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Introduction: This study aims to provide a landscape of the global antiretroviral (ARV) market by analyzing the transactional data on donor-funded ARV procurement between 2003 and 2015, and the ARV price determinants. Design: The data were obtained from the Global Price Reporting Mechanism (GPRM) managed by the AIDS Medicines and Diagnostics Service of the WHO, and it consists of information that covers approximately 80% of the total donor-funded adult ARV transactions procurement. Methods: ExWorks prices and procured quantities were standardized according to the guidelines in terms of yearly doses. Descriptive statistics on quantities and prices show the main trends of the ARV market. Ordinary least squares estimation was carried out for the whole sample, then stratified according to the type of supplier (originator and generic) and controlled for time and geographical fixed-effects. Given that analyses were carried out on a public dataset on ARV transactional prices from the GPRM, ethics are respected and consent was not necessary. Results: Originator medicines are on average the least expensive in the sub-Saharan Africa region, where at the same time, generic medicines are on average the most expensive. By contrast, originator medicines are the most expensive in Europe and Central Asia, and generic medicines are the least expensive. In fact, the data suggest mixed strategies by ARV suppliers to exploit opportunities for profit maximization and to adapt to the specific conditions of market competition in each region. Our results also suggest that the expiration of patents is not sufficient to boost additional developments in generic competition (at least in the ARV market) and that formal or informal agreements between generic firms may de facto slow down or even reverse long-term trends towards price decreases. Conclusions: Our findings provide an improved understanding of the ARV market that can help countries strengthen policy measures to increase their bargaining power in price negotiations and the use of TRIPS flexibilities, with a special emphasis on negotiations with generic manufacturers. Keywords: HIV-treatment; price determinants; originator and generic medicines; patents., Introduction The prices of first-line antiretroviral (ARV) medicines fell significantly in recent years, allowing for the scaling up of access to ARV treatment in the developing world. In 2012, nearly [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.01.029 Byline: Patrick Peretti-Watel (a), Jean-Paul Moatti (b) Keywords: Risk behaviour; Sociology of deviance; Health promotion; Risk denial; Drug-taking Abstract: This paper argues that the sociology of deviance can be used to improve our understanding of some difficulties and unintended effects of health-promotion interventions designed to change risk behaviours, especially drug-taking. Firstly, many people engaged in 'risk behaviours' tend to deny the 'risky' label just as delinquents neutralise the 'deviant' label, and preventive information itself may be used by individuals in shaping risk denial. Secondly, deliberate risk-taking may be an 'innovative deviance',which is related to difficulties of conforming to the dominant 'risk culture'. Health promotion is likely to be quite ineffective if it remains wedded to the dominant risk culture and de facto contributes to the spread of it. Author Affiliation: (a) Health and Medical Research National Institute, French National Cancer Institute, and Regional Centre for Disease Control of South-Eastern France, Marseilles, France (b) University of Provence, Inserm U379, France

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jhealeco.2005.09.006 Byline: Pierre Lasserre (a), Jean-Paul Moatti (b), Antoine Soubeyran (c) Abstract: Criteria for initiation of highly active antiretroviral treatments (HAART) in HIV-infected patients remain a matter of debate world-wide because short-term benefits have to be balanced with costs of these therapies, and restrictions placed on future treatment options if resistant viral strains develop. On the other hand, postponing the introduction of HAART may involve a therapeutic opportunity cost if a patient's health is allowed to deteriorate to such an extent of becoming unable to benefit from new treatments currently under development when they become available. We introduce a two period model where period one treatment adoption is an irreversible act with future, but uncertain, consequences. New information, both endogenous and exogenous, arises over time and shapes the conditions surrounding the second period therapeutic decision. A surprising result is that, under conditions that appear close to those surrounding the HAART debate, the magnitude of the feared resistance effect has no effect on leaves the optimal treatment decision as far as it is high enough. JEL classification: I18; C61 Keywords: Therapeutic decisions; Uncertainty; Information; Irreversibility; Treatment Resume Le bien-fonde d'administrer precocement des traitements antire troviraux a haute activite (HAART) aux personnes infectees par le VIH reste objet de debats dans le monde car leurs bienfaits a court terme peuvent compromettre les traitements futurs si se de veloppent des souches resistantes du virus. Par ailleurs retarder le recours aux HAART comporte un coA't d'opportunite therapeutique si la sante du patient se degrade au point qu'il ne peut plus ben eficier par la suite des traitements encore en cours de de veloppement. Nous formulons un modele a deux periodes oA[sup.1] l'adoption du traitement de premiere periode est irreversible et engage le futur, alors que des informations et connaissances nouvelles, exog enes et endogenes, determinent les conditions entourant la de cision therapeutique de deuxieme periode. Paradoxalement, sous des conditions refletant bien les enjeux du recours aux HAART, il s'av ere que l'effet resistance eventuel a d'autant moins de chance d'importer pour la decision optimale, que sa gravite est elev ee. Author Affiliation: (a) Departement des sciences economiques, Universite du Quebec a Montreal, CIRANO, GREQAM, France (b) Faculte d'economie et gestion, Universite de la Me diterranee, GREQAM, INSERM Research Unit 379, France (c) Departement des sciences economiques, Universite de la Mediterranee, and GREQAM, Rte des Milles, 13290 Les Milles, France Article History: Received 1 January 2001; Revised 1 January 2003; Accepted 1 September 2005

Factors associated with nonadherence during the maintenance phase of highly active antiretroviral therapy (months 12- 60) in the Anti PROtease Cohort (APROCO) cohort after correcting for the bias due to missing outcome data is identified. Psychosocial interventions and the selections of the Best- tolerated regimens are needed to improve long- term adherence of HIV- infected patients to their lifelong treatment.

