The contrast between the long term prognosis for someone living with HIV in the UK, with access to antiviral treatments which are transforming HIV into a chronic long term illness for many, and the position for many people with HIV in the developing world, where lack of treatment access and poor health systems mean an early and often painful death for most, is stark. This situation has led to condemnation of pharmaceutical companies and Western governments for not doing more and in particular, harsh criticism for the tight control of prices and patents particularly from treatment activists. The price of HIV medications to the developing world and the scale of the epidemic mean that treatment costs would exceed the total national health care budgets by many times in a number of developing countries. Reducing the price of drugs to cost price or providing them free in the developing world has an easy surface appeal and logic. However, the situation is very much more complex and needs a more considered and co-ordinated response.
Cheaper drugs are only a small part of any long term and effective solution.
6 The HIV situation in the developing world varies enormously from place to place, often even within the same country. We are familiar with the principle of needs assessment to devise appropriate responses to health care issues. Reducing the impact of HIV in the developing world requires needs assessments and strategies to fit local situations. Cheaper drugs will form an element but it may be that greater health benefits for the money available may be had by prioritising other things. Geographical variety 7 Even in the developed world, access to treatments is uneven.