Millions of people with HIV die because they cannot get access to Aids drugs, according to a cross-party group of MPs. As of this summer, 13.6 million people were taking combinations of antiretroviral drugs that keep HIV levels so low in the blood that people stay well and do not infect others.
But, says the all-party parliamentary group on HIV and Aids, that means two-thirds of adults with HIV, and three-quarters of the children, are not on treatment.
Its report says the global effort to get the drugs to children and adults in low and middle-income countries and save lives is still falling short, in part because of high prices charged by pharmaceutical companies and cuts in donor funding.
It is “a modern tragedy of epic proportions”, according to Pamela Nash, the MP who chairs the committee. “This is a stark warning to governments, including the UK, that if we fail to address the barriers to access we will ultimately lose the battle to control and end the epidemic,” she said.
The committee’s report, Access Denied, says it is expected that 55 million people will need HIV treatment by 2030. Last year, 1.5 million people died of HIV-related illnesses.
Two groups in particular are in jeopardy – children, for whom there are inadequate drug formulations, and people who need second-line drug combinations because the basic first-line medicines have stopped working as drug resistance has set in.
Second-line drug combinations are far more expensive than the basic cocktail, which costs not much more than $100 (£64) per person per year. As resistance inevitably grows, more and more people will need second-line drug combinations, as has happened in Europe and north America.
But, says the report, “international funding for the Aids response has stalled”. That is causing particular problems for middle-income countries such as India, where the UK and the Global Fund, which pays for Aids drugs in poor countries, have their reduced financial aid.
“Funding is being removed very quickly from middle-income countries,” said Nash. “I think we need to re-think that. I understand where that is coming from, the idea is to get best value for money and there’s nothing wrong with that. But we are doing it far too quickly.”
The report calls for the UK government, drug companies and multilateral organisations to work together to make second-line and third-line Aids drugs available and affordable to all.
It also calls for more attention to developing drugs that are suitable for children, who were left behind because they did “not represent a lucrative sales market for the pharmaceutical industry”, said Nash
“People need to come before profits,” she said
More money for the specialised lab facilities that allow viral load testing is also vital, says the report. The test shows raised levels of virus in the blood, indicating a need for second-line treatment. Charities told the committee of patients dying while on the waiting list for a test.
Ben Simms, director of the charity StopAids, urged the UK government, the Global Fund and others to act on the report’s recommendations. “This report shows that the fantastic progress we’ve made in scaling up access to treatment and turning the tide in the Aids epidemic masks some deeply worrying challenges and growing threats,” he said. “We are failing to reach key population groups, witnessing a building crisis in middle income countries around pricing and resources, seeing trade deals threaten global access to medicines, and persisting with an approach to medical innovation that excludes billions of the world’s poor.”
Gareth Thomas, Labour’s shadow minister for Africa and the Middle East, said he was concerned about the slow progress on women’s rights, long recognised as key to tackling the epidemic, and the anti-gay legislation in countries such as Gambia and Uganda. This, he said, was “only reinforcing the stigma that those living with HIV/Aids still have to face and therefore making the task of tackling the epidemic harder still”.
The One Campaign said the tipping point in the epidemic had finally been reached, because more people were put on treatment last year than became newly infected. It said the fight against Aids is $3bn per year short of what is needed to control the disease and unsustainable because contributed mostly by just three countries – the US, UK and France. Progress is fragile and HIV is increasingly concentrated in groups that are hard to reach, such as those who inject drugs, men who have sex with men, sex workers and adolescent girls.