Africa: AIDS Policy Updates, 1/2, 12/10/01

Africa: AIDS Policy Updates, 1/2, 12/10/01

Africa: AIDS Policy Updates, 1 Date distributed (ymd): 011210 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

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Region: Continent-Wide Issue Areas: +economy/development+ +health+


This posting contains several documents related to the current status of AIDS funding and related issues: an op-ed in the Seattle Post-Intelligencer by Africa Action executive director Salih Booker, excerpts from an interview with Stephen Lewis, the UN Special Envoy for HIV/AIDS in Africa, and a press advisory from U.S. Representative Henry Hyde on legislation to be voted on in the House of Representatives on Dec. 11.

The Hyde bill authorizes $750 million for the Global Fund in Fiscal Year 2002, the highest level among legislative proposals currently under consideration. If approved, this would set an upper limit-- the funds would still have to be appropriated. Current appropriations bills still being considered by Congress include much smaller sums. The higher figure would in all likelihood require a supplemental appropriation.

Another posting today has the concluding statement from a meeting of international experts held in Paris on care for people living with HIV/AIDS. The statement clearly spells out the need for the Global Health Fund for AIDS, TB, and Malaria to prioritize financing for AIDS treatment, inclusive of antiretroviral drugs.

The XIIth International Conference on AIDS and STDs in Africa is being held 9-13 December 2001 in Ouagadougou, Burkina Faso. More information, including a daily conference journal, is expected to be available on the conference web site at:

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Seattle Post-Intelligencer Seattle, Washington

AIDS pandemic threatens planet

Friday, December 7, 2001

by Salih Booker

Whether judged by the number killed each day or by the potential collapse of entire nations, the AIDS pandemic is a greater threat to global human security than are organized terrorist groups. Yet the Bush administration refuses to acknowledge this fact.

This past weekend, as the international community once again commemorated World AIDS Day by noting new estimates of 3 million more dead, 5 million new HIV infections and 40 million people now living with HIV/AIDS, even these shocking new statistics failed to stir action from those whose intervention could turn the tide of the pandemic. And most media outlets gave the occasion only perfunctory attention.

Those on the front lines -- people living with AIDS, medical professionals and community activists, family and friends -- are fighting the war on AIDS with the resources they have. But they are not nearly enough. Indeed, they are a pittance compared to the billions quickly mobilized for the war on terrorism. The rich countries that could easily fund a serious defense against the global threat of AIDS have refused to make more than token contributions to the United Nations' Global Health Fund created to fight the war against it. As the pandemic continues to devastate Africa, and threatens to explode in other regions, including Russia and south Asia, policymakers in Washington are hardly noticing.

Nowhere has the AIDS crisis had a more terrible impact than in Africa. The continent has already lost more than 17 million people to AIDS and is currently home to 28 million of the 40 million people worldwide living with the disease. While the crisis is most severe in Africa, HIV infection rates are rising around the world. The pandemic highlights the shared vulnerability of all countries to global threats to human security and it underscores the need for a strong global coalition to win the war on AIDS.

Twenty years into the pandemic, the failure of world leaders to respond to HIV/AIDS in Africa, and their incapacity to grasp the global implications of their inaction, has fanned the flames of the global crisis. This failure is directly related to Africa's marginalization in the international system. The perception that Africa lies outside the interests of the world's major powers, and that intervention is therefore unwarranted, has allowed HIV/AIDS to inflict devastation on the continent. The unstated but clear assumption that African lives are expendable is at the root of the West's disinterest.

AIDS is the worst plague humankind has ever known, and world leaders must take urgent action to combat it. The Global Health Fund, launched in April to finance prevention and treatment efforts, aims to mobilize $10 billion a year to fights AIDS. But it has been undermined from the outset by the stinginess of rich country governments. The United States has pledged (though not appropriated) only $300 million, which is but a fraction of the $2.5 billion that would represent a contribution commensurate with its share of the global economy. Despite the enormous scale of the pandemic, the leaders of the world's richest countries still rank the fight against AIDS low on their list of priorities.

