated with this public-private partnership. I wish it a long life and hope that with your help we can better confront all of our problems
concerning women’s health. Thank you.
Dr. Wolfson: Dr. Phooko
Dr. M. Phooko: Thank you, Madam President, for giving me this forum. I am Dr. Phooko, the Minister of
Health in the Kingdom of Lesotho in southern Africa. I believe my talk is going to be very short because I just am going to state a sense of appreciation indeed. I believe you have called us and others here to enjoy the meal that you have so graciously offered us. And, therefore, I would like us all to
enjoy that meal. At the same time, you have been so gracious as to give us this forum, and for this I
wish to express appreciation.
I want to say to this august gathering here that private-public partnership (what we in the
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Southern African Development Community now call PPP) is very much on our lips. And, we are beginning to live the PPP concept. It is in this spirit that I appreciate what this gathering is all about. I
want to state here that this public-private partnership is very much alive in the sub-region, a sub-region that is so highly afflicted with HIV/AIDS and so very much appreciates the interventions that are
being made from all quarters.
I will highlight a few of those areas in which there are interventions in our sub-region, just to illustrate my point. I think that within the sub-region there are about five countries actually enjoying the
partnership with Bristol-Myers Squibb in a program called Secure the Future. Bristol-Myers Squibb has
made great interventions and has allocated the sum of, I think, 100 million US dollars for a five-year
period in those countries. This had assisted them to develop their own plans and acquire antiretrovirals to treat patients.
This program is in its fourth year now, which leaves it with just one more year to go. After that, I
believe, it is going to wind up. This will be unfortunate, probably for reasons that I will elaborate here.
I want to state, too, that another company, Boehringer-Ingelheim, is supporting the prevention of
mother-to-child transmission of HIV, definitely in my county of Lesotho and I believe also in a number
of countries in the sub-region. This is a program that we value very much. Through it, many countries
in our region are finding an easy entry point for the introduction of ARVs into the communities. I do
not know whether it is because the PMTCT program is the easiest to implement or because we are
very concerned about the mother. Indeed, this is an area in which we are receiving a lot of assistance.
My country has just launched a PMTCT program. It is about four or five months old now, but
we have an agreement with Boehringer-Ingelheim to provide us with nevirapine free of charge for
the next five years. Another company, Pfizer, Inc., is providing Diflucan to my country as part of a
long-term program of about five years. Merck Sharpe & Dohme also has taken a great interest in our
country, again in the area of HIV/AIDS. It is even involved in training and in delivery capacity-building.
To these companies and others, we want to express our appreciation for the kind of partnership we
are having—the public and private partnership.
We really value these partnerships very much. However, ladies and gentlemen, distinguished
guests, we continue to face challenges. Considering that these partnerships are for periods of
around five years, our biggest concern now is what happens after five years. Are we going to have
continuity of these programs?
One of the most serious difficulties that we face in our regions is providing enough capacity to
be able to implement the programs that we have assigned ourselves to. It is in this area that oftentimes we are found wanting. Just at about the time it will take us to acquire that capacity, about
five years, most of these programs tend to wind up. So, while we appreciate these partnerships, we
would ask you to please reconsider the length of your commitment and ease our anxieties over the
continued survival and support of these programs.
Through public-private partnership we are receiving research assistance. I may venture to
mention here that in the partnership with Bristol-Myers Squibb, through our Secure the Future program,
there is ongoing research now into the immunologic diagnosis of tuberculosis. We have noticed in
the clinical studies of HIV-positive patients that the normal tests for TB through x-ray and through spuGlobal Alliance for Women’s Health — Edited Proceedings of
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tum examination does not at times indicate its presence. And yet, when you subject those patients
to anti-TB treatment, they respond, and respond well. Therefore, we are inclined to believe that there
is some immunologic aspect to this, and a great deal of research is ongoing now to try and find out
if there is any immunologic laboratory test that we could subject these HIV-positive patients to.
We want to detect TB to ensure that anti-TB treatment is a welcome intervention. The work is
ongoing. If support for it is short-lived, committed for only five years, then we are worried that we may
not be able to carry this program forward. I would like to cover many more topics, but because of
time considerations, I will end at this juncture. Thank you very much for giving me the floor, Madam
Dr. Wolfson: Thank you very much. And we hope to continue this discussion. Now, I would like you to
hear from three speakers before we go to Q&A. First we will hear from Julian Fleet of UNAIDS.
