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Show CHARLES H. MONSON PRIZE WINNER SPRING 2013 50 provoking the ire of industrialized countries, such as the United States and countries of the European Union, by bypassing their patents or issuing a compulsory license. Said countries are valuable to the less-developed countries because of international aid, and the risk of losing this support is too great a threat to many less-developed countries. Thus, political pressure acts as yet another impediment to greater accessibility to HIV/AIDS drugs in resource-limited countries. In addition, cost plays an important role in limiting accessibility to HIV/AIDS drugs through means such as parallel importation and compulsory licensing. Although parallel importation allows a country to purchase essential drugs at the cheapest global price, that price may still be too expensive for people in the world's least-developed countries to afford. For example, one type of AIDS triple-combination therapy, a cocktail of three ARV drugs, is available from Cipla, a manufacturer of generic drugs in India, for less than US$ 200 per year (Wise, 2006). However, in sub-Saharan Africa, the area most severely affected by HIV/AIDS, 47 percent of the population lives on less than US$ 1.25 per day ("World Bank sees," 2012). Thus, a person living at this rate would need to spend 44 percent of his or her yearly income on HIV/AIDS medications, leaving approximately US$ 250 for food, clothing, and providing for one's family for the entire year. Therefore, it is evident that even the world's cheapest prices for HIV/AIDS medications may not be cheap enough to be accessible to populations living in extreme poverty. It is interesting to note that, although the TRIPS agreement was negotiated in 1994, adherence to its regulations was not required immediately. Most W T O member countries were required to implement TRIPS by January 1, 1996; however, those countries designated as "developing" did not have to be compliant until January 1, 2000 (Thomas, 2001). Furthermore, "[i]f on January 1, 2000, a developing country did not extend patent protection to all areas of technology within the meaning of Article 27, that developing country [could] delay implementation of these provisions for an additional five years," extending the compliance date to January 1, 2005 (Thomas, 2001). In addition, least-developed countries have until January 1, 2016 to become fully compliant with TRIPS (World Trade Organization, 2006). This delayed implementation of TRIPS in certain cases has shown that, in spite of the agreement's efforts to make essential medications more accessible to countries in need, great strides toward increased drug accessibility have been made by countries prior to the mandatory compliance date for TRIPS. O n e case in particular highlights the promise of better drug accessibility, were patent and intellectual property regulations less stringent. In 2001, India, considered a developing country by the W T O , did not yet have to comply with TRIPS regulations. Thus, in that year, an Indian generic pharmaceutical manufacturer combined three ARV drugs into a single pill, called a fixed dose combination (Avert). Each of the three drugs was patented by a different pharmaceutical company, but the generic drug manufacturer was not required to abide by the patents, in the absence of TRIPS. Furthermore, the drug was made available at an extremely low price, because it was manufactured using the generic versions of the three drugs. The advent of this drug was a tremendous achievement toward making HIV/AIDS drugs more widely accessible to the Indian population. The availability of fixed dose combination drugs is greatly advantageous to those suffering from HIV/AIDS. The drugs are valuable because they greatly simplify the drug-taking process, supporting drug adherence (WIPO, 2011). W h e n a patient has to take multiple pills on a regimented schedule, it is easy to forget to take one drug or to upset the timing and regimen. Having a fixed dose combination pill makes the process more facile, and drug adherence increases markedly. Another advantage of fixed dose combination drugs is that they can reduce the chances of drug resistance. As aforementioned, when multiple drugs need to be taken daily, it is not uncommon to forget to take one. W h e n a structured drug regimen is interrupted or inconstant, drug resistance can occur, because the virus replicates in a stronger form in the absence of |