Beyond funding, there are other immediate measures that need to be taken -- at an international level -- to remove the obstacles that hinder African governments' own efforts to respond to the AIDS pandemic. The cancellation of sub-Saharan Africa's illegitimate foreign debt would stop the diversion of resources from health care systems and social services in Africa. It would halt the hemorrhaging of resources from African countries to the rich countries and financial institutions of the global North, now running at more than $13.5 billion a year.

Enhancing the ability of African governments to acquire affordable treatment for those living with HIV/AIDS, by taking full advantage of international trade rules, would help prolong the lives of millions of people and would also help in prevention efforts. These steps would do much to confront the spread of HIV/AIDS in Africa and would promote global public health efforts in the long-term.

On World AIDS Day, as every day now, more than 8,000 people worldwide died of the disease -- the equivalent of two World Trade Center tragedies each and every day.

It is obvious that AIDS threatens the stability of all countries in the world. Yet there is no talk of a strong global coalition to fight this threat. While the resources exist to change the course of the pandemic, the necessary political will is still lacking. With the numbers infected with HIV/AIDS rising rapidly across the globe, the continued inertia of the world's most powerful leaders will have global consequences we cannot yet begin to imagine.


Interview with Stephen Lewis, UN Special Envoy by UN Integrated Regional Information Network (IRIN)

[Excerpts only. Full text available on IRIN web site:, under PlusNews. PlusNews is produced under the banner of RHAIN, the Southern African Regional HIV/AIDS Information Network.]

NEW YORK, 3 December (IRIN) - Stephen Lewis is the UN Secretary-General's Special Envoy for HIV/AIDS in Africa. In an interview with PlusNews recently, Lewis said that gender inequality, ineffective leadership and lack of resources were key issues facing the world in the battle against HIV/AIDS in Africa.

QUESTION: What do you see as your greatest challenges?

ANSWER: In a pretty fundamental way the biggest challenge is gender. It is to get the entire continent to understand that women are truly the most vulnerable in this pandemic, that until there is a much greater degree of gender equality women will always constitute the greatest number of new infections and there is such a degree of cultural oppression that has to be overcome before we really manage to deal with the pandemic. You simply cannot have millions of women effectively sexually subjugated, forced into sex which is risky without condoms, without the capacity to say no, without the right to negotiate sexual relationships. It's just an impossible situation for women and there has rarely been a disease which is so rooted in the inequality between the sexes. Therefore, gender is at the heart of the pandemic and until governments and the world understand that it will be very difficult to overcome it. ...

Second, there is still not a sufficiently effective leadership in the countries. There is a much greater awareness in Africa than there ever was before and there is some evidence of behaviour change in some countries. In Uganda and Senegal there is evidence that you can lower the rate of infection and begin to stall the pandemic. But the leadership that is growing at the president level must somehow infiltrate leadership at every level of society: political, bureaucratic, professional, community, NGOs etc and that has not yet happened.

Third, I am absolutely persuaded as I travel that there are so many good things happening in many countries that if we were able to take them to scale we would be able to turn the tide of the pandemic. I don't feel despair. I am tortured by the numbers as everyone is but not paralysed by the tremendous challenge that is involved because we know how to turn the pandemic around. We know how to decrease dramatically mother-to-child transmission, we know how to do testing and counselling, we know how to undertake prevention of many kinds through the schools and targeted at vulnerable groups. We know how to do antiretroviral therapy - initially limited of course but available to us. We know what it means to find a way of integrating orphans back into the community when their parents have died. We have all over the continent individual projects and programmes that are successful and the frustration lies in our inability to take them to scale. ...

