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Critical issues of access to life-saving medications are being overlooked in the excitement about new technologies and prevention methods, activists warned at the international AIDS conference yesterday, with the risk that the hundreds of thousands of people newly started on anti-retroviral drugs in poor countries could be left without medications in a year or two.

The price of the so-called “first line” of drugs — the optimal initial regimen for a person with AIDS — has come down to $132 (U.S.) per patient per year, thanks to competition from generic companies and activist pressure. But within three or four years, people taking those drugs become resistant, and need to switch to a new regimen — which today costs at least six times more.

This is costly for a country such as Canada, but unsustainable for one such as Malawi, which is already using the bulk of its health budget to put people on first-line drugs.

The problem looms increasingly large as the world's poorest countries, which are also some of the most infected, scramble to get people on to anti-retrovirals.

On Tuesday, former U.S. president Bill Clinton said one of the key lessons at the conference for him was the urgent need for these drugs and the fact that their existing prices put them out of reach for most developing countries.

Today the standard second line of treatment in Africa costs $1,500.

“That's 10 times the price of the first line, so if 10 per cent of your patients go on it, your overall costs double,” said Anil Soni, director of pharmaceutical services for the Clinton HIV/AIDS Initiative. “So the first issue is that the products are not available and patients are dying today.

“But the macro issue is that this is driving an exponential increase in cost, just as we're talking about universal access.”

And it isn't just “second line.” The World Health Organization released recommendations this week on optimal AIDS treatment, but the new list of drugs includes many that are priced far out of reach for developing countries.

The newly recommended first line, for example, is a combination with Tenofovir, which is not available in many developing nations. “It means countries can't implement the guidelines,” said Alexandra Calmy, HIV-AIDS adviser for the access to essential medicines campaign.

Compared with the current first line used all over Africa, the combination with Tenofovir causes fewer of the side-effects that plague people on ARVs, such as nerve damage and disfiguring fat redistribution.

Much of this debate centres on the drug Kaletra, a key component of second-line treatment. Abbott Laboratories introduced a new version of the drug that doesn't require refrigeration — essential for African countries. But Abbott is not giving a voluntary licence to any generic company to make the drug (spokeswoman Jennifer Smoter said the manufacture of the drug involved proprietary technology), insisting instead that it will scale up production to make quantities for the developing world.

And new pricing announced on Monday did little to placate organizations of people with AIDS desperate for the drug. In Thailand, for example, Abbott will sell the new Kaletra for $2,200 per patient per year — down from $3,000.

But in a country where the monthly wage of a university-educated office worker is $120, it is still not feasible, said Nathan Ford, who has been struggling to get the new Kaletra for Thai AIDS patients treated by Médecins sans frontières (Doctors Without Borders).

Meanwhile, those working in front-line HIV health services in Canada said yesterday that people at the conference may be left with the “false impression” that everything in this country is fine.

“It's a total myth that people have access or equal access to drugs in Canada,” said Louise Binder, the chair of the Canadian Treatment Action Council, which lobbies on behalf of people with HIV.

Bigger, wealthier provinces such as Ontario, Quebec and Alberta tend to pay for and provide HIV drugs. But not the Maritimes, she said. “People literally have to move to stay alive,” she said.

As well, Ms. Binder said there are about 19 different federal drug plans that cover HIV medications. Some drugs that aren't covered for aboriginals are covered for military personnel or pensioners, she said.

With a report from

Carolyn Abraham