Dear Friends,

Thank you for the letter of 5 April 2004 addressed to Dr Lee and myself concerning the lack of affordable differential pricing of antiretroviral medicines for lower middle income countries. I apologise for the delay in responding, but am now pleased to advise you of work in this area being conducted by UNAIDS and WHO.

While the prices of many antiretrovirals have come down to more affordable levels in sub-Saharan Africa and in least developed countries, I absolutely agree that we need to focus simultaneously on affordability in middle-income developing countries. Indeed, I have raised this issue regularly in my meetings with pharmaceutical companies. Many lower middle income countries have relatively strong health systems and human resource capacities, offering greater possibilities for more immediate procurement and quicker gains in expanding access to treatment. Yet we know, as you have cited in your letter, we have a long way to go to achieve affordable pricing in many of these countries.

The World Health Organization is the lead Cosponsoring agency within UNAIDS for the area of care and treatment. I have directed my staff, in collaboration with the WHO HIV Department's AIDS Medicines and Diagnostics Service (AMDS), to contact both research-based and generic pharmaceutical companies. Initial contacts have been made and formal discussions with the companies are planned for next month. In preparation for discussions with the companies, the AMDS is examining the pricing practices of the companies in a number of middle income countries.

I have asked Julian Fleet to continue to keep you abreast of developments. I will follow closely the results of the upcoming meetings with the companies and will continue to advocate for far greater progress in this area.

Yours sincerely

Dr Peter Piot