Mr. Fleet: Thank you, Elaine. Thank you to the Global Alliance, to the missions of Angola and Niger,
and to, not least, our corporate partners in the Accelerating Access Initiative.
My name is Julian Fleet. I am from UNAIDS, and I can think of at least two good reasons why
it is a privilege for UNAIDS to be here to talk about partnership. The first is general and the second
specific. The first, of course, is that UNAIDS itself is perhaps the boldest experiment in partnership
within the UN in UN history. UNAIDS consists of a small secretariat, for which I work, seven UN agencies
and the World Bank. The lead UNAIDS co-sponsor in the area of care and treatment is, of course, the
World Health Organization.
On the specific level, it is a privilege to be here because at UNAIDS we highly value our partnership with the research-based pharmaceutical companies in the Accelerating Access Initiative.
Ambassador Moutari, at the outset, told us that 4.5 million people living with HIV in Africa today need
treatment, and that only 50,000, or about 1%, actually have access. Chris Murray and his colleagues told us that this is not good enough, that we have a long way to go. Minister Abdallah from
Tanzania talked about scaling-up from pilots to mass programs that can reach truly millions rather
than thousands. We could not agree more with all of those emphases by the previous speakers.
UNAIDS and WHO were involved in perhaps the earliest pilot, beginning in 1998, which demonstrated that antiretroviral medicines could be used safely and effectively in resource-limited
programs. It was the drug access initiative. Since then, we have had one pilot after another. At the
Durban AIDS conference, then at the Barcelona AIDS conference, WHO and UNAIDS and a vast array
of partners committed themselves to reaching 3 million people with access by the year 2005.
We know, as others have said, that we have a long way to go, that this number is not acceptable given the current spread of this disease. But at the same time, we think that there have been
some encouraging developments in recent years that actually bring access to treatment within
much closer reach for people living with HIV in Africa. I would like to just go through these very briefly.
First, we have unprecedented political commitment. We know from the Declaration of Commitment
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passed at the UN General Assembly Special Session on HIV/AIDS that all UN member states unanimously committed themselves to moving forward on treatment planning by 2003 and scaling-up,
implementing treatment programs to the highest attainable standards by 2005.
If you read the strategic national plans on HIV and AIDS that we have received at UNAIDS,
you will see that more than two thirds of them include plans to scale up antiretroviral HIV treatment
and contain specific targets for coverage. So, we have unprecedented political commitment. We
also have unprecedented sources of international financing for HIV care. I do not have time to go
through all of these with you, but I think you are all familiar with the Global Fund, which so far in its first
two rounds of grant-making has approved grants to 50 countries that have HIV care in their proposals. According to the Global Fund, some 86% of the HIV grants approved have monies planned for
strengthening antiretroviral distribution systems. Some 76% of those grants have monies specifically
for procurement of medicines.
Through the World Bank’s Multi-country HIV/AIDS Program (MAP) and other sources with which
you are familiar, donor governments have become increasingly open to supporting treatment, including procurement of medicines. The United States is just one example, having committed itself to
supporting 2 million people on access to antiretrovirals by the year 2005. National budgetary allocations are on the increase, and this is also all important.
The third major development that gives us hope -- and now I turn more directly to the Accelerating Access Initiative -- is the extraordinary reduction in the price of antiretrovirals over the past
couple of years. Before the year 2000, the prevailing global price was some 10 or 12 thousand US
dollars per patient per year. By our latest calculation at WHO and UNAIDS, the least expensive brandname combination approved by WHO and recommended by WHO as a first-line regimen is now
priced just under $700. Our calculation is $675 per patient per year, based on the most recent price
cuts announced by one of our Accelerating Access Initiative partners a few weeks ago.
These are major developments. The Accelerating Access Initiative was a vehicle through
which the companies were able to commit themselves to differential pricing of these medicines for
developing countries. I think it is important to point out that there are companies that produce medicines of importance to people living with HIV that are not in the Accelerating Access Initiative. They
have not yet committed themselves to this principle of differential pricing. So, we continue to commend our partners within this Initiative for their efforts. We know, of course, that at just under $700 per
patient per year these figures are still more than twice the annual per capita income in many of the
least-developed countries.
