MSF Statement at UN High-Level Meeting on HIV/AIDS

Delivered by Dr Tido von Schoen-Angerer,
Executive Director, MSF Campaign for Access to Essential Medicines

UN High-level Meeting on HIV/AIDS, New York

Thank you Chair,

Ten years ago, I was working as a doctor in Thailand where we had just opened Médecins Sans Frontières’ first AIDS treatment programme. Starting from that first project, we have witnessed time and time again how treatment saves lives and keeps people healthy.

Committing to a target of 15 million people on treatment by 2015 is a critical step and the clock starts ticking now. This target recognizes the evidence that treatment not only saves lives but prevents transmission of the virus. The latest data from the HPTN052 trial that earlier treatment has a dramatic effect on preventing TB disease, and preventing HIV transmission by 96%, has very real policy implications, also in terms of how to approach the integration of care.

With treatment as one of the most important tools in the prevention toolbox, we can get ahead of the wave of new infections — but we need treatment to be integrated into every clinic in endemic settings. This will also reduce the toll that tuberculosis continues to take as the main killer of people living with HIV.

There are ways to reach more people with care and yet reduce the strain on the health system, reduce the burden on patients and reduce costs: Providing integrated treatment of HIV and other diseases as a one-stop-shop at primary health care clinics and rural health posts. Empowering nurses to start people on treatment and post exposure prophylaxis – not just doctors. Allowing people who are doing well to only come to checkups twice a year, like we do with the Ministry of Health in Malawi. Having neighbours take turns getting medicine refills for each other like we do in Mozambique. Providing HIV and TB care by the same health care worker as in Swaziland, and providing outpatient treatment of drug-resistant TB like we do with the Ministry of Health in South Africa.

But integration and getting ARVs into every clinic means that drugs must be affordable.   

Even though the price of drugs has fallen by 99% over the past decade thanks to generic competition, another price crisis is looming at the doorstep. We need access to newer medicines that are better-tolerated and newer medicines to treat those that have grown resistant to the virus. But with patents blocking the affordable production of these drugs, we won’t see prices come down the way they did with the first generation of AIDS medicines - unless governments act decisively.

Action has to be taken to ensure price-busting competition can continue. TRIPS flexibilities must be used to overcome patent barriers. But the only flexibility specifically mentioned in today’s declaration, for countries that don’t make their own medicines, doesn’t work and needs to be fixed, not affirmed. Governments that choose to increase access to medicines through compulsory licensing should not face retaliation. Ten years ago, countries affirmed the primacy of health over commercial interests in the Doha Declaration, which was created for the world we face today. But we must confront the reality of what is happening outside this building: Countries should stop pushing free trade agreements that demand stricter patent rules than what the TRIPS Agreement requires. New, innovative mechanisms should be supported to increase access to drugs in all developing countries, like the Medicines Patent Pool.

We are at a unique point in time. The lessons learned from treating HIV/AIDS over the last decade, combined with the latest science that treatment is prevention could help us break the back of the epidemic. As has been said: ‘pay now, or pay forever.’

We now have a commitment for 15 million people to be on treatment by 2015, which will help save lives and stop the virus.   

Let’s do it. These are the lives that hang in the balance.