Africa: Treatment Access Updates, 09/20/03

AFRICA ACTION Africa Policy E-Journal September 20, 2003 (030920)

Africa: Treatment Access Updates (Reposted from sources cited below)

This coming week the 13th International Conference on AIDS and STIs in Africa (ICASA) convenes in Nairobi, Kenya from September 21-26, under the theme "Access to Care." [see]. On September 22, the United Nations convenes a high-level meeting on the implementation of the 2001 Declaration of Commitment on HIV/AIDS [see].

Meanwhile, the U.S. Senate, under pressure from President Bush, has rejected an amendment to provide $3 billion instead of $2 billion for the first year of President Bush's promised $15 billion HIV/AIDS initiative. The U.S. is currently spending an estimated $1 billion a week in Iraq, and Congress is currently considering a request from President Bush for an additional $89 billion.

This posting contains excerpts from several documents and additional links to these and other recent developments related to access to treatment. Another posting today contains a set of talking points released earlier this week by Africa Action, detailing the broken promises of the Bush administration on HIV/AIDS.

Below find an opening report from Nairobi from the Nigeria-AID eforum, a report on demands by Kenyan AIDS activists for more rapid action to make anti-retrovirals available, and the key points of a summary campaign platform on these issues from HealthGap USA.

Also last week the United Nations Economic Commission for Africa in Addis Ababa launched its new high-level Commission on HIV/AIDS and Governance in Africa [for details see]

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ICASA 2003: Community forum kicks off

September 20, 2002

Nigeria-AIDS eForum

Olayide Akanni Nigeria-AIDS eForum correspondent Nairobi, Kenya Email:

NAIROBI, KENYA - 20/09/03: Only just about ten percent of the expected 4000 delegates are in town, but as far as these are concerned, the 13th International Conference on AIDS/STIs in Africa (ICASA) is on - and the official opening hasn't even held yet.

Some 400 people from all over Africa are attending the pre-ICASA community forum, a 2-day event that will climax with the opening ceremony of the conference proper on Sunday at the Kenyatta International Conference Centre, Nairobi.

Even though most of the nearly 4000 delegates expected at the ICASA are just about now preparing to leave their respective countries to descend on host city Nairobi, the participants at the community forum are already seeping into the ICASA experience.

On Friday, the community forum was declared open by the First Lady of Kenya, Mrs. Lucy Kibaki.

Welcoming participants to Kenya, she called for the development of innovative strategies that will lessen the burden HIV/AIDS places on African women. Women, she said, bear the brunt of social and cultural practices that fuel the spread of HIV on the continent and she charged representatives of community based groups to actively engage women in their progamme implementation.

"Women should not be viewed as mere recipients of such initiatives. They must be carried along in order to help them lessen the social and economic burdens AIDS has placed on them. Communities must also come up with strategies through which they can partner with their national governments to reduce AIDS related stigma and discrimination", she said.

Kenya's Health minister, Hon. Charity Ngilu in her keynote address urged the delegates to utilize the community forum to proffer solutions to the challenges of stigma and discrimination and care of orphans, among other key issues that continue to pose a challenge to mitigating the impact of HIV/AIDS on the continent.

She announced the commencement of a plan by the Kenyan government to provide treatment for 6000 people living with HIV at the cost of $20 per month. She noted however that the impact of such treatment initiatives would be limited without community support of PLWH.

Also speaking at the event, secretary-general of the Network of African People Living with HIV (NAP+), Mr. Mike Anganga challenged participants to ensure that "accurate information reaches people before they are infected with HIV and not while they are on their death beds."

"PLWH need to make decisions based on knowledge rather than fear", he said.

Earlier in his opening remarks, chair of the Community Forum, Mr. Allan Ragi, had expressed the hope that delegates would utilize the forum to strengthen existing networks, build strong alliances with pharmaceutical industry and other stakeholders to facilitate access to care for PLWH on the continent.

The forum also featured roundtable discussion sessions on a variety of topics include: such as access to care, stigma and discrimination, social support, youth involvement and prevention, gender and sexuality as well as resource mobilization.

The 2-day event is jointly organized by the African Council of AIDS Service Organisations (AFRICASO), NAP+, Kenyan AIDS NGOs Consortium and the Society for Women and AIDS in Africa (SWAA).


Activists Demand Better Access to Antiretrovirals

UN Integrated Regional Information Networks (]

September 19, 2003


A lobby group, the Kenya Coalition for Access to Essential Medicines, is demanding that the government provide affordable or free antiretrovirals (ARV) for Kenyans.

