Antiretroviral drug discounts should be extended for countries classified as 'middle-income'

Pricing antiretroviral drugs and other "lifesaving" medications based on a country's gross national income per capita "seems particularly arbitrary -- and even cruel" -- given that HIV-positive people often have incomes "well below what might be considered a country's 'average' income," Jorge Saavedra Lopez, general director of Mexico's National Center for the Prevention and Control of HIV/AIDS, and AIDS Healthcare Foundation President Michael Weinstein write in a San Jose Mercury News opinion piece.

Only countries classified as "low-income" based on GNI by the World Bank qualify for discounted antiretrovirals under the Accelerated Access Initiative, a public-private partnership that aims to increase access to essential medicines in developing countries, according to Saavedra Lopez and Weinstein.

Countries classified as "middle-income" are "subjected to outrageous drug prices -- keeping lifesaving medicines out of reach and creating a serious obstacle to combating growing AIDS epidemics in these countries," the authors write.

Mexico, which is classified as "upper middle-income," has a GNI of $6,790 annually, while the average annual per person cost of antiretrovirals in the country is $8,000, according to the authors.

Saavedra Lopez and Weinstein write that Gilead has reduced prices for its HIV/AIDS-related medications by two-thirds for middle-income countries and that other pharmaceutical firms "must follow suit" and expand AAI to such countries.

"There is no question that the poorest countries of the world hardest hit by the AIDS epidemic ... must be allowed to purchase lifesaving AIDS drugs at the lowest price possible," the authors write, adding, "[But] a middle-income designation should not spell death for millions of people, especially when such a classification does not accurately reflect what people, and governments, can actually afford" (Saavedra Lopez/Weinstein, San Jose Mercury News, 10/16).