We know more progress can be made, and we can do better. But I think it is important to
point out that in my view in addition to the achievements I have mentioned so far this partnership
has had catalytic effects. Its efforts, for example, have provoked or been followed by reductions in
prices by generic antiretroviral manufacturers. It has allowed, I believe, the price reductions that I referred to earlier, and has contributed to helping the UN mobilize unprecedented international financing. I do not think we should have any illusions that the Global Fund or the directors of the World Bank
would have made the decisions they made about supporting care without these more attractive
All these achievements have helped shift the spotlight to national governments and interGlobal Alliance for Women’s Health — Edited Proceedings of
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national actions taken to provide them with support so they could strengthen health infrastructures,
including training, and encourage the all important growth of their national human resources capacity.
Now, because of time considerations, I want to end by thanking you all for the opportunity to
be here. I have tried to sketch a bit of the history that we have seen so far, and I will rely on my colleague from the World Health Organization, Jos Perriens, to tell you a bit about the future. Thank you.
Dr. Wolfson: After Jos Perriens, we will hear from Dr. Ndola Prata from Angola and the United States.
Mr. Perriens: Thank you, Dr. Wolfson. My being in this assembly has meaning only if I can move the
agenda. In preparing for this gathering, I planned to analyze all the good things that the Accelerating Access Initiative has done, what we have learned from it, and what the future should be. But as
I heard you all speaking and all analyzing and making constructive contributions to this debate, I
decided that I should not do that.
In Geneva, at the World Health Assembly today, we have an important debate going on in
Committee A about the future of the health sector’s response against HIV. Part of that debate concerns whether our member states will endorse a target of 3 million people on antiretroviral treatment
by the year 2005, as civil society has already done at the Barcelona AIDS conference. We want to
inspire them to endorse and actively support the expenditures that we calculate have to be made
for the kind of resources needed to provide a comprehensive response to HIV. And we hope that,
indeed, our member states will explicitly endorse that target.
This is very important because treatment access for people living with HIV does not just mean
that a few people will have a few extra years of life. Countries that have provided more treatment
access in spite of doubts about whether their programs would be funded for the following year have
demonstrated that their efforts have brought results. Many more people are able to get tested for
HIV infection. Many more people learn what HIV means to them and their families. Societies get mobilized because people talk to each other.
The programs in developing countries that have moved on have also shown the way treatment access can be used synergistically to fight the HIV epidemic. Programs in Uganda, in South
Africa, in Botswana have all involved significant numbers of community groups and community
members not just to support treatment adherence but also to talk to their peers, their communities,
their societies. People come together to discuss and help decide who should be treated first and
how the treatment approach should be prioritized in terms of cost, in terms of geographical coverage, and in terms of cost-recovery policies.
People living with HIV have been given the opportunity to be an important force in the fight
against HIV in those counties. I think the Accelerating Access Initiative can pride itself on having
facilitated these approaches. If anything will survive from this Initiative, it will be this: it has put treatment access squarely in the middle of the treatment agenda where it belongs, and it belongs there
Global Alliance for Women’s Health — Edited Proceedings of
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because it affects all dimensions of the fight against HIV. Thank you very much.
Dr. Wolfson: Dr. Prata.
Dr. Prata: My name is Ndola Prata, and I am originally from Angola, now residing in Berkeley, California, and affiliated with the University of California there. My task today is to remind all of us of some of
the challenges to the successes of treatment programs, especially in Sub-Saharan Africa.
We can divide the success of the programs into three levels: the individual level (when each
individual affected by HIV accepts and adheres to a treatment program); the community level
(related to the social support and support from family members who learn how to care for their sick
relatives); and the providers of health services who could be from the private or public sectors. In
much of Sub-Saharan Africa most of the burden would fall to these providers who would likely come
from the public sector.
Some challenges relate to the need for massive education information and communication
in terms of raising awareness, decreasing the stigma, and also increasing access to services. Another challenge would be to develop the required medical infrastructure needed in order to scale-up
the treatment programs. That would include the support of laboratory services necessary to a successful treatment program and also the training of health personnel in the country to provide adequate and quality HIV care and to manage side effects and assure compliance to the programs.
Another challenge would be to monitor and evaluate programs, and to manage drug distribution which in some countries where most of the population affected is rural can be really a big
problem. We also have to find ways to ensure that the most disadvantaged people affected with
HIV can get access to treatment. Here I am talking specifically about women and the poorest of the
poor who most of the time live in very distant areas and have no access to health care at all.
I am going to finish here by saying that we have a lot more to do in Africa to make treatment
programs successful. Receiving donated drugs is a first step, but we have to remind ourselves that a
lot more needs to be done. We need to organize ourselves in order to make our HIV efforts successful. Thank you.
