New York -- As the World Bank considers the launch of a new set of loans to combat the HIV/AIDS epidemic in Africa, development sources told The Monitor individual countries could decide how to get the best drug regimens at the best cost. The sources implied recipient countries could buy generic antiretroviral drugs, possibly infringing on pharmaceutical companies’ patents, without Bank interference.

The Bank Wednesday announced the appointment of Debrework Zewdie as the Bank’s first Global HIV/AIDS Adviser. Zewdie, an Ethiopian and former medical scientist, will be responsible for intensifying the Bank’s efforts in the field and representing the Bank in the global fight against the AIDS epidemic.

The Bank also announced Wednesday its Board of Governors will decide January 17 on a proposed second round of Multi-Country HIV/AIDS Program (MAP) interest-free loans in Africa, totaling $500 million. Uganda, one of 10 countries to benefit from MAP 1, received a $47.5 million loan in July.

Zewdie said the Uganda project is progressing well, as "the background work that needs to be put in place so community groups and NGOs can access the funds, is already put in place," she told The Monitor.

Unlike MAP 1, which only provided for antiretrovirals (ARVs) to prevent mother-child transmission, MAP 2 funds may be used for full ARV treatment for adults suffering from HIV/AIDS.

On the matter of generic ARVs, Zewdie told The Monitor "the rules and regulations that are internationally accepted also bind the World Bank."

In Uganda, a number of firms are planning production of generic versions of ARVs, including Kampala Pharmaceutical Industries and Rene Industries.

Until the latest round of World Trade Organization talks in Doha, Qatar, earlier this month, it was clear that international trade regulations banned the sale of patent-violating generic drugs, unless countries had declared national emergencies. But the Doha declaration, adopted after intense pressure from developing countries, recognised governments’ unrestricted right to adopt effective health policies for their populations.

While 20 new countries have applied for MAP 2 funds, Zewdie said countries that received MAP 1 funds are also eligible for more. "If Uganda utilizes its resources appropriately, according to the project proposal we all agreed upon, and uses all the money by tomorrow, there will be more money for Uganda," she said.

Among the components of the MAP 2 proposal Zewdie will take to the Bank in January is a pilot ARV program for Senegal. "We want to see whether bank resources could be used in a sustainable manner to buy ARVs," she said.

Senegal was chosen as a test country because it has one of the lowest rates of HIV infection in sub-Saharan Africa, under two percent. Furthermore, "They have a fairly well developed infrastructure and they’ve negotiated cheaper prices with pharmaceutical companies," Zewdie said.

After gaining clearance for the Senegal pilot project, the Bank will immediately start the necessary work for other countries to purchase ARVs under MAP 2, Zewdie said.

Antiretrovirals are the most effective treatment for people infected with HIV. The drugs have prolonged the lives of millions, particularly in the United States and Europe. But their high prices have kept them out of reach of most HIV-positive people in the developing world.

That is changing, as pharmaceutical companies have recently slashed prices on a number of ARV drugs, and, simultaneously, generic drug manufacturers in Brazil, India, and Thailand have produced cheaper versions of the drugs.

Barbados, a Caribbean country which is comparatively well-off and has a well-developed health infrastructure, recently received a $15.5 million loan from the Bank to begin providing ARVs to its infected population. Development sources indicated that Barbados would be free under procurement rules to buy ARVs from the cheapest possible source, which may, for some drugs, be generic manufacturers in Brazil or elsewhere.

One of the innovations in the MAP 2 proposal is a plan to aid AIDS-fighting projects that cross national borders. Zewdie will pitch to the board the Abidjan-Lagos Corridor Project, which will coordinate treatment and care for HIV-positive people crossing between five West African nations: Togo, Nigeria, Côte d’Ivoire, Ghana, and Benin.

Truck drivers, commercial sex workers, traders, migrants, and others who travel frequently are among those hardest hit by AIDS. This project would make it possible for an infected person to continue treatment after moving to a new country.

Zewdie cited the new AIDS diagnosis training center at Makerere, which will train doctors from around the continent, as a regional cooperation project that might merit MAP 2 funds. The newly-formed Confederation of East African Medical Associations might also qualify.

Some Ugandan NGOs fighting HIV/AIDS complained that MAP 1 did not provide enough funds for civil society. Zewdie pointed out that a large portion of MAP 1 went to NGOs, but she also said, "We are flexible. MAP is learning by doing. If there is this feeling, it can be corrected immediately."