Memorandum submitted by the Stop AIDS
Campaign
The Stop AIDS Campaign (www.stopaidscampaign.org.uk)
represents more than 80 UK-based organisations who are fighting
HIV and AIDS in developing countries. The campaign is part of
the Make Poverty History mobilisation, and works alongside other
networks that focus on debt, aid and trade justice.
1. ADDRESSING
THE EPIDEMIC
1.1. Since the beginning of the HIV epidemic,
an estimated 60 million people have contracted the virus, 20 million
of whom have died of AIDS-related illnesses. These figures continue
to rise each year. UNAIDS estimates that 4.9 million people were
infected with HIV in 2004[2]
and the total number of people with HIV/AIDS reached a peak of
40 million in that year.
1.2. The global response is not keeping up with
the rapid spread of HIV. Fewer than one person in five at risk
of HIV has access to basic HIV prevention,[3]
while the World Health Organisation (WHO) reported in June this
year that only one million of the three million people targeted
by its 3 by 5 initiative had access to antiretroviral (ARV) medicine.[4]
Global response to the epidemic
1.3. WHO's 3 by 5 initiative aims to extend
HIV treatment to 3 million people in low and middle income countries
by the end of 2005. Despite an anticipated failure to reach the
target, important progress has resulted from this process. However,
WHO estimate that 6.5 million people currently still need HIV
treatment.[5]
1.4. The scale of the epidemic has prompted increased
action, including the establishment of the Global Fund to Fight
AIDS, Tuberculosis and Malaria, the 3 by 5 initiative, and the
US President's Emergency Plan for AIDS Relief (PEPFAR). We have
also seen increased efforts by national governments, the European
Commission, and other donors. Communities and non-governmental
organisations have worked hard to increase the numbers of people
receiving life-saving treatment. However limited access to ARVs
continues to leave millions of people sick, impoverished and dying
unnecessarily.
Global resources for AIDS
1.5. Resources to treat and prevent HIV and AIDS
in the developing world are steadily increasing, as advocacy and
moral outrage from across the world leads to growing political
commitment. But there is still a substantial resource gap, with
UNAIDS estimating a total shortfall in what is needed of US$18
billion between 2005-7—a figure UNAIDS itself considers
an underestimate.[6]
In addition, low levels of funding for technical support and organisational
development are significantly constraining programme expansion.
Healthcare services
1.6. In many cases, inadequate healthcare is
the result of World Bank and IMF fiscal constraints that discourage
government spending on public health.[7]
This lack of investment leads to poor infrastructure. Healthcare
in developing countries is characterised by a lack of clinics,
diagnostic technology, drug procurement, storage, distribution
and supply mechanisms.
1.7. The lack of funding is also leading to a
human resource crisis, which is not only limiting HIV programming,
but is also being further undermined by HIV and AIDS. Vast numbers
of healthcare workers are HIV-positive themselves, affected by
HIV, or are demoralised by the system's failure to meet the challenge
of educating people, or testing for and preventing new infections.
Similarly, large numbers of healthcare workers from many poor
countries are moving to richer nations, including the UK, in order
to get better pay and conditions and career development opportunities.
Access to generic medicines
1.8. The existence of ARV drugs and diagnostics
has had a radical effect on HIV and AIDS epidemics in the rich
North. Whilst ARV medicines do not provide a cure, for many people
living with HIV and AIDS (PLWHA) they mean much longer and healthier
lives. Death rates in wealthier countries have been reversed,
and PLWHA are living relatively normal lives—returning to
work, raising families and enjoying the benefits of longer lives.
1.9. Approximately half of the one million people
in poorer countries who receive ARV medicine rely on generic production[8]—ie
unbranded medicines that are far cheaper than their patented equivalents.
The 2001 World Trade Organisation Doha Declaration on TRIPS (Trade
Related aspects of Intellectual Property rights) and Public Health,
which stated that patents should not obstruct governments from
meeting public health needs, appeared to be a vital step in attempting
to increase access to medicines. However, the flexibilities in
TRIPS that the Doha Declaration delivered still leave considerable
obstacles to access to medicines for poor people with HIV and
AIDS in developing countries. When South Africa sought to legislate
to improve access to cheaper medicines, the US government accused
it of failing to adequately protect American drug patents. The
US objection was directed at provisions in the proposed law that
would allow for compulsory licences and parallel importing. Despite
its proposals falling within the terms of the TRIPS, the South
African government and parliament came under immense pressure
to stop the law. It was only after intense campaigning that the
US retreated from its position and the bill finally became law.
