5 April 2004

Jong-Wook Lee, MD, MPH
Director General
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
Switzerland

Peter Piot, MD
Executive Director
Joint United Nations Programme on HIV/AIDS
20, Avenue Appia
CH-1211 Geneva 27
Switzerland

Dear Dr. Lee and Dr. Piot:

On February 4-7, 2004 in San Francisco, a meeting was held between 30 treatment activists, many living with HIV/AIDS, from all regions of the world, and three pharmaceutical companies: Roche, Glaxo Smith Kline and Boehringer Ingelheim (see attached draft report).

One of the key issues discussed at the February meeting was differential pricing of antiretroviral drugs for lower middle income countries. It seems that price reductions negotiated through the Accelerating Access Initiative(AAI) for least developed and sub-Saharan African countries do not apply to middle income countries in Africa and elsewhere around the world. This leaves these nations faced with prices reaching as high as US$ 1000 per month for WHO-recommended first-line regimens and higher prices still for second line alternatives. For instance, in Egypt, Combivir (300mg, 60 tablets) costs US$ 643, Viramune (200mg, 60 tablets) costs US$ 321, Stocrin (200mg, 90 tablets) costs US$ 407. In Ukraine, Combvir costs US$ 375, Retrovir costs US$ 95 and Epivir costs US$ 205. The per patient per year costs can also vary widely even with a given region: for Combivir, Glaxo Smith Kline is charging US$ 329 a year in Honduras, US$ 655 in Costa Rica, El Salvador, Panama, Nicaragua and US$ 2100 a year in Venezuela; for Stocrin, Merck is charging US$ 346.75 a year in Pakistan, US$ 767 a year in Papua New Guinea; for Viracept, Roche is charging US$ 886.95 a year in Cambodia, US$ 2937 a year in Indonesia, US$ 4058 a year in Moldova, US$ 6240 in Georgia. This is unacceptable in countries with GNIs per capita ranging from $736 to $2,935. We know many middle-income countries are also heavily hit by unemployment and drastic inequalities in income distribution with the poor bearing the brunt of the AIDS epidemic in many of these nations.

We are strongly urging UNAIDS and WHO to re-open negotiations with brand-name pharmaceutical companies on price reductions for lower middle income countries to ensure affordability of antiretroviral therapy for those who need them. Reaching the WHO's goal of treating 3 million people in the developing world by 2005 will only be attained by using the highest quality drugs at the lowest cost, whether they are brand-name drugs or generic equivalents. We look forward to your response.

Yours truly,

Violeta Ross
ICW/ REDLA
Bolivia

Richard Stern
Agua Buena Human Rights Association
Costa Rica

Dr. Lobna Ibrahim
Pan African Treatment Access Movement (PATAM), North Africa

Mark Harrington
Treatment Action Group
USA

Gregg Gonsalves
Bob Huff
Gay Men's Health Crisis
USA

Simon Collins
Polly Clayden
I-Base
United Kingdom-Community Advisory Board
United Kingdom

Mauro Guarinieri
European AIDS Treatment Group
Italy

Delme Cupido
AIDS Law Unit, Legal Assistance Centre
Namibia

Aruna J. Hewapathirane
HEAL Project Sri Lanka / Lanka Plus

Oswaldo A. Rada
Regional Secretary of Latinoamerican Network of PLWHA - REDLA+
Colombia

James Kamau
Kenya Treatment Access Movement

Azita Amirieh
Persia+
Iranian Network of PWHA
Iran

Chris W. Green
Yayasan Spiritia
Indonesia

Lucia Stirbu
National Union of PLWHA Organisations (UNOPA)
Romania

Greg Gray
Asia Pacific Network of People Living with HIV/AIDS
Thailand

Robert Munk
New Mexico AIDS InfoNet
USA

Edward Low
Positive Living Group
Malaysia

Julio Cesar Aguilera
REDBOL
Red Nacional de Personas que Viven con el VIH de Bolivia

Pablo Anamaria
Coordinadora Peruana de Personas Viviendo con VIH y SIDA
Peru

Svilen Konov
Eastern States Working Group of the European AIDS Treatment Group
Plus and Minus Foundation
Bulgaria

Nenet L. Ortega
Remedios AIDS Foundation
Philippines

Dhayan Dirgantara
Injection Drug Users Living with HIV/AIDS
Bali Plus Support Group
Indonesia

Sharonann Lynch
HealthGAP
USA

Dr. Alexey Bobrik
Open Health Institute
Russia

Frika Chia
APN+ / SPIRITIA Foundation
Secretariat of Indonesian Network of PLWHA
Indonesia

Samuel Nugraha
PITA
Indonesia

Raminta Stuikyte
Central and Eastern European Harm Reduction Network
Lithuania

Kasia Malinowska Sempruch
Open Society Institute
USA

Daniel Novichkov
Humanitarian Action Foundation
Russia

Andrei Panov
Piter-Positive
Russia

Sandris Klavins
AGIHAS
Latvia

Olive Edwards
Jamaican Network of Seropositives
Jamaica

Mohammed Farouk Auwalu
Aids Alliance in Nigeria
Nigeria

Stephen M. Massey
Transatlantic Partners Against AIDS (TPAA)
USA

Dr. Wim Landman
AIDS Foundation East-West (AFEW)
Russia

Grace Muro
PATAM
Tanzania

Dr. Anne Herman
Those in Fight Against HIV /AIDS Tanzania (WAMATA)
Tanzania

Dr. Bwijo A. Bwijo
National AIDS Control Program
Tanzania

Joseph Kato
Service Health and Development for PLWHA (SHDEPHA)
Tanzania

Julius Kaaya
Tanzania Network of Organizations for PLWHA
Tanzania

Dr. Lydia Mungherera
National Forum of People living with HIV/AIDS
Uganda

Stuart Flavell
The Global Network of People Living with HIV/AIDS
The Netherlands

Slava Vassiljev
ESPO Society
Estonia

John Rock
National Association of People with AIDS
Australia

David Ananiashvili
Georgian Plus Group
Georgia

Augustine Chella
Network of African People Living with HIV/AIDS
Zambia

Ben Cheng
Forum for Collaborative HIV Research
USA

Lei Chou
AIDS Treatment Activist Coalition
USA

Roman Dudnik
AIDS Foundation East-West
Russia

Anastasia Kamlyk
Positive Movement
Belarus

Karyn Kaplan
Paisan Suwannawong
Thai AIDS Treatment Action Group
Thailand

Hanna Khodas
Vladimir Zhovtyak
All-Ukrainian Network of PLWH
Ukraine

Rolake Nwagwu
Treatment Access Movement
Nigeria

Germán Perfetti
Asociación Líderes en Acción
Colombia

Subhasree Sai Raghavan
Solidarity and Action Against the HIV Infection in India
India