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Africa: Treatment Access Updates Date distributed (ymd): 011125 Document reposted by APIC
Africa Policy Electronic Distribution List: an information service provided by AFRICA ACTION (incorporating the Africa Policy Information Center, The Africa Fund, and the American Committee on Africa). Find more information for action for Africa at http://www.africapolicy.org
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Region: Continent-Wide Issue Areas: +economy/development+ +health+
SUMMARY CONTENTS:
This posting contains three new documents concerning access to treatement for people living with AIDS: (1) a Nov. 22 joint press release by NGOs prior to the latest planning meeting in Brussels of the Global Fund for AIDS, TB and Malaria, (2) a call for support by South Africa's Treatment Action Campaign (TAC) in their court case demanding that the South African government implement programs to prevent mother-to-child-transmission of HIV, and (3) a consensus statement on AIDS treatment resulting from a TAC consultation in South Africa in October.
For additional background and updates, see Treatment Action Campaign: http://www.tac.org.za Global Treatment Access: http://www.globaltreatmentaccess.org Africa Action Treatment Access page: http://www.africapolicy.org/action/access.htm
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22 November 2001
Joint Press Release by NGOs from Belgium, Burundi, France, Ivory Coast, Morocco, Nigeria, South Africa, South Korea, UK, and US.
CONTACT:
Sharonann Lynch (Brussels mobile): 0474 939319 Paul Davis (U.S. mobile) +1 215 833 4102 Gaelle Krikorian + 33 6 09 17 70 55
Global Fund for AIDS, TB and Malaria: Bureaucrats Betray People with AIDS in Poor Countries
AIDS activists from around the world demand the Global Fund subsidize cheap AIDS Drugs
(Brussels) International AIDS activists and medical organizations confront the opening day of meetings of the Board for the Global Fund for AIDS, Tuberculosis and Malaria, in Brussels. Activists are concerned by the clear lack of commitment among Global Fund decision makers to financing AIDS treatment in poor countries.
Set to launch on December 15, 2001 the Global Fund is currently poised to finance treatment only for diseases cheaper to treat than HIV, despite public health evidence that AIDS treatment is cost effective and is a key aspect of an effective response to the AIDS pandemic. The activists insist that access to AIDS treatment is a fundamental human right that the Global Fund must help fulfill, as 30 million people with HIV are currently living with no access to affordable medication.
Activists from 10 countries have gathered in Brussels to meet with Global Fund Board members to demand funding for AIDS drugs, including antiretrovirals. The activists report that Global Fund decision-makers have already made clear that funding HIV treatment in poor countries will not be a priority for the Fund, despite the desperate worldwide need for AIDS drugs, and the tremendous gap in access to AIDS treatment that spurred the creation of the Global Fund by U.N. Secretary General Kofi Annan in April, 2001.
"The Global AIDS TB and Malaria Fund is turning into a slow, under-funded bureaucracy that will not be able to produce results. 27,000 people will die today because they lack access to affordable treatment for AIDS, tuberculosis and malaria," said Zackie Achmat of the Treatment Action Campaign in South Africa.
"What we're seeing here is a betrayal of what the Fund was invented for in the first place. Rich countries cannot be allowed to simply sentence 30 million people with HIV to death because they prefer to focus on cheaper diseases," said Evan Ruderman of the Health GAP Coalition. "There is no reason for the Fund to wait to deliver vital medicines and start turning the tide while global comprehensive plans guidelines are developed over the next year."
The proposals being debated by the Global Fund board members fail to address proposals for treatment programs, or for the procurement or distribution of medicines. A concrete proposal that NGOs are making is for the Fund to start saving lives now, by putting vital HIV drugs into the hands of qualified field organizations through procurement and delivery systems already housed within UN agencies.
"Hospitals, clinics and workplaces in the field can immediately scale up effective treatment and care if they are given the HIV/AIDS drugs they can not afford," said Joseph Essombo, an AIDS doctor with the Ivory Coast Bouake Health Network.
"The fund must prioritize programs that quickly put critical medicines into the hands of the suffering," said Pearl Nwashili of Stop AIDS in Nigeria. "But the donor countries seem perfectly content that the Global Fund will not finance programs to start saving lives now, when 10,000 people with AIDS die each day."
The Doha declaration on Public Health affirms the rights of poor countries to bypass patents and purchase generic HIV medicines. "Even the World Trade Organization recognizes that economics can not dictate double standards on world health" said Gaelle Krikrian of ACT UP Paris. "The experience of doctors in the field shows that HIV treatment is absolutely feasible in poor countries, and, since the advent of generic competition, entirely affordable".