What it really needs is the fourth challenge. It needs dollars. It is the single most inhibiting factor. It's not just drug prices, you can lower drug prices as low as they will go and countries will still not be able to afford them so you've got to have the resources. And that's where the Global Fund comes in and that's where we are struggling. No question.

Q: Why is the Global Fund to fight AIDS, tuberculosis and malaria so grossly under funded? Why have donors not been forthcoming?

A: I'm not sure they haven't. ... Countries have started to contribute to it. The amounts are not yet sufficient but once you've got some global funds going it will build in momentum. You won't be able to turn it back. The one-and-a-half billion [dollars] which I think will move pretty quickly to two billion has got to start being distributed, it's got to reach communities, it has to start making a difference in the lives people lead, it has to give money for care, money for treatment, money for prevention and then there will be so much recognition of its value that the donors will start giving more money. ...

Q: Would the Fund ever buy or recommend generic antiretrovirals over brand name drugs?

A: I don't know whether it would be over brand name drugs. You are putting it in an unnecessarily combative fashion. I'm not sure it couldn't be done in conjunction with brand name drugs. I'm not sure that you couldn't have a range from which you pick based on price and availability and application - what has worked and what hasn't worked. You understand that you have me at your mercy because I am not privy to the discussions, but I would imagine that any sensible person would recognise that as all of us have talked about how generic drugs have been indispensable to bringing down drug prices of major manufacturers that they will be a part of this. They are already being used in countries. [Nigerian President] Obasanjo sent his Minister of Health to India and said go to [generic drug manufacturer] Cipla and negotiate the best price possible. And he went to India and he negotiated a price of $350 per person per year and the drugs have now arrived in Nigeria. So surely the Global Fund will respect what many of the countries are doing and generics will be a part of the package but they won't be the sole package.

QUESTION: Nigeria took a bold step earlier this year with a programme to provide generic antiretrovirals to 15,000 people living with HIV/AIDS. Was this a demonstration of positive African leadership, and what do you make of the delays to the implementation of the programme?

ANSWER: Every delay is desperately painful as human life is hanging in the balance but this was actually a valuable delay. Initially, Nigeria was thinking of a two drug combination. They brought a UNAIDS team into Nigeria to take a hard look at how they wanted to handle the antiretrovirals and what the regimen should be. They came to the conclusion that they needed three drugs and not two. So the delay was in part changing the regimen which they had intended to purchase and making sure Cipla had the required combination of drugs. And now I gather they have arrived. So instead of being two years this delay was two months and I think the programme is about to begin. It is supposed to start on December 10th ...

(President Festus) Mogae's in Botswana seems to me to be the most dramatic (programme) of all. It hopes to have well over 100,000 people in treatment starting dramatically in the year 2002 and building in numbers. And they've really laid the groundwork. It's just truly impressive. I sense that the preparation they're doing means that there will probably be success and Botswana will be seen as the country against which antiretroviral treatment is measured because they will have the largest numbers. They obviously have an advantage as they have money. But the actual use of antiretroviral drugs and the way they restore life, the way people start eating and look better and their hair doesn't fall out and they return to work and it's like a miracle transformation in a very short period of time. All of that will be happening in Botswana and it will have an impact. According to the UNAIDS report there are now 10 countries in East and Southern Africa which are introducing antiretroviral drugs to a greater or lesser degree.

Q: In South Africa, the government has come in for criticism over its HIV/AIDS policies, which have been marked by an alleged lack of political commitment. What can be done when national governments appear hesitant to tackle the epidemic head-on?

A: I am not going to comment on things like the court case because that it something distinctly internal to South Africa and it involves a legal interpretation of the South African constitution. The arguments have been made and it would be presumptuous to comment on a high profile court case. But I would say that the policy of UNAIDS and WHO and therefore the UN system is absolutely clear. It is that nevirapine should be available in mother-to-child transmission clinics, that it is an effective drug, that any side effects or difficulties are far, far outweighed by the positive impact of the drug itself because kids emerge HIV negative and huge numbers of children's lives are saved. ...

