Market dynamics As with any new market dynamic, executives involved with licensing must rewrite existing business rules. GSK, for example, licensed several AIDS patents to Kenyan-based Cosmos, but is just now negotiating what the generic's name will be.

There are also questions about how both brands will work in one market. "Here we are licensing for exactly the same territories and indications for which we are supplying and marketing our product," says Jon Pender, GSK's director of global access issues. "It's new for us to do it this way."

Intellectual property Although licensing (and the Aspen deal) give the impression that pharma's intellectual property is being respected, there are strong signs that it will not be for long. Marie-Paule Kieny, director of WHO's Initiative for Vaccine Research, recently stated that, when an HIV vaccine is finally developed, it will be made widely available irrespective of patent rights.

Promising Models Merck went into Botswana in 2000 with good reason. In this small, relatively well-off and politically stable country, 38 percent of adults were infected with AIDS. The government had stalled, unable to combat the the situation with few hospitals, clinics, or professionals trained to treat AIDS patients—they hadn't even mapped out how they planned to fight the epidemic. In short, if there was ever a place to test public/private partnerships to combat AIDS, Botswana was it.

What resulted is the African Comprehensive HIV/AIDS Partnership (ACHAP). Merck pledged $50 million and free drugs over five years and the Bill and Melinda Gates Foundation donated another $50 million, to kick-start a response to AIDS in that country.

Brad Ryder, ACHAP knowledge support manager, says the program gets at the heart of knowledge transfer: "What if you helped governments, gave them enough resources, and made HIV drugs free of charge? How would that country then go about fighting, tackling, and turning around the AIDS epidemic?"

As of December 2004, 28,000 people in Botswana received ARVs as part of ACHAP's free drug program. That's a huge accomplishment. But for Merck, and other companies doing development work in Africa, the greatest challenge lies in leveraging the learnings of individual programs into a much broader anti-AIDS strategy.

Sustainable, scalable, replicable Although the number of patients on ARVs is growing (next year more than a million patients will access those drugs in Africa), it's no match for the increasing rate of infection. In that context, it would be easy to dismiss pharma's demonstration programs as irrelevant "islands of excellence." But, aside from treating people today, these initiatives provide treatment models for tomorrow.

"Pharma initiatives should be sustainable, scalable, and replicable," says Trevor Neilson, executive director of the Global Business Coalition on HIV/AIDS, which leads corporate involvement in the AIDS crisis. "My biggest fear is companies will say, 'We don't have much to show for these five years except the people we served and the programs we built. We haven't been able to replicate. We haven't been able to scale up,'" he says.

Neilson worries less about drug and medical supply donation programs than about cash-heavy programs like BMS'.

Secure the Future's John Damonti, president of the BMS Foundation. echoes those concerns. "At the conclusion of the community support programs, there can't just be six well-operated communities on HIV/AIDS. Those have to be models for larger expansion across the country."