1.10. The impact of these complexities and problems
surrounding TRIPS will become increasingly apparent in the coming
years as large numbers of people taking ARVs are forced to switch
to newer, "second line" medicines as the effectiveness
of their regimes reduce. Second line medicines are four to 10
times more expensive than first line treatments, and almost all
are likely to be patented in countries where there is the capacity
to produce them generically.
1.11. The problems posed by drug patenting go
beyond just HIV and AIDS, and the developing world. For instance,
there would be an impact upon developed countries' ability to
produce drugs in response to any pandemic, such as SARS or avian
flu.
1.12. Health ministers at the recent African
Union Conference called upon trade ministers " . . . to seek
a more appropriate, permanent solution at the WTO that revises
the TRIPS agreement, and removes all constraints, including procedural
requirements, relating to the export and import of generic medicines."[9]
1.13. The research and development needs
of global public health require us to look beyond current arrangements
that strictly encode intellectual property. A system that rewards
both innovation and benefits to public health, rather than one
that protects monopolies, is necessary, if universal access is
to be achieved.
HIV-related stigma and discrimination
1.14. HIV remains one of the most highly stigmatised
diseases in the world. Though many commentators argued that discrimination
would decrease with greater access to treatment, there is no evidence
that this is the case. Indeed the combined experience of members
of the Stop AIDS Campaign working with local communities highlights
just how deep and abiding HIV-related stigma and discrimination
continue to be, fuelling misinformation, fear and loathing.
1.15. Stigma infects government as well as communities
and families. There are significant barriers to addressing AIDS
that go beyond financing and the constraints imposed by global
financial institutions. Many governments just cannot face the
seriousness and complexity of AIDS, while some are ignoring their
HIV-affected populations for reasons that are as much about discrimination
as they are about resources. HIV continues to affect groups on
the fringes of mainstream society—drug users, sex workers,
gay men or men who have sex with men, young women, and street
children. Governments continue to be reluctant to support HIV
programmes that protect and value the human rights of these marginalised
groups.
Comprehensive HIV programmes
1.16. Treatment and prevention programmes are
closely interrelated. The Stop AIDS Campaign is increasingly advocating
for comprehensive HIV programming that includes both treatment
and prevention, as the success of one is always crucially dependent
on the presence of the other; prevention programming is enhanced
by treatment programming when services can offer people a reason
to test for HIV. Support for HIV-treatment programmes will not
be sustained if HIV infections continue to rise unchecked by scaled-up
HIV-prevention programmes.
Access and equity
1.17. WHO's 3 by 5 initiative has raised expectations
that treatment could reach people in many of the hardest hit countries.
The costs of testing and treatment are beyond the reach of the
very people who are often the most vulnerable. Early studies of
programmes that charge patients show clear barriers for poor and
marginalised people, as well as greater levels of treatment interruption
and poor compliance as patients struggle to find money for medicines
each month.[10]
A global commitment to access and equity in HIV treatment must
also be a commitment to free treatment.
1.18. Children who are HIV-positive largely
respond very well where they have access to ARVs. However very
few children have access to treatment, and the case for attention
on this issue is urgent. Suitable and affordable ARVs are vital,
but this requires childrens' needs becoming more of a priority
in research and development. HIV programmes must keep a focus
on the needs of families and children when supporting people to
stay on treatment.
Supporting the role of civil society in treatment
scale-up
1.19. Communities hit hard by HIV and AIDS require
support and resources to sustain and expand the response to the
epidemic. Many non-governmental and community-based organisations
are engaged in this effort, advocating for access for marginalised
people, educating communities, and improving support for patients.
The skills to do this already exist in communities heavily affected
by HIV and AIDS. Any successful strategy to deliver universal
access must utilise and support community-based strengths.
2. POLITICAL
LEADERSHIP
UK government
2.1. The Stop AIDS Campaign welcomes the UK government's
leadership on HIV and AIDS at the G8 summit this year. It demonstrated
significant political leadership in negotiating the G8 commitment
to achieve "as near as possible universal access to treatment
by 2010," which is the best and boldest HIV-treatment target
the world has seen in more than 20 years of the pandemic. The
scale of the epidemic demands leadership of this standard and
more to see these commitments turned into action.
