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But the increasing activism to lower AIDS-drug prices has forced some grudging changes in boardrooms and government offices. Last May the U.S. reversed course when President Clinton, over fierce resistance from the Republican Congress, issued an Executive Order promising that the U.S. would not challenge laws in African countries that seek to improve access to AIDS drugs. For five years, UNAIDS (the Joint United Nations program on HIV/AIDS) jawboned the companies to set lower prices for developing countries. Finally, just before the international AIDS conference held last July in Durban, South Africa, five major pharmaceuticals joined an "Accelerated Access" program to negotiate 60% to 80% reductions in AIDS-drug prices for poor nations. To stave off a wave of compulsory licensing around the globe, one company has said it will match generic prices where it can't block copycat production.
On-the-ground impact from these moves in Africa is hard to find. Each country must negotiate the price of each AIDS-cocktail component with each company, and the tough bargaining has barely begun. While Senegal, for instance, might haggle prices down 75% or 80%, the therapy is still too costly at $1,200 a year for people who earn $510 a year, Senegal's per capita income. And to start, the company will provide sufficient drugs for only 800 patients over five years. Kim Nichols, policy director at the New York City-based African Services, calls it "too little, too late."
Now all eyes are on the Bush Administration. Will it stick with Clinton's order to stop blocking Africa's efforts to get cheaper drugs? Or will it give way if Republicans and drug companies apply pressure to rescind the order? So far, says a trade official, "no one has said, 'Hold your horses.'"
While access to antiretrovirals would bring a medical miracle to Africa, it would still provide no more than a holding action. Only a vaccine that could actually stamp out the virus would provide a lasting cure--and that remains tragically elusive. --Reported by Jay Branegan/Washington, William Dowell and Alice Park/New York