Dr. Wolfson: We do have a few minutes for Q&A now.
Mr. Samuel Ochieng, Chief Executive, Consumer Information Network, Kenya: Thank you very
much. I will be very, very brief because I know time is not on our side. I am Samuel Ochieng, I work
for a consumer organization in Kenya, and we have been working on this issue of access for quite
some time. We are part of a coalition in Kenya known as the Kenya Coalition for Access to Essential
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
First of all, I want to thank all the speakers for their very excellent presentations. I also want to
thank the corporate sector for all the effort they are making, effort that we highly appreciate. Among
the concerns I have is, first of all, the issue of sustainability which has been reiterated so much, stated
so much by other speakers. How do we ensure that even after these programs have ended that
we are still able to continue providing the medicines required? Even after some years of support for
programs like those dealing with tuberculosis, should that support stop today, we would not be able
to manage them. How do we integrate sustainability when donations end one day?
Another issue is the need for a universal approach. There are governments which have entered into contracts, but my government does not intend to enter into such contracts. How do we
bring care to those in countries without contracts who are suffering? How do we incorporate care for
these people and the communities which are affected? We have to find some sort of a universal
approach, not the sort of selective approach that seems to be in place now.
The last issue which I want to reiterate is the issue of effectiveness. We have to see that the issue of HIV/AIDS is not just an issue of access to drugs. We have to look at the whole infrastructure, we
have to look at the medical facilities, we have to look at food issues, awareness issues. How do we
integrate all of this into the system so that we have effective programs?
These are the very few remarks that I want to make. Thank you very much.
Dr. Wolfson: Would the next speaker introduce himself.
Alexander Mangwiro, Director, Environmental Health, Zimbabwe: Good afternoon, ladies and
gentlemen. My name is Alexander Mangwiro, from Zimbabwe. I just have a few questions. I would
like to know if these donated drugs are generics. And, are they free? And for how long is this donation going to take place? Thank you.
Dr. Delavelle: I will answer the question as it applies to the donation program of nevirapine, of Boehringer-Ingelheim’s Viramune. Our program was announced in July 2000 during the World AIDS Conference in Durban, South Africa, with the first donations going to Congo Republic in October and to
Senegal in December 2000. Initially the program was designed to be in effect for five years. However, considering the increasing and recent demands of applicants, combined with national and international community mobilization for Persons Living with HIV/AIDS and especially HIV Mother-to-Child
prevention, and the creation of the Global Fund for AIDS, Tuberculosis and Malaria, Boehringer-Ingelheim is investigating the possibility of continuing this Donation Program beyond the five-year period.
Instead of stopping the program in 2005, the company is thinking of intending it.
The official announcement of this could be made in the following months. Please do not
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
make this known before the official announcement. But, since many health ministers and others
responsible for effort to fight HIV/AIDS are in this audience, I ask you to consider this information as an
opportunity to set up your national prevention of mother-to-child-transmission (PMTCT) programs using
2005 must not be considered as the Viramune Donation Program deadline, and it will not
mark the end of Boehringer-Ingelheim’s commitment to accelerate access to HIV drugs and to care
for people living with HIV/AIDS. The more Viramune we give through the Donation Program, the more
applicants we have, the prouder we are.
Ours is a totally free donation. You can ask the question to the Minister of Health of Ivory Coast,
of Tanzania, both present in this audience, or to officials in many other countries. We give it totally
free of charge to ministries of health, to governments, and to organizations. The only thing we look at
is whether there is a relevant program, a relevant medical program. We give the drug to NGOs like
Medicins Sans Frontieres, like the French Red Cross, like the German GTZ, like Caritas, like other faithbased organizations. And it is totally free.
Dr. Longuet: Merck has a program in Botswana called ACHAP (African Comprehensive HIV/
AIDS Partnerships), which deals with prevention, awareness, education, care and support. Our company donates two antiretrovials: Crixivan and Stocrin. Both are branded drugs approved by Food
and Drug Administration (FDA) for sale in the United States and by the European Agency for Evaluation of Medicinal Products (EMEA) for sale in Europe. They are given free to ACHAP in Botswana for
five years. For the other African countries involved in the Accelerating Access Initiative, we are committed to providing them with these two branded drugs at not-for-profit prices. And this is sustainable.
