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OPINION
SPECIAL TO MSNBC

April 4 — If drugs are credited with transforming HIV from an almost certain death sentence to a chronic, manageable disease in developed nations, isn’t it our moral duty to make sure that people in the poorest countries hardest hit by the AIDS epidemic have access to these same medications? The answer to that question may seem obvious. But it isn’t.

AIDS IS cutting a terrible swath of death through sub-Saharan Africa and parts of Asia. It is the leading killer of people under 40 in many African countries. And AIDS threatens to explode with devastating consequences in Russia, India and parts of Eastern Europe.

AIDS is still a major problem in the United States. But it is not the lethal plague it once was. What accounts for the difference in the body count between Africa and America? The answer is drugs.

The lethal sting of HIV has been somewhat blunted by a new generation of powerful drugs that, while not a cure for AIDS, do slow the effects of the virus and allow people to live for many years.

These drugs cost a lot of money: $15,000 per person per year is the figure most often cited. Obviously, a person living in poverty — as is often the case in areas of the world hardest hit by AIDS — cannot afford them.

So the solution seems equally obvious: Make the drug companies that produce the requisite drugs, and make a lot of money selling them, offer them at deeply discounted prices or give them away for free.

In fact, international agencies, governments and patients’ rights groups are placing enormous pressure, with some success, on the huge multinational drug companies to do exactly this. The companies are being told that they must either give anti-AIDS medicines away to poor nations such as South Africa or allow smaller companies to infringe their patents and produce cheap, generic copies at greatly reduced prices.

Giveaways sound good. Huge pharmaceutical companies make billions each year in profits. So why not force them to help the poor, who will otherwise die?

Because, in the end, giveaways are a bad idea. While drugs are an answer to the AIDS plague in North America and Western Europe, they are not the solution for Africa and many other extremely poor nations.

The reasons are simple. Drugs designed for people in more developed countries will not work as well for people living in countries that have no hospitals, clinics, clean water, sewers, roads or doctors. Some of these drugs must be taken with food to work effectively, for example. So in nations on the edge of famine, they will not do much good.

It also is not easy to stay on the latest generation of anti-viral medications. A person infected with HIV must take more than 30 pills every day. Some medicines have to be taken with water, but without food. Some must be ingested early in the morning, others late at night. Probably 10 or more different prescriptions are involved in the life-preserving regimen that is slowly changing AIDS from a lethal condition to a chronic one in developed nations.

So what happens when a person can’t get to a clinic to fill all these prescriptions? Or fails to take all his medication as directed? Nastier, drug-resistant forms of HIV that are even harder, if not impossible, to treat emerge and proliferate.

Drugs also don’t get to the heart of the AIDS epidemic. Simply throwing drugs at countries that have no educational or public health programs will not slow the spread of the disease. Unless drug distribution is linked to public health campaigns, AIDS will not be stopped. And the high cost of drugs means that eventually, the patience of drug companies and their shareholders for giving the medications away will run out and the media will get bored with the story of people in far-away lands dying in droves for want of medications. After a few years, charity will disappear, only to be replaced by the same old indifference.

What these poor nations need is what they always have needed: A solid health care infrastructure. Those dying of AIDS need drugs, but they need a clean bed to lie in and safe water to drink even more.

No pill should be given away to any poor nation without a commitment to build a clinic, a road, a source of clean water or a public health program aimed at AIDS prevention.

Drugs alone are not the answer. The world’s poor who have AIDS needs clean water to take their pills.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania in Philadelphia.