The real reason the pharmaceutical industry is trying to hold the line on its AIDS patents in impoverished nations is its fear that the Third World battle is simply the thin end of the wedge and that the activists' real goal is universal price controls on drugs -- in effect, socialism justified by overpowering moral arguments. Making AIDS drugs available at cost in impoverished nations facing one of the greatest plagues in human history would seem to be morally imperative -- but, the drug companies' defenders argue, it's a slippery slope. Where do you draw the line? Tactically, the industry fears that once it can be shown that AIDS drugs can be produced cheaply in Third World countries, Americans will demand the same.

In fact, activist groups like the Consumer Project on Technology are fighting for the right to produce or import generic versions of d4T, at cost, for distribution in the U.S. and other industrial nations -- effectively preventing Big Pharm from making any money from sales of AIDS drugs in those countries. Student groups on campuses from Yale to Minnesota to Harvard have been organizing around the issue -- both on campus and through e-mail list-servs like the one maintained by Healthgap.

A look at the numbers shows why the battle over AIDS drugs has very little to do with developing countries (contrary to what media coverage suggests) and everything to do with protecting the American and European markets. According to market research firm IMS Health, of the $3.7 billion spent on AIDS drugs in 2000, the lion's share, $2.6 billion, was paid out in the United States. The Europeans racked up $950 million in sales, while Africa, Asia and Australia spent only $108.5 million -- a small fraction of the total.

Critics of the activists charge that their real agenda is gaining control of the entire pharmaceutical industry. "What's happening on these campuses is a tragedy," says Robert Goldberg, a healthcare policy analyst at the National Center for Policy Analysis. "Students like Amy Kapczynski at Yale aren't really thinking about AIDS -- it's capitalism that they see as the real virus. AIDS is a glamorous disease to worry about." Arguing that corruption and ignorance will doom AIDS efforts in South Africa, Goldberg notes that drugs were made widely available for free in Russia and Africa to treat tuberculosis and malaria, but that has done "little to stop a disease that claims 2 million lives a year." With AIDS drugs, he argues, the outcome wouldn't be much different: "You could dump all the AIDS drugs and cocktails for free in Africa. Half of the drugs would be stolen, a quarter unused or improperly used." Goldberg is also concerned about generic AIDS drugs slipping across borders into Europe and the U.S. "There's a short-term problem of these drugs showing up in Europe through gray markets," he warns. "Government medical agencies tend to turn a blind eye toward parallel imports from Greece and Turkey. A company like [India's] CIPLA could export its generics, relabel them" and funnel them through this market.

"In this country, groups like [Consumer Project on Technology] see the South Africa campaign as a way to get lower prices here," Goldberg goes on. "This is simply First World selfishness being manifested, using the Third World as a backdrop. As we've seen, minutes after the victory in South Africa [when the pharmaceutical companies dropped their case], the government said it was not going to use the cocktails." Indeed, just days after the case was dropped, South African Health Minister Dr. Manto Tshabalala-Msimang stated that supplying AIDS drugs would not be a government priority, despite the drastic reduction in prices. Instead, the government will focus on treating opportunistic infections and improving nutrition among HIV patients. South African President Mbeki has in the past expressed concerns about the safety of cocktail treatments and even questioned publicly, to international dismay, whether HIV is the true cause of AIDS.

Critics like Goldberg, pointing to South Africa's weak healthcare infrastructure, also fear that improper distribution and consumption of the cocktail drugs could lead to more resistant and deadly strains of HIV. Instead of emphasizing cocktails, Goldberg proposes that the African governments institute prevention and education programs and make widespread use of AZT, which is inexpensive to produce and has been shown to reduce childbirth transmission by as much as 50 percent -- a plan that could certainly make the biggest difference in the long run, since it would reduce the infection rate.

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