PARIS--Potent antiviral drugs have begun to cut the death rate from HIV infection in developed countries. But in the developing world, where 90% of the estimated 35 million HIV-infected people live, the high cost of these drugs makes them virtually unobtainable. Now, a French fund is trying to change that, by subsidizing anti-HIV therapy in Africa.
The idea for the Fund for International Therapeutic Solidarity (FSTI), as it is now called, was aired by French health minister Bernard Kouchner in December 1997. Last month, the fund announced that it will carry out its first projects in the West African nation of Côte d'Ivoire, which has an estimated 700,000 HIV-positive people. FSTI will subsidize "bitherapy"--two drugs that inhibit the key HIV enzyme reverse transcriptase (RT)--for just 500 patients, chosen among infected AIDS prevention activists and patients who have already participated in clinical trials for antiviral agents. A second, larger effort will support testing and therapeutic follow-up for 20,000 pregnant women and their families in Abidjan, the nation's capital. Those who test positive will be offered a "short course" of antiviral drugs to prevent mother-child transmission, and mothers in the advanced stages of HIV infection will be offered triple therapy--generally two RT inhibitors and a protease inhibitor directed at another HIV enzyme.
FSTI's sole contributor so far is the French government, which has provided $4 million in start-up money. In addition to FSTI's contribution, a charitable foundation set up by the French arm of the Glaxo Wellcome drug company will kick in about $250,000 and the Côte d'Ivoire government will supply $1 million. Other partners--including the U.S. Centers for Disease Control and Prevention in Atlanta and UNAIDS, the Geneva-based United Nations AIDS program--will lend logistical support and expertise. But an additional $3.3 million may be forthcoming from the European Commission, after a vote by the European Parliament last October directed the commission to make a donation. A dozen developing countries have already lined up to request money from the fund.
While they welcome the program, health officials agree that it will have only a small impact on the explosive AIDS epidemic. "It is very easy to be paralyzed by the magnitude of the problem," says Joseph Saba, who is in charge of UNAIDS's drug access initiatives. "But do we wait until everything is perfect and everyone has access, or should we go on a step-by-step basis?"