I wish to tell you that branded drugs can sometimes be cheaper than generics: 600 mgs of Merck’s
Stocrin, which is one tablet once a day, in combination with two other antiretrovirals, is cheaper than
its generic version. So, you should not consider that because it is generic you have to go for it. No,
you have to consider the quality of what you buy. Branded drugs can be cheaper, and their quality
meets international standards.
Dr. Wolfson: Dr. Phooko.
Dr. Phooko: Thank you, Madam. I just want to make a small intervention here. Indeed, we have been
talking about prevention of mother-to-child HIV transmission (PMTCT) but I think it is most important to
come up with some kind of strategic plan to address the question of the health of the mothers of
those children that we are protecting at birth. We are having disjointed interventions in our respective countries on how we wish to intervene with these mothers whom we know are HIV positive. But,
if we could come up with some kind of program, we would be able to convince a lot more mothers to come forward and declare their HIV status, and therefore be subject to treatment. Thank you,
Global Alliance for Women’s Health — Edited Proceedings of
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Dr. Delavelle: Regarding this intervention, I would like to tell you how the PMTCT Plus Program could
be a relevant example of concrete action and, for me, of concrete partnership. I would like to tell
you about the French Red Cross PMTCT Plus Program in Point Noire in the Congo Republic. This program was built by the French Red Cross with monetary support coming from the European Commission. Boehringer gave the drug for free in order to prevent mother-to-child transmission. Through
this program, mothers can also receive AZT for medical reasons if they can be followed very early.
GlaxoSmithKline is also donating AZT.
When, unfortunately, HIV is transmitted, the baby can have access to treatment, especially for
anti-opportunistic infection, and it can have access to triple combinations. Those triple combinations
are made up of branded drugs made available through the Accelerated Access Initiative. And the
mother, who has been given AZT or nevirapine, also has access to triple combination.
And I say this only to show you the partnership between Glaxo, Merck, Boehringer, and NGOs
like Red Cross. Several months ago, the Total petroleum company joined the partnership. Now their
HIV-positive employees can have access to care through the French Red Cross pilot center. I just
had a discussion today with the Minister of Health of Congo, who told me that this pilot experience
will be transferred to a center in Brazzaville, the head town of Congo, in the following weeks.
So, once again, this shows you a concrete example of partnership--private, public, petroleum companies and pharmaceutical companies, and of course, government.
Dr. Wolfson: Would anyone else like to make an intervention?
Dr.Tesfanesh Belay, Head of the Family Health Department, Ministry of Health, Ethiopia: Thank you
very much. Mine is a very simple question. As you know, the antiretroviral drug is a new drug, and the
service providers have to be trained. What training arrangements can be made?
Mr. Murray: Let me say on behalf of a number of the Accelerating Access Initiative companies, we
have programs in place to educate medical professionals in the correct and appropriate use of
antiretrovirals. I think that what we would need to have from a particular country is information about
exactly what programs they have in place and what products they will be using. Then we can talk
with the companies and establish who has the better resources to meet their needs.
We no longer see our role as purely and simply a supplier of products. We are also a supplier
of information and a supplier of technical information relative to our products. So, I think that one
of the companies—or a number of the companies—would be able to support you once you have
your antiretroviral program established and identified.
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
Dr. Wolfson: I will conclude our roundtable with thank-yous to our speakers and attendees. We are really delighted that so many countries are represented and so many people are here. This is only the
beginning of interactions such as this. We hope we can continue. And for those of you who will be
attending the Economic Commission for Africa meetings next week in Addis Ababa, or the meeting
of the African Development Bank, we would like very much to connect with you and see if you can
join us at a similar program that we expect to hold on June 1st at the Sheraton.
If any of you have ministers of finance or planning and development or health who will be in
Addis at that time, would you kindly tell us, and we will contact them immediately to see whether
they can join us for our roundtable on scaling-up access to treatment for HIV/AIDS. I want to thank
you again.
We will be doing edited proceedings, but it will take some time. It involves transcribing our
tapes, so we will ask our speakers to review their words, et cetera. And, we post the completed work
on our website (http://www.gawh.org) and will notify you when it is available there.
We really do appreciate your taking the time to come here today, and I hope that our discussions will make a difference and will advance the care and treatment of women and men and
children in Africa. Thank you very much.
Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”
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Global Alliance for Women’s Health — Edited Proceedings of
“Successes and Challenges in Scaling-up Treatment for HIV/AIDS in Sub-Saharan Africa: A Role for Public/Private Partnerships”