"What we want to see is an expanded programme to treat as many people as possible," said Gitura Mwaura, Chairman of the coalition. "We believe the government has the resources, and can do something," he said. "Its priorities need to change."

Of the some three million people living with HIV in Kenya, at least 10 percent are in urgent need of ARVs, while only between 7,000 and 10,000 are able to access them - mainly through mission hospitals, the private sector, or NGOs who sponsor the drugs.

Buying imported generic ARVs costs up to 3,500 ksh (US $45) per month, which is way beyond the reach of the vast majority of Kenya's 32 million people, over half of whom live on less than a dollar a day.

The government has committed itself to providing ARVS for 20 percent of those in need by 2005, but has no comprehensive national treatment plan in place, mapping out detailed procurement plans, supply chains, training for medical personnel and essential monitoring for all those in need of the drugs, says Mwaura. "Though they're [the government] talking about treatment, we don't seem to see much concrete action."

Meanwhile, an estimated 700 people died of AIDS every day in 2002, or over 200,000 people during the course of the year.

Through the UN's Global Fund to Fight AIDS, Tuberculosis & Malaria the government plans to treat 3,000 people from December - namely TB patients, mothers and their families, ministry of health workers and emergency cases including rape. A further 6,000 will be able to access ARVs this year in 28 district hospitals around the country, at half of the purchase price or in some cases for free, the Director of Medical Services in the MoH, Dr Richard Muga, told IRIN.

But this is just a drop in the ocean, say activists.

Aside from the lack of a national strategy in place to treat and monitor all of those in need, the ministry of health's technical capacity has also been called into question. A pharmaceutical tender produced last month for 2004-2005, inviting suppliers to quote prices for drugs including ARVS, had "serious errors" in it, the coalition reported, despite readily available guidelines from the World Health Organisation and Kenya's own Essential Drugs Lists and Treatment Guidelines.

The tender asked for a combination ARV pill that did not exist, the wrong dosage for another ARV regime, and left out other essential items - paediatric doses, ARVs for people with TB, for use after rape or immediately after infection, or second-line ARVS for use where initial drugs do not work.

The coalition welcomed the fact that ARVs were on the tender list for the very first time, Mwaura said, but added "If that tender is anything to go by, then we certainly have a serious problem regarding the technical advice on offer to the ministry".

"In a country faced with a massive co-epidemic of HIV and Tuberculosis, it is absolutely unacceptable for incorrect and non-existent drug combinations to be tendered for from the highest technical office of the Ministry of Health."

Since 7 June the coalition has been trying unsuccessfully to meet the Kenyan minister of health, Charity Ngilu, to discuss a national treatment plan - which the government is reportedly working on - and to offer its expertise. To date it has not been granted a hearing.

Meanwhile, the government is delaying in granting permission to a Nairobi firm, Cosmos, to start producing generic ARVs at home, which would push the monthly price down to 2,500 ksh (US $32). Dr Prakash Patel, managing director of Cosmos, told IRIN that due to a "grey area" in international law he was waiting - for several months - to receive a letter from the Ministry of Health and the intellectual property office to allow him to begin large-scale production.

"We are asking the Kenyan government to give us the go-ahead," he told IRIN.

Government initiatives, or the absence thereof, have also been heavily criticised on other fronts. The National AIDS Control Council - which spent only 6 percent of its budget on programmes in 2000-2001, and a staggering 94 percent on overheads and salaries - has been under investigation for corruption and mismanagement this year, while the cabinet committee on AIDS had produced little by way of concrete results, said Mwaura.

"We would like to see some more concrete action on the ground," he said. "We need some political will."


Health GAP (Global Access Project)

04-Stop-AIDS: an Urgent Presidential Agenda to Halt the Scourge of AIDS

Paul Davis e: t: +1 215.833.4102 (mobile) f: +1 215.474.4793

September 15, 2003

This platform for the 2004 US Presidential Race will be taken to all of the candidates --including President Bush. Let's show the leader of the United States from 2004-2008 that organizations the world over demand an end to the Global AIDS crisis.

The platform will not be used to endorse any candidates. All of the candidates will be urged to adopt the provisions below.

For now, we are only collecting endorsements from organizations. We will collect endorsements from individuals later. Please send *ORGANIZATIONAL* endorsements, along with the city, state and country of your NGO to:


Health GAP USA

04-Stop-AIDS: an Urgent Presidential Agenda to Halt the Scourge of AIDS

20 August 2003

In the face of a pandemic that threatens global security while devastating economies and destroying the social fabric of nations, the leader of the most powerful country must have a comprehensive plan to stop global AIDS. With more than three million deaths expected this year, AIDS must become the highest priority foreign policy issue for any credible candidate seeking the 2004 presidential nomination.

