Its two years since the Joint United Nations Programme on HIV/AIDS told delegates at the Durban AIDS conference all about its promising public/private partnership Accelerating Access to HIV/AIDS Care, Treatment and Support.

The global initiative advanced a plan for reducing the price of antiretroviral therapy and getting it to those most in need: people with HIV/AIDS in the developing world, in particular sub-Saharan Africa.

And the biggest drug companies were all on board: Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo Wellcome, Merck & Co. and Hoffman-La Roche. As the original press release (of May 2000) pointed out, each had agreed to work with governments and others to find ways “to broaden access to care and treatment, while ensuring rational, affordable, and effective use of drugs for HIV/AIDS related illnesses.”

Two years later, however, Accelerating Access seems to be making glacial progress. While a progress report from last fall offers detailed descriptions the individual initiatives of each company, a recent briefing confesses more.

Issued by the World Health Organisation, which took over the leadership of the programme in November, it notes that 80 poor and middle-income countries worldwide have “expressed their interest” in the initiative and the scheme has proven that “HIV/AIDS care was possible in resource-limited countries.”

But it adds that “scaling up of treatment of people living with HIV/AIDS proved more difficult than expected as only an estimated 20,000 patients out of 5 million receive adequate treatment in low-income countries.”

That’s right: 20,000. (About 500,000 of the 1.5 million people living with HIV/AIDS in rich countries have access to antiretrovirals.

When asked about this low number, Dr Joseph Perriens, Director of the Care Evidence and Policy Group in the Department of HIV/AIDS at the WHO and a leader of the access programme, says that he prefers other statistics. The 2002 UNAIDS global report, for instance, which estimates that roughly 230,000 people in low- and middle-income countries are receiving anti-HIV drugs: though 110,000 of these are in Brazil.

(Perriens estimates that about 6 million people in these countries need this therapy now – they will die in less than two years, otherwise – so about 4% of the people most in need have a hope of living for more than another two years.)

Perriens freely admits that even these figures are deeply disappointing. And he says he has no doubt that drug prices are still too high. But he also blames domestic governments for being “slow on the uptake” with Accelerating Access, and the world’s richest countries for failing to support the Global Fund to Fight HIV, Tuberculosis and Malaria, which will provide money for Accelerating Access.

Bernard Pecoul sees things differently. The director of the Access to Essential Medicines Campaign at Médicins Sans Frontières describes Accelerating Access as “an industry-led initiative” and notes that individual companies have been reluctant to agree to systematic price reductions, instead negotiating with countries on an interminable case-by-case basis.

Better, he says, for countries to exploit other options. Brazil, Thailand and Cameroon, for example, have vastly expanded access to antiretroviral drugs by a number of strategies to encourage competition in pricing. These include local production of drugs, importation of generics and forceful negotiations with proprietary companies.

“We need to reverse the leadership of this initiative,” Pecoul says. “By taking more control, countries create more competition. This is the way to get the medicines to the people who need them. Accelerating Access is simply too time consuming.”

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team