And now ... a group of foundations, headed by Rockefeller, are introducing something called [prevention of mother-to-child-transmission] PMTC-plus. And the plus is antiretroviral treatment for the mothers because until now, of course, you had the very difficult human situation where you saved the life of the child and the mother looks at you and says with a kind of poignant terror: 'What about me?' And now there will be a significant effort made first on a pilot basis to introduce antiretroviral treatment for the mother and this is being launched in a few days time. ...

Q: What is your prognosis for the future? Do you believe that HIV/AIDS will eventually be brought under control?

A: For 20 years we watched this plague grow exponentially and ruthlessly. HIV/AIDS is the most apocalyptic thing that has happened in the history of disease. For 20 years African leadership was largely silent, in denial, frightened, traumatised, paralysed. For 20 years the Western world, which had the resources, was developing the drugs and knew how to deal with the pandemic. The Western world contributed a negligible quantity of money to Africa.

It only started to turn around in the year 2000. In the process 17 million lives were lost and 25 million people were already infected. It is one of the most astonishing moral lapses in post-war history. I really feel frustrated and extremely angry at the inertia in response to the epidemic ...



House International Relations Committee Congressman Henry J. Hyde CONTACT: Sam Stratman, (202) 226-7875, December 6, 2001

Committee on International Relations

Hyde Global HIV/AIDS Legislation Scheduled for House Vote December 11

December 7, 2001

(WASHINGTON) - A $1.3 billion one-year authorization bill to address the global HIV/AIDS crisis is scheduled for a vote in the House of Representatives on Tuesday, December 11 its chief sponsor, U.S. Rep. Henry J. Hyde (R-IL), chairman of the House International Relations Committee announced Thursday.

The bipartisan legislation, the Global Access to HIV/AIDS Prevention, Awareness, Education and Treatment Act (HR 2069), was approved 32-4 in June by the committee with support from cosponsors U.S. Reps. Tom Lantos (D-CA), Jim Leach (R-IA) and Barbara Lee (D-CA).

"The scourge of HIV/AIDS is one of the great moral challenges of our era, for it is one of the most compelling humanitarian and national security crisis of modern times," Hyde said, adding, "Everyone has a stake in what tragically could be the plague of the 21st century, and we must meet this test by reaching out now to those most in need. It is the right thing to do for our children, our country, and our world," Hyde added."

Highlights of the HR 2069 (As amended):

* $750 million for an international AIDS trust fund.

* $485 million in bilateral assistance largely through non-governmental organizations including faith-based organizations and administered by the U.S. Agency for International Development (USAID) to undertake a comprehensive program of HIV/AIDS education, and treatment; including prevention activities that promote behavioral change.

* $50 million for a pilot program for treatment of those infected by assisting developing countries in procuring pharmaceuticals and anti-viral therapies.

* Establishes programs to strengthen and broaden indigenous health care delivery systems and the capacity of such systems to deliver HIV/AIDS pharmaceuticals.

* Provides assistance aimed at the prevention of transmission of HIV/AIDS from mother to child.

* Provides assistance to strengthen and expand hospice and palliative care programs.

* Funds care and support of children who are orphaned by the HIV/AIDS pandemic.

* Funds vaccine research and development partnership programs to develop a safe, effective, accessible, preventive HIV vaccine for use throughout the world.

* Establishes microenterprise programs that provide poor families affected by HIV/AIDS with the economic means to care for themselves, their children, and orphans.

* Establishes an aggressive oversight program to monitor projects, and activities.



Africa: AIDS Policy Updates, 2 Date distributed (ymd): 011210 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

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide Issue Areas: +economy/development+ +health+


This posting contains the concluding statement from a meeting of international experts held in Paris on care for people living with HIV/AIDS. The statement clearly spells out the need for the Global Health Fund for AIDS, TB, and Malaria to prioritize financing