Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
BBC News - Friday, 21 November, 2003
Karen Allen, BBC Health Correspondent
Ninety-five percent of the 42 million people worldwide who are infected with the virus which causes Aids live in poor countries.
As more of these people reach the point where their infections require the treatments - known as antiretroviral drugs - demand will increase further.
But few will be able to afford the medicines.
Progress is being made to bring the drugs to poor nations, but it is slow.
Since 2000 when the inequity of access to treatment forced its way onto the international political agenda, some pharmaceutical companies have reduced the prices of the drugs.
The price of antiretroviral treatment has fallen from ú6,000 per patient per year to ú180. Even so, that is still beyond the means of millions of people who survive on less than a dollar a day.
Alliances are being forged with politicians, international agencies and businesses to try to push forward the production of "generic" or copy antiretroviral drugs.
Agencies are also striving to provide the back-up medical training and clinics to enable patients to take the drugs safely and effectively.
Trade deal
The Bill Clinton Foundation - an HIV/Aids charity - recently signed an agreement with generic drugs manufacturers to offer two key drugs at half the cost of "named" antiretroviral drugs to countries like Mozambique, Rwanda, South Africa and Tanzania.
However, agencies like Oxfam worry that initiatives like these will run into trouble in 2005, when developing countries lose their automatic right to produce generic medicines.
Many do not dare to exercise this right at the moment because they are either afraid of the political repercussions or do not have the technology.
A deal singed in August 2003, just before the World Trade Organisation meeting in Cancun, tried to refine trade agreements that protect patents and scare off poorer countries from manufacturing copies of drugs.
Cheap copies
The WTO deal would allow developing nations to import low cost copies of brand name drugs by issuing a compulsory license.
However many aid agencies fear that the deal is bureaucratic and still puts far too much power into the hands of the big pharmaceutical giants.
They say it will apply to only a limited number of drugs and it will not allow for the quantities of copy drugs needed to deal with the HIV/Aids pandemic.
Countries like India, South Africa, Thailand and Kenya all have the capacity to develop copies of drugs.
Many commentators see them as holding the key to the drugs debate if the issue about patents can be resolved.
Indeed the World Health Organisation hopes to build on this capability to deliver on its promise to provide 3 million more people with aids treatments by 2005.
Drug-resistant strains
For richer countries like Britain, HIV/Aids may now be considered a chronic disease rather than a death sentence because of the availability of antiretroviral drugs, but it too has its problems.
Patients who have been on antiretroviral drugs for some time are beginning to develop resistance to them.
Their treatment options are running out. And worryingly doctors in Britain are beginning to see drug resistant strains of the virus being transmitted from person to person.
New classes of treatment are coming on stream which scientists hope may get round the resistance problem.
But these classes of drugs called fusion inhibitors - for example Fuzeon - are expensive and complicated to use.
Unlike conventional antiretroviral drugs, they work by preventing the HIV virus from entering a cell in the first place.
Put simply - doctors believe that because of this unique way of working, patients may be less likely to become resistant to them.
The challenge to deliver aids drug treatments is a race against time - the virus is constantly mutating and one person is infected every 14 seconds.
Although more medicines will certainly make a difference to the harrowing death toll, scientists are looking at other options like microbicides, better prevention strategies and ultimately - a vaccine.
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