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Boston Globe, July 12, 2004

U.S. under fire at AIDS conference

Activists, officials clash on purchase of generic drugs

By John Donnelly, Globe Staff

BANGKOK -- The 15th International AIDS Conference opened yesterday with scenes of tension, repeatedly pitting the Bush administration against activists and top global AIDS officials over the purchase of generic antiretroviral drugs for poor countries.

The US government -- by far the largest donor fighting AIDS around the world -- authorized earlier this year the spending of hundreds of millions of dollars on AIDS treatments for 15 poor countries. But it has put on hold the purchase of any generic drugs until the US Food and Drug Administration undertakes its own review of the copycat medicines.

While the administration believes the reviews could be done in six weeks, activists worry that the delays could stretch for months or longer. If that happens, they say, dramatically fewer AIDS patients will receive treatment, perhaps just one-third of those who could have taken the generic medicines.

Stephen Lewis, the special UN envoy on AIDS in Africa, said in a speech that the Bush administration, by waiting for the FDA reviews, was conducting a ''not-so-subtle" attempt to derail the World Health Organization's own review of the efficacy of generic combinations.

Although US officials ''say they will purchase generic drugs, the fact is those monies are now being used if not entirely, then mostly, for brand-name drugs," Lewis said. ''We are spending two to three times the cost to treat people at a time when dollars are scarce."

The conference, which has attracted an estimated 20,000 delegates from around the world, also featured an opening address by UN Secretary General Kofi Annan, who called on world leaders to take much stronger action in preventing the spread of HIV, the virus that causes AIDS. Annan also drew attention to the ever-increasing numbers of young women who are contracting the virus.

A UNAIDS report released last week found that in sub-Saharan Africa among the age group of 15- to 24-year-olds, three times as many young women were infected than young men.

The report estimated that in some African countries, such as Mali and Kenya, for every 10 boys and young men infected, 45 girls and young women were infected.

Annan called that a ''terrifying pattern" for girls and young women.

He told more than 11,000 delegates attending the opening ceremonies that much more effort should be put toward empowering women and girls to protect themselves against older men.

''Society's inequalities puts them at risk -- unjust, unconscionable risk," he said to applause. ''A range of factors conspires to make this so: poverty, abuse, and violence, lack of information, coercion by older men, and men having several concurrent sexual relationships that entrap young women in a giant network of infection."

Annan said men must change their sexual behavior. He called on leaders to free ''boys and men from some of the cultural stereotypes and expectations that they may be trapped in -- such as the belief that men who don't show their wives 'who's boss at home' are not real men, or that coming into manhood means having your sexual initiation with a sex worker when you are 13 years old."

As in past conferences, activists became a major presence immediately in Bangkok: staging a march to demand greater access to antiretroviral drugs; jeering Prime Minister Thaksin Shinawatra of Thailand during his opening address for his country's crackdowns on drug users, a population with high rates of HIV infection; and challenging the US global AIDS coordinator, Randall Tobias, during a news conference. Tobias told reporters the US policy was to ''buy the least expensive drugs we could find without regard to brand-name, generics, or copied drugs, as long as we could be assured" the medicines were ''top quality."

''We should not have two standards of treatment -- good in the Western world and good enough elsewhere," he said.

At the beginning of the briefing, Tobias telegraphed that he anticipated a challenge from activists. Two years earlier at the previous international AIDS conference in Barcelona, activists drowned out a speech by US Health and Human Services Secretary Tommy G. Thompson, who chose not to attend the Bangkok meeting.

Tobias said yesterday that he hoped activists and others would ''leave whatever agendas at the door," but 20 minutes into his briefing, an activist told him protesters wanted to meet with Tobias to accept a petition demanding treatment for all.

Tobias refused. ''I'm not sure I want to help you generate a media event," he said..

A second activist, Jerome Martin of Act Up-Paris, shouted at Tobias: ''You are not coming, sir? This is a shame. Tens of thousands of people are dying, and you will not meet with us?"

The briefing ended minutes later.

But demonstrators were not the only ones voicing concern over US policies on generic drugs. Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said he hoped the FDA would approve the applications for generic drugs in the ''next month or two. . . . I hope that the fast-tracking procedures really are fast."

Feachem said it would be intolerable if the Global Fund was purchasing generic medicines while programs funded by the US government were buying other, more expensive ones.

Daniel Berman, a specialist on generics and trade issues with Doctors Without Borders, said that scenario was about to come true in a hospital in Bulawayo, Zimbabwe's second-largest city. He said two AIDS treatment programs were being run at the hospital, one by his organization and the other by the US Centers for Disease Control and Prevention.

The Doctors Without Borders program was buying fixed-dose combinations of antiretroviral drugs that cost about $200 a year per patient. He said the CDC had recently ordered drug combinations at a cost of roughly $600.

John Donnelly can be reached at donnelly@globe.com.

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