“We all have AIDS”: case for reducing the cost of HIV drugs to zeroCommentary: The reality of treating HIV and AIDS in poor countriesCommentary: Most South Africans cannot afford anti-HIV drugs

doi:10.1136/bmj.324.7331.214

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“We all have AIDS”: case for reducing the cost of HIV drugs to zero

Donald Berwick, president and chief executive officer (dberwick@ihi.org)

Institute for Healthcare Improvement, 375 Longwood Avenue, Boston, MA 02215, USA
GlaxoSmithKline, Greenford, Middlesex UB6 0NN
Treatment Action Campaign, Nonkqubela 7793, Cape Town, South Africa

Accepted 30 October 2001

An editorial last year in the Washington Post challenged directors of drug companies to reduce the cost of HIV drugs in poor countries to zero. Here the reproduced editorial is accompanied by a discussion about why it was written and the response to it. We invited comment from one of the named directors and from a man with AIDS who refuses to take antiretroviral drugs until they are available to the public sector in South Africa

Last year I wrote a guest editorial for the Washington Post in which I challenged the world's pharmaceutical companies to cut the cost of HIV drugs to zero in poor countries (see box on next page).1 Here I explain why I wrote it and describe some of the responses it provoked.

Summary points

Complex drug regimens, combined with social support, have been used to treat infectious diseases, even in conditions of extreme poverty

The high costs of drugs can be used as an excuse for poor countries not to construct effective infrastructures for the care of patients with chronic infectious diseases

Dramatic reductions in the costs of antituberculosis drugs catalysed worldwide action against multiresistant tuberculosis

The boards and executives of drug companies could catalyse action against the AIDS epidemic by immediately reducing the costs of HIV drugs in poor countries to zero

The prologue

People living in poverty being denied access to modern health care is a form of violent, systematic social deprivation that we, as a civilised global community, ought not to accept. Even the poorest people in the poorest settings can, if they are allowed and assisted, be involved in improving their health and can benefit from the most advanced drugs.

This philosophy of social justice drives the international health programme Partners in Health, which was founded by Paul Farmer and Jim Yong Kim. Partners …

Correspondence to: Z Achmat