AIDS treatment demands humane economics

Rosa Thamae spoke of her children at home, 7,919 miles away in Johannesburg, South Africa. But only a few feet separated the HIV-positive activist from her audience at an emotionally charged AIDS teach-in on Mon., Apr. 2.

REBECCA ROSENTHAL/YH Lungi Mazibuko, a South African HIV-positive activist from the National Association of People Living with AIDS.

"I want to live for my babies," Thamae told her audience. With her words and those of others, a relatively faceless issue for many in the Yale community quickly assumed the most human of qualities.

"They say HIV is a woman's disease," Lungi Mazibuko, a South African HIV-positive activist, said, referring to the rampant gender stigmatization surrounding AIDS in her native country. "You fear that your husband, the breadwinner, will leave you."

Thamae, Mazibuko, and Mpho Babusi, another South African activist, joined local activists in an effort to deconstruct and expose popular myths about the disease and its treatment that both South Africans and Americans harbor.

Yale and Bristol-Myers Squibb (BMS), partners in the discovery and development of d4T, an antiretroviral drug used to treat HIV and AIDS, have garnered international attention as a result of their decision not to enforce their patent rights in South Africa, effectively allowing the drug to be sold for a fraction of its cost.

The teach-in, organized by the Law School AIDS Action Coalition, was an attempt to give a more personal voice to the rhetoric of intellectual property rights through the often-unheard stories of people battling HIV and AIDS, both within themselves and within their communities. Many in the U.S. no longer consider the virus to be of pandemic proportions due to the success of antiretroviral treatments such as d4T in redefining HIV as a chronic but manageable illness in the U.S. As a result, activists find it difficult to persuade the U.S. public and policy makers that the great majority of the undeveloped world remains decades away from finding effective treatment options, let alone a cure, for this most devastating disease.

After Thamae, Mazibuko, and Babusi delivered three poignant talks on the crisis in South Africa, the discussion turned decidedly partisan as Asia Russel, an activist with the Health Global Access Project Coalition, spoke vehemently against what she dubbed "state-sanctioned genocide" on the part of the U.S. government and pharmaceutical companies due to their "profit-motivated" collusion.

The World Trade Organization (WTO) and the North American Trade Agreement (NAFTA) bore the brunt of Russel's criticism. Much of the audience laughed at the mere mention of the WTO or NAFTA effectively squelching even the remote possibility for a meaningful dialogue on the issues.

Toby Kasper from Doctors without Borders, a humanitarian activist group, joined the chorus, calling for "equity pricing" of life-saving pharmaceuticals in economically depressed regions of the world. Ironically, Kasper cited "a 68 percent decline in prices due to the introduction of generic competition." He joked, "Even I'm surprised to find myself supporting free trade." However, the line between Russel's "deadly and rampant globalization" and Kasper's more benevolent "generic competition" remains thin.

With Yale controling countless drugs, including a vaccine for Lyme disease, that are currently in pre-clinical and clinical trials, Fran Balamuth, MED '03, expressed her fear that Yale might easily find itself in the not-too-distant future holding the patent to a drug whose life-saving benefits only reach the most affluent of patients. In addition to reconsidering Yale's licensing policy, Balamuth mentioned what she referred to as the "forgotten diseases" that are anomalous in Western countries but nevertheless plague much of the undeveloped world. African Sleeping Sickness, or trypano-somasis, infects an estimated 300,000 to 500,000 sub-Saharan Africans every year, according to the Seattle Biomedical Research Institute. Despite the magnitude of such an epidemic, the incentive for Western pharmaceutical firms to invest the requisite capital in research and development of potential treatments remains shockingly low, because the countries plagued by the disease could not pay full price for such treatments. Balamuth classified this phenomenon as a market failure and called for increased government funding of such research.

Amy Kapczynski, LAW '03, pointed out that d4T was largely funded in the '60s by a grant from the National Institute of Health. While conceding that BMS funded the drug's passage through the Federal Drug Administ-ration's costly clinical trials, both Kapczynski and Bala-muth cite d4T's substantial government funding as a reason that d4T should be used throughout the world wherever need exists. Kapczynski mentioned Mexico and Romania, countries in which HIV cases are on the rise, as possible venues for future patent concessions.

"We'll be protesting every industrialized country that doesn't promise billions to fight the global AIDS crisis," Russel warned. "People are not expendable because they are poor." Preemptively, Russel summarized her opponents' argument in favor of strong patent protection: "They say you don't want to kill the goose that lays the golden egg," referring to the pharmaceutical industry and its products, such as d4T. "But the profit motive must come second—if it comes at all—in the face of this Holocaust."

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