For AIDS treatment to reach millions, it needs to be free

Starting Tuesday, December 14, 2004, an alliance of renowned experts, institutions and non-governmental organisations will launch the 'Free by 5' declaration and present it to the World Bank, aid donors, the World Health Organisation (WHO), UNAIDS and many other parties. While the WHO aims to have three million HIV-positive people on Anti-Retroviral (ARV) treatment in the course of next year, the declaration points out that ARVs and associated care need to be provided free of charge to all patients in developing countries. Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa and signatory of the declaration states: "The push for access to Anti-Retroviral treatment has greater momentum than ever before. For many it will mean the difference, literally, between life and death. However, if it is not free then the poor…will not benefit. This declaration clearly sets out why treatment should be available free. It is deserving of our support." Of the 5.5 million HIV-positive people in need of treatment globally only 440,000 are receiving it. In Africa, not more than 4% of people living with HIV/AIDS are on ARV treatment. Despite decreasing market prices of the drugs, many people who have AIDS in developing countries are dying because they cannot afford the user fees asked for treatment. The declaration gives evidence that the payment required (patient fees) excludes many patients, heightens people's vulnerability to HIV/AIDS, as well as decreases treatment adherence, which may lead to drug-resistance. From a medical, a public health, an economic and a human rights perspective providing universal free treatment to AIDS patients is a necessary and rational course of action. Gorik Ooms of Médecins Sans Frontières: "Patient fees often make it impossible to reach those who need treatment most. The families that are most affected by AIDS in many cases lose their income from labour and can simply not afford to pay for treatment. Where AIDS care is provided in clinics that are sponsored by international donors but require patients to pay part of the cost, patients that can no longer afford tests or drugs, will drop out. Some turn to our clinics where care is free, but MSF can only provide a temporary solution for a limited number of people." The "Free by 5" declaration, initiated by the Health Economics and HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal, rapidly gathered support from key actors and organisations all over the world. To date nearly 600 people have signed in support. Among them are many esteemed public health experts, economists and policy makers including Stephen Lewis (UN Special Envoy on HIV/AIDS), Helene Rossert (Director-General of AIDES, France and Vice President of the Global Fund to fight AIDS, Tuberculosis and Malaria), and Gorik Ooms (Executive Director of Médecins Sans Frontières in Belgium). Professor Alan Whiteside, Director of HEARD, summarises: "Levels of poverty in most resource-poor settings are such that, unless treatment is provided completely for free, people will be excluded. I believe that it makes economic sense for public health services to offer free HIV/AIDS treatment." The declaration urges international donors to actively promote the implementation of free treatment and to pledge additional resources to make this a reality. It also presses WHO and UNAIDS to formally adopt clear guidelines on the necessity of free ARV-treatment. The full text of the declaration, as well as the list of signatories, can be found at www.heard.org.za