A study of contingent valuation of user fees for medical care i.e., assessment of the value patients in Palestine are willing to pay to improve medical care is presented.

Despite the acceptance that health gain is the most important attribute of health care, other aspects of health care may affect utility. The aim of this paper is to report an experiment to test the impact of providing different levels of information in the context of the EuroWill study, a joint contingent valuation (CV) of multiple health programmes. Three hundred and three respondents were simultaneously asked for their willingness-to-pay (WTP) for three health care programmes: more HEART operations, a new BREAST CANCER treatment and a HELICOPTER AMBULANCE service. To test for the impact of variation in information, three versions of one of the programmes (HEART) were provided. Results show that WTP for all three programmes tended to be significantly higher for respondents who were provided additional positive information about the HEART programme. Our results show that CV of health care programmes, which only take into account medical outcomes, may lead to the value of such programmes not being adequately estimated, and that the impact of information may even be more decisive in the context of joint evaluation of multiple, rather than single, programmes. Keywords: Contingent valuation; Willingness to pay; Value of information; Health care priorities; Joint evaluation; Europe

Research has been conducted on the role of highly active antiretroviral therapy in health-related quality of life. The durability of response to antiretroviral therapy and the long-term strategies have been evaluated in identifying factors related to normal levels of h ealth-related quality of life after 1 year of treatment, and the results are reported.

Research has been conducted on the role of social instability in adherence to highly active antiretroviral therapy among HIV patients infected via injection drug use. The authors have analyzed sociodemographic baseline characteristics in order to develop social instability indicator, and the details are reported.

To-date, most socio-behavioural research about HIV-infected patients' adherence to highly active antiretroviral therapies (HAART) has been based on cross-sectional studies. The French APROCO cohort gave us the opportunity to conjointly analyse the relationships between short-term adherence to HAART and HIV-infected patients' characteristics before initiation of treatment on the one hand, factors related to patients' subjective experience with HAART on the other hand. At the fourth-month follow-up visit (M4) after first prescription of HAART (M0), 26.7% of our sample of 445 patients self-reported non-adherence behaviour. Some patients' characteristics at M0 (younger age, poor housing conditions, lack of social support, and problems of adherence with previous antiretroviral regimens) were related to non-adherence at M4 in multivariate analysis. Non-adherence at M4 was, however, also related to the evolutions that affected a number of factors between M0 and M4: levels of depression, symptoms associated with treatment side effects, perception of individual state of health, beliefs towards effectiveness and toxicity of HAART, increases in alcohol and tobacco consumption, as well as contacts with other physicians than hospital HAART prescribers. Our prospective study brings additional evidence that even short-term non-adherence cannot be reliably predicted on the sole basis of a few a priori patient characteristics that clinicians could easily identify before initiation of HAART. It suggests that a dynamic approach to adherence, continuously monitoring the impact of experience with HAART on patients' daily lives, is needed for improving management of HIV/AIDS care. Keywords: HIV-infection; HIV/AIDS care; Adherence; Health behaviours; Highly active antiretroviral therapies

HIV patients who always take their AIDS drugs when they should are the ones most likely to have a good response to therapy. This was the conclusion of a study of 436 HIV patients, of whom only 31% always took their drugs when they were supposed to.

HIV patients who comply with their protease inhibitor treatment are the most likely to achieve low viral levels, according to a study of 750 patients. A good immune response can occur even in those who are not completely compliant, but it may not last.

This paper is an introduction to the various contributions in this special issue of Social Science & Medicine which are an attempt to synthesise the main debates of the 2nd European Conference on Social and Behavioural Research on AIDS held in Paris, in January 1998. The paper discusses how the recent advent of highly active antiretroviral therapies (HAART) and new trends in the epidemic (its concentration in the socially most vulnerable groups and countries) have affected the research agenda of European social and behavioural sciences (SBS) in HIV/AIDS. Questions which had already been thoroughly studied by SBS (like determinants of HIV-related risk behaviours, or impact of gender and socio-economic inequities as well as discrimination on the diffusion of HIV) will have to be 'revisited' in light of these recent changes. New issues (such as risk behaviours among already infected patients, impact of therapeutic advances on psychosocial and daily life management of their disease by people living with HIV/AIDS, adherence to treatment, or 'normalisation' of AIDS public policies) will have to be strongly and quickly dealt with, in order for SSB to keep the pace with the rapid evolution of the epidemic and of the societal responses to it. Finally, the paper argues that to face these challenges, new theoretical and methodological advances will have to go beyond the classical oppositions in internal debates among SSB between individualistic and holistic approaches, or between radical criticism of the existing state of the world and practical involvement in public health decision-making.