Issue brief |

XIVth International HIV/AIDS Conference 2002 - Background Information on HIV/AIDS

8 min

Short document presenting MSF’s message and recommendations at the AIDS conference in Barcelona. Recommendations include increasing international funding for HIV/AIDS treatment, fighting the false dichotomy between prevention and treatment, moving towards equitable access to treatment, putting health before intellectual property rights, and simplifying treatment to adapt it to developing country settings.

7-12 July 2002 –XIVth International HIV/AIDS Conference, Barcelona

AIDS treatment: 36,000,000 people still waiting.

UNAIDS estimates that out of the global total of 40 million people currently living with HIV/AIDS, 36 million do not have access to antiretroviral (ARV) therapy that could prolong their lives. Today’s treatment deficit is even more dramatic: 96% of the people living in developing countries who need treatment immediately do have no access to antiretroviral drugs. This is more than 5.7 million individuals (WHO, 2002). In 2001, AIDS killed 3 million people – it is now the single leading cause of death in Africa.

HIV/AIDS: The treatment deficit

In some of the poorest countries in the world, one in every five adults is infected with HIV. Yet while medical advances have offered hope and life in the industrialised world, life-extending drugs remain out of reach for the vast majority of HIV-positive people. Combating the AIDS pandemic requires battles on many fronts. Prevention activities, palliative care, reducing social stigma, home-based care, mother-to-child transmission prevention, addressing opportunistic infections, and antiretroviral treatment are all important elements. But without the appropriate medicines, prevention efforts are severely limited and treatment is impossible.

Since the fall of 2000, essential AIDS medicines have become more affordable through international competition between generic and proprietary drug producers. One triple therapy combination now costs as little as US$209 per patient per year compared to US$10,000 one year ago. What is needed now is a true mobilization of political will to deliver these medicines and comprehensive care to the millions who need it. Developing countries will need the financial support of wealthy countries to implement meaningful treatment programmes.

Antiretroviral (ARV) drugs are needed in order to directly combat HIV. Since 1996, potent ARV combinations known as “drug cocktails” or “triple therapy” have been available. They do not cure AIDS, but can improve a patient’s quality of life and prolong survival when taken as prescribed.

Making treatment available

“Since I started the treatment, I’ve been feeling better and better, it’s miraculous! I can fetch wood for the fire, I can even walk to the hospital on my own, which is two hours on foot. Taking my medication twice a day and going to the hospital once a week is not a problem because I am fully aware that this treatment is saving my life.”

– Dorothy, person living with HIV/AIDS in Malawi

Challenges for treating AIDS in resource-poor settings include the widespread lack of diagnostics, lack of experience of health professionals in HIV treatment, and lack of resources for organisations of people living with AIDS. Problems related to the therapy itself include complex treatment regimens, drugs with uncomfortable or even life-threatening side-effects, and the need for close medical supervision. Yet, in an increasing number of developing countries, these challenges are being met. National governments and non-governmental organisations have started providing triple therapy in some developing countries with very encouraging results.

MSF and HIV/AIDS

MSF currently runs or supports AIDS programmes in Brazil, Burkina Faso, Cambodia, Cameroon, China, Ethiopia, Guatemala, Honduras, Kenya, Kyrgyzstan, Malawi, Mongolia, Mozambique, Myanmar, Nigeria, Peru, Russia, South Africa, Thailand, Ukraine, Uganda and Zimbabwe. Medical programmes include prevention efforts, voluntary counselling and testing, psychosocial support and treatment of opportunistic infections using essential medicines. Some of these programmes focus on reducing the transmission of the virus from pregnant mothers to their children.

As part of a comprehensive approach to tackling AIDS, MSF has also launched programmes offering ARV treatment in seven of these countries and has approximately 1000 patients under treatment as of July 2002. Similar programmes are being planned in other countries as well.

- Since 1997, MSF has worked in the Norodom Sihanouk hospital in Phnom Penh, Cambodia, taking part in AIDS patient care and prevention of opportunistic infections, for both patients in hospital and outpatient consultations. Triple therapy was introduced in July 2001.

- Thailand was the first country where MSF introduced ARVs in December 2000. Patients are treated at home and in the Surin hospital, and there is another treatment project in Bangkok.