President Bush has offered strong rhetoric on AIDS, promising by 2008 "nearly $10 billion in new money to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean" in his State of the Union address in January 2003. Unfortunately, that rhetoric has yet to translate into effective action. Meanwhile, the Bush Administration continues to under-fund the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). The Global Fund, launched in 2001, should be supported by the U.S. as the premier financing vehicle to deliver comprehensive prevention and treatment for the scourge of these three diseases. Yet the Fund has already been forced to downsize its mission and scope, seeking fewer proposals from impoverished nations due to a lack of funds from the U.S. and other donors.

To be a serious and credible candidate for President, Democratic and Republican contenders must commit to an ambitious and comprehensive plan to effectively stop the global AIDS pandemic. In order for a stop AIDS plan to be effective, such a plan will require significant new cash pledges from the U.S. as well as real and verifiable commitments to new policies. The undersigned organizations urge all candidates to adopt the following policies:

1. Donate the Dollars: at least $30 billion by 2008

Candidates must commit at least $30 billion to fight global AIDS over their four-year term in office. By 2006, annual contributions should reach at least $6 billion. Regular payments to the Global Fund should be made annually at levels equal to at least 33% of the Fund's projected needs. These donations should support rapid utilization and expansion of existing physical and human capacity in developing countries.

2. Treat the People: commit to treat those in immediate clinical need

Candidates must support prioritization of treatment of people with HIV who are in immediate clinical need, as well as pledge to commit the resources and personnel required to the Global Fund and other initiatives to reach the WHO goal of at least three million people with HIV on antiretroviral treatments by 2005, 7 million by 2007, and towards universal treatment for all people with HIV/AIDS by 2012.

3. Support trade policies that ensure access to affordable generic drugs

Candidates must commit that the U.S. will cease inserting provisions in bilateral and regional trade agreements that limit countries' ability to take appropriate measures to address HIV/AIDS and other public health problems. The U.S. must not prevent countries from exporting generic medicines to nations that have issued a compulsory license to meet public health needs, or countries where no patent is in effect. US Trade policy should promote access to affordable medicine for all developing countries.

4. Drop the Debt

Candidates must pledge to use the power of the U.S. Treasury, as the largest donor to the IMF and the World Bank, to fully cancel the debts of the world's poorest countries, and put an end to the imposition of structural adjustment policies such as user fees and privatization of health care, education, and water.

5. Disease prevention policies must be guided by science, not politics

Candidates must pledge the U.S. support for effective science-based prevention strategies, rather than politicized and unscientific approaches such as abstinence-only interventions. The U.S. must commit adequate resources and ensure access to a global supply of HIV prevention commodities and programs to avert 29 million of the most preventable new adult HIV infections projected between now and 2010.

6. Stop the crisis amongst orphans and vulnerable children

Candidates should commit billions of additional U.S. global AIDS spending for addressing the needs of children orphaned or vulnerable due to HIV/AIDS. The U.S., working with other nations, should ensure the implementation of national policies to provide total support to orphans and children infected and affected by AIDS through enrollment in school, housing, and access to health and social services by 2005.

7. Invest in the empowerment of women and girls

Candidates should pledge U.S. support for policies to reduce the vulnerability of women and girls to infection and needless death such as: greater access to female condoms; the development of vaginal microbicides to prevent sexual transmission of HIV by 2008; greatly expanded access to HIV, STD and reproductive health services; and programs preventing maternal-to-child transmission while ensuring treatment for mothers themselves.

8. Fight tuberculosis and malaria as part of a comprehensive plan to combat HIV/AIDS

Candidates must uphold the targets set out with leaders of other wealthy nations in the G8 Okinawa 2000 agreement: to reduce tuberculosis deaths and prevalence of the disease by 50% by 2010 and to reduce the burden of disease associated with malaria by 50% by 2010. For successful treatment of malaria, the U.S. should help finance the implementation of artemisinin-based combination therapy (ACT) in areas of high resistance to first-line treatments.

9. Ramp up research and development

Candidates must commit to considerable new resources towards developing effective vaccines, microbicides, simplified antiretroviral treatment and monitoring tools adapted for use in resource-poor settings as well as novel and adaptive treatments for tuberculosis and malaria.

[for additional explanatory background, initial signatories, and notes, see]

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Date distributed (ymd): 030920 Region: Continent-Wide Issue Areas: +economy/development+ +health+


Message-Id: <> From: "Africa Action" <> Date: Sat, 20 Sep 2003 16:17:24 -0500 Subject: Africa: Treatment Access Updates