2.2. As the current holder of the European Union
presidency, the UK must maintain this momentum by ensuring the
EU increases its political and economic commitment to both universal
treatment and progressive prevention programming.
2.3. We welcome the UK's advocacy to protect
evidence-based HIV-prevention programmes in the face of growing
pressure from the US to adopt approaches that undermine prevention,
specifically through decreased availability to condoms.
UK Department for International Development (DFID)
2.4. The Stop AIDS Campaign welcomes and endorses
DFID's HIV strategy, Taking Action, but has growing concerns
about the translation of its commitments at country level. Many
of our partners are experiencing problems with DFID's in-country
delivery, finding DFID offices are not yet oriented towards comprehensive
HIV programming, let alone a concern to reach universal access
to treatment by 2010.
2.5. The campaign is concerned that DFID's spending,
particularly the monies that accompanied Taking Action,
be directly and transparently spent on comprehensive HIV programming
in countries with high rates of HIV infection, in particular in
southern Africa. DFID needs to use a variety of innovative delivery
systems for its assistance if it is to reach the universal access
target. Its programmes must show how they support shared commitments
to meet UN objectives as articulated at UNGASS.
UN agencies
2.6. UNAIDS is responsible, with WHO, for developing
the technical and operational guidance to make universal treatment
access possible. Building on the successes of WHO's 3 by 5 programme,
the Stop AIDS Campaign stresses the urgency of cooperative work
between UNAIDS and WHO towards universal access.
2.7. The G8 and other governments need to maintain
a sense of urgency and accountability, and bring political pressure
to debates about financing and strengthening healthcare services.
But the blueprints for implementing universal access are the responsibility
of UNAIDS and the WHO. Good data collection will be essential
to ensuring that universal access is achieved.
3. WHAT THE
UK GOVERNMENT SHOULD
DO TO
INCREASE ACCESS
TO ARV TREATMENT
3.1. Maintain global leadership, ensuring the
commitment to universal treatment access by 2010 made at July's
G8 summit is put into action.
3.2. Increase UK government funding for HIV and
AIDS programmes in order to address part of the US$18 billion
global resource shortfall, projected over 2005-7.
3.3. Ensure that IMF and World Bank policies
do not restrict the increased spending on healthcare that is required
to achieve universal treatment access.
3.4. Reorganise DFID programmes so that they
promote the rapid growth of comprehensive HIV programmes in high
prevalence countries.
3.5. Continue to support evidence-based HIV prevention,
linked to treatment and stigma reduction.
3.6. Demand swift, efficient and cooperative
leadership from UN agencies as they develop operational and technical
plans towards reaching the universal treatment target.
3.7. Work with WHO and UNAIDS to issue an international
policy statement supporting free access to treatment.
3.8. Ensure that the TRIPS agreement at the WTO
is not a barrier to accessing essential medicines (including ARVs)
at affordable prices.
3.9. Provide technical assistance to developing
country governments to ensure ARVs are available and accessible
universally.
3.10. Explore better mechanisms for financing
research and development to ensure greater public health gains
in developing countries.
November 2005
2 AIDS Epidemic Update. Geneva, UNAIDS, 2004. Back
3
Progress Report on the Global Response to the HIV/AIDS Epidemic
2003. Geneva, UNAIDS, 2003. Back
4
Progress on Global Access to Antiretroviral Therapy, an Update
on 3 x 5. UNAIDS/WHO, June 2005. Back
5
www.who.int/3by5/en/ Back
6
Resource needs for an expanded response to AIDS in low and middle
income countries, UNAIDS PCB meeting, 27-29 June 2005. Back
7
Action Aid report, R Rowden et al, Changing Course-Alternative
Approaches to Achieve the Millennium Development Goals and Fight
AIDS, ActionAid, September 2005; Rowden R et al, Blocking Progress:
How the fight against HIV and AIDS is being undermined by the
World Bank and the IMF, September 2004; Investing in Development:
A practical plan to achieving the Millennium Development Goals,
www.unmillenniumproject.org Back
8
Médecins Sans Frontie"res, 2005. Back
9
Third World Network, Martin Khor, Impasse on talks on TRIPS and
Health "permanent solution", Geneva, 26 October 2005. Back
10
"Free access at the point of service delivery", WHO
policy position and background papers (in press), 2005. who.int/3by5 Back
| 