- In February 2001, MSF and the Ministry of Health of Kenya signed a first agreement for the introduction of ARV treatment into the MSF programme in Homa Bay, Kenya. The first patient began treatment on November 15th 2001, and 20 new people are admitted into the programme every month.

- AIDS has become a public health priority for Cameroon, thanks largely to the mobilization of civil society groups: a total of 2000 people are being treated in various programmes across the country. MSF started its own ARV project in Yaounde in January 2001.

- In Malawi, where around 15 % of the population is HIV-positive, MSF has been treating patients in the Chiradzulu district since August 2001.

- The MSF ARV programme in Khayelitsha, South Africa, started just over a year ago. Setting up an ART programme in the face of the government’s denial of the pandemic and refusal to offer treatment was no easy task. One of the major challenges was the cost of medicines. MSF took the decision to use generic Brazilian antiretrovirals in the Khayelitsha clinic, cutting costs by half and allowing more patients to be treated.

- In Guatemala, MSF has helped launch antiretroviral treatment programmes for both children and adults with HIV/AIDS in Clinica Familiar Luis Angel Carcia at San Juan de Dios Hospital, and at Roosevelt Hospital, in Guatemala City, two centres which care for HIV/AIDS patients.

MSF recommendations to the Barcelona Conference:

The widespread implementation of AIDS treatment programmes remains a huge challenge, but one that we cannot afford to ignore. While NGOs like MSF can help show that AIDS treatment can and must be implemented in resource-poor settings, it is a job for governments and the international community to tackle the pandemic on a global level. In order to make AIDS treatment available to more people in developing countries, the following goals must be achieved:

Deliver on promises: Put the money on the table

One of the most significant barriers to scaling up treatment programmes is the failure of both donor governments and national governments in developing countries to mobilise promised resources for the Global Fund to Fight AIDS, TB and Malaria and other financing mechanisms. Donors have abandoned their responsibility and repeatedly broken promises made over the last two years by pledging just 8% of the estimated funding necessary to scale-up the global response to HIV/AIDS. The time is long overdue for donors and other governments to deliver on their promises.

Fight false treatment versus prevention dichotomy

The dramatic funding deficit has led to debates about how to allocate scarce resources, and some have argued that since prevention is more cost-effective than treatment, treatment should not be a significant emphasis of international efforts. This logic is medically and ethically unacceptable – we cannot stand by and watch millions of people already living with HIV die because treating them is not considered cost-effective. Furthermore, this logic disregards the mutually dependent nature of prevention and treatment in disease control.

Move toward equitable access

The price of treatment continues to be too high for people with HIV/AIDS in developing countries. The target price of ARV treatment for patients in developing countries should be US$50-100 and the cost of the treatment monitoring must also drop. This will only happen if Equitable Access, an emerging alternative to the industry-led Accelerating Access Initiative, is fully supported. Equitable Access means: generic competition; clear guidelines for differential pricing of proprietary name drugs; support for technology transfer and scale-up of local or regional production; and UN-led bulk procurement and distribution (including pre-qualification). Implementation of Equitable Access strategies will require involvement and support of people living with HIV/AIDS, leadership from national governments, and support from UN agencies such as WHO and UNICEF.

Put lives before profits

The WTO Ministerial Declaration on the TRIPS Agreement and Public Health adopted in Doha must be implemented to overcome barriers to access resulting from intellectual property protection. UN agencies such as WHO and WIPO should step up technical assistance to countries to give legislative teeth to the Doha Declaration at the national level. WTO members must implement the Doha Declaration in good faith by supporting patent exceptions for export of medicines that are produced under a compulsory licence and by showing a clear commitment to the Doha Declaration as the ceiling for negotiations of bilateral and regional trade agreements, such as FTAA.

Simplify treatment

Treatment must be further simplified: once-a-day fixed-dose combinations should be developed for WHO recommended regimens as soon as possible. In addition to originator pharmaceutical companies, companies in the developing world should be supported to develop easier-to-use formulations. There is also an urgent need to support operational research to develop protocols and efficient low-cost monitoring tools adapted to the reality of resource-poor settings.