The international group of NGOs will meet with Global Fund board members this week to demand:
* GF must commit to saving the lives of people infected with AIDS, tuberculosis and malaria by providing treatment. Treatment for AIDS must not be a lower priority than prevention, or treatment for TB or Malaria.
* GF must prioritize, encourage and fast-track financing for provisions for AIDS medications at best world prices through international bidding and bulk procurement.
* GF must agree that the Fund will quickly make funds for treatment available to any qualified care providers that can rapidly deliver treatment to people with AIDS tuberculosis and malaria.
* GF must support the use of best world price and not restrict the use of affordable generic medicines to fight HIV/AIDS, TB and malaria .
* GF must not use a shortage of resources to justify deadly ineffective measures such as HIV prevention in the absence of treatment. Donor countries must commit sufficient amounts to give the Global Fund, and make good on the promise made last June at the United Nations' Special General Assembly on AIDS to commit at least 10 billion USD a year to the global fight against aids.
Oxfam International, Health GAP Coalition, ACT UP New York, ACT UP Philadelphia, ACT UP Paris, Treatment Action Campaign (South Africa), WOFAK (Kenya), People's Health Coalition (South Korea), Stop AIDS (Nigeria), Renaissance Sate Bouake (Cote D'Ivore), Pharmacist's Association for Healthy Society (PAHS), Intellectual Property Left (IPLeft), People's Solidarity for Social Progress, Team of Drug Policy, Korean Association of Physicians for Humanism, People's Health Coalition
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Treatment Action Campaign (South Africa) Web: http://www.tac.org.za E-mail: info@tac.org.za
19th November 2001
Dear Friends
GIVE WOMEN A CHOICE! GIVE CHILDREN A CHANCE!
TAC APPEALS FOR GLOBAL SOLIDARITY IN MOTHER-TO-CHILD-TRANSMISSION (MTCT) COURT CASE
On the 26-27 November 2001, South Africa will witness a court case that can help to alter the course of the HIV/AIDS epidemic in our country. The Treatment Action Campaign (TAC) calls on your support and solidarity to save people from unnecessary death and suffering. We ask you to encourage our government to change its tragic course in the HIV/AIDS epidemic. At heart, this court case is about giving women a choice and children a chance.
Across our country nearly 300 000 women with HIV will give birth this year. The majority do not know their HIV status and are not given information or medicine that can reduce the risk of HIV transmission to their children. As a consequence, at least 70 000 children will be infected with HIV during labour and through breastfeeding. They will suffer an unnecessary painful death.
The government has the resources and the opportunity to give women a choice to look after their own health and a chance to prevent their infants from becoming infected with HIV. But, it has dithered and reacted unscientifically, unlawfully and with no morality to calls for the implementation of MTCT prevention programmes.
For more than five years civil society, initially led by the AIDS Law Project and the AIDS Consortium, have lobbied government to implement MTCT programmes to reduce HIV transmission to infants. Since December 1998, TAC has led the call for government to take action. We have petitioned, negotiated, written appeals, organised workshops and conferences, publicised the need for government action -- all to no avail.
In March 2000, Judge Edwin Cameron made the following appeal to the government in the presence of the Minister of Health at a national conference of people living with HIV/AIDS:
"Since 1994, very detailed and careful scientific and medical studies have been done on how to reduce the risk that a mother with HIV will transmit it to her baby during or after birth. The overwhelming scientific consensus is that effective anti-retroviral medication can be made available in a developing country to reduce transmission. Every month in our country, approximately five thousand babies are born with HIV. Medicines exist that, now, can reduce this figure by half. Economists have done detailed studies that show that this medication can be made available cheaply and affordably. Their studies have also shown that, from a purely economic point of view, it is better to save young babies from getting HIV than to let them fall sick and die of AIDS, and that intervention will save the country money.
"So overwhelming is the medical, scientific and economic consensus on these points, that many people find it almost impossible to understand why our Government is still delaying the immediate implementation of programs to prevent mother to child transmission of HIV. If government commits itself to helping pregnant mothers, it will throw a beam of hope onto the entire epidemic. It will throw a beam of light onto all our lives. If babies can be protected from exposure to HIV by giving medicine to their mothers, then all of us can hope that progressive implementation of an accessible drugs programme will save many more lives in South Africa and in our continent as a whole..
The government has spurned every opportunity to do the right thing. Despite the TAC's unshakeable support for the government during its court battle with the drug companies, TAC has had no option but to defend the rights of poor women with HIV and children against the government.
For TAC, legal proceedings were our last resort - they give people who have lost faith in the government's commitment to address all aspects of the HIV/AIDS epidemic a legitimate and legal avenue to defend their constitutional rights to healthcare access, life, dignity and equality. We are not opposed to our government. We are opposed to the misguided and unconstitutional actions (or lack of them) on HIV/AIDS prevention and treatment. You can consult our court papers at http://www.tac.org.za
In August, we appealed publicly to the Government to abandon its opposition to the orders TAC is seeking from the court: access to Nevirapine for women and children who need it (under proper medical supervision), and a clear national programme to prevent mother to child HIV transmission. The Minister of Health spurned this appeal.
We therefore appeal to every person in South Africa and across the globe to support TAC's court action. We urge you to write letters of support to TAC at the following address: TAC, National Office, Town One Properties, Sulani Drive, Site B, Khayelitsha. Tel: +27 (0)21-364 5609; Fax: +27 (0)21 364 6653; Email: info@tac.org.za
Where possible, TAC requests supporters in South Africa to attend the hearing in court or to join demonstrations. We request that international allies arrange meetings with the South African Embassies to urge the South African government to settle the court case.
Please do not hesitate to make further enquiries.
Yours sincerely
Siphokazi Mthathi (TAC) Cati Vawda (Children's Rights Centre) Dr. Haroon Saloojee (Save Our Babies)
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Bredell Consensus Statement on the Imperative to Expand Access to Anti-Retroviral (ART) Medicines for Adults and Children with HIV/AIDS in South Africa
Released: 19th November, 2001
On October 18th and 19th 2001 the Treatment Action Campaign (TAC) hosted an expert consultation of doctors, scientists, nurses, policy specialists and activists to discuss the benefits of using anti-retroviral therapies (ART) for the treatment of HIV and AIDS in South Africa. Participants included specialist clinicians and nurses who treat people with HIV and AIDS and who prescribe or study anti-retroviral medications. Included were representatives from diverse backgrounds, including the public and private health sectors, academic medicine, tertiary hospitals, urban, peri-urban and rural clinics. Several internationally respected scientists from South Africa and elsewhere made presentations. Religious bodies, trade unions, government and AIDS organizations also participated.
The following consensus emerged:
1. The AIDS epidemic is one of the greatest challenges confronting South Africans. In facing up to the epidemic we confront not only a crisis of illness and death and a crisis of action, but a challenge to accept the truth, to tell the truth and to act on the truth.
2. Very large numbers of people are dying of AIDS or are sick with AIDS-related illnesses. The Department of Health estimates that last year 628 000 (25%) public hospital admissions were for AIDS- related illnesses. The Consultation also heard that AIDS-related illnesses are the most common causes of death in the medical wards among adults aged 19-49 at teaching hospitals affiliated to the Universities of Cape Town, Natal and Witwatersrand. The first aim of ART is therefore to decrease HIV associated illness (morbidity) and death (mortality). This goal can be achieved.
3. Access to anti-retroviral therapy is a vital and indispensable complement to both treatment of HIV disease and effective HIV prevention. It can restore hope to both health professionals and patients, and can assist us in regaining control of this epidemic. Therefore treatment for HIV and AIDS that includes anti-retroviral medicines should no longer be withheld as a result of government policy. ART in the public sector is necessary and possible, and a start must be made to implementing it as a matter of urgency in the interests of millions of lives.
4. As with any potent and effective medication there are side-effects and toxicities experienced by some patients taking ART. However, registered anti-retroviral medicines are effective and safe when they are appropriately prescribed and monitored. ART significantly improves the quality and length of life of men, women and children with AIDS. In South Africa this has been convincingly demonstrated in managed health care programmes, mainly in the private sector. It is estimated that 20 000 people are now using ART in South Africa. Extending access to these life-saving medications has become a moral, political, social and economic imperative.
5. Further delays in standardizing anti-retroviral use in the midst of a severe AIDS epidemic will undermine public health. Absence of appropriate standards is already leading to widespread inappropriate prescription and misuse - mainly by medical practitioners operating without training outside the framework of protocols and guidelines.
6. 'Anti-retroviral drug anarchy' may become a danger as more people need access to ART, prices come down, and untrained doctors prescribe the medicines. This threatens patient health, public health and the efficacy of the medicines themselves because of the possible development of resistant strains of HIV. In some cases, current prices have resulted in the prescription of sub- optimal drug combinations with the likelihood that this will result in the emergence of drug resistance. In view of this, participants agreed on the need for:
a. respect for patients' rights to information and to fully- informed consent before starting treatment;
b. comprehensive and urgent training of nurses, doctors and community health care workers in ART in the public and private sector throughout South Africa;
c. establishing networks for sharing experience between all health care professionals;
d. clear and strictly maintained criteria for ART access;
e. standardized but flexible protocols about when to start therapy and the optimum choice of initial treatment regimens;
f. a minimum of three drugs as the standard of ART care;
g. guidelines for anti-retroviral management of patients with HIV who also have TB;
h. guidelines for anti-retroviral management of pregnant women;
i. health systems ensuring patient care and support, efficient delivery of medicines, adherence monitoring and staff support; and
j. public information and education that creates a culture of openness about HIV and AIDS and awareness that it can now be medically managed with ART.
7. Adherence to treatment requires informed and motivated patients together with an enabling clinical care environment. These conditions are practical and feasible. Research and ongoing treatment access in a variety of settings in South Africa have shown that people with HIV in poor and disadvantaged areas can adhere successfully to treatment regimens and thus can achieve treatment outcomes that are the same as in developed countries.
8. The capacity and infrastructure to use anti-retrovirals safely and effectively and to treat tens of thousands of people with AIDS already exists within the private health sector, parts of the public sector, and within some non-governmental organizations. These provide a foundation to devise and implement a national treatment plan, while simultaneously identifying needs and gaps in under-resourced sectors to promote equity.
9. Administration of anti-retroviral medications to reduce mother-to-child transmission must be introduced country-wide.
10. Post-exposure anti-retroviral prophylaxis for sexual assault is a moral necessity and an essential public health intervention.
11. Tuberculosis (TB) is the most common AIDS-related opportunistic infection and cause of death amongst HIV patients in South Africa. ART substantially reduces the risk of acquiring TB disease. Access to ART will relieve the burden and cost of TB and other common AIDS-related opportunistic infections on the public health system. New and recurring TB cases will be reduced and prevented by ART and TB treatment.
12. Anti-retroviral medicine prices must be further reduced. Price reductions should be across the board, and not limited to the public sector. Generic competition of bio-equivalent medicines is essential in order to arrive at the lowest and most sustainable prices for essential medicines. This is especially important if treatment is to be accessible to and sustainable by all people in South Africa.
13. Price reductions for diagnostic tests and tests monitoring the efficacy of ART are a priority. The price of these tests contributes substantially to ART costs and can result in inadequate clinical management.
14. However, even at current prices, HIV/AIDS medications could pay for themselves through reduced hospitalization, prevention of opportunistic infections, and improved quality of life and productivity of persons with AIDS. This has been demonstrated worldwide, including developing countries such as Brazil.
15. Most clinical research into ART in South Africa is currently driven and funded by pharmaceutical companies. This needs to change to grant-driven research that investigates issues such as:
* determining the most appropriate and well-tolerated combinations of medicines taking into account the needs of women and children as well as conditions that exist in developing countries such as South Africa;
* improved clinical algorithms or simple laboratory markers that can replace some expensive current laboratory monitoring;
* long-term cohort studies investigating adverse drug events; and the
* interactions between TB and HIV therapies.
On the basis on the above points of consensus we state our belief that advocacy for access to anti-retroviral treatment is an ethical duty for health professionals. In addition, expanded capacity to treat HIV is an immediate imperative. Treatment literacy, support systems and de-stigmatizing HIV/AIDS is a duty of community activists and institutions of civil society such as trade unions, faith- based organizations, community organizations and NGOs at every level. Ensuring expanded, equitable and sustainable access to life-saving and prolonging medicines is a moral and legal responsibility for government, business, international agencies and private health-care funders.
Signed:
[extensive list of individuals and organizations, available in on- line archive version of this posting at http://www.africapolicy.org/docs01/acc0111.htm]
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Message-Id: <200111251427.JAA30124@server.africapolicy.org> From: "Africa Action" <apic@igc.org> Date: Sun, 25 Nov 2001 10:17:23 -0500 Subject: Africa: Treatment Access Updates
Editor: Ali B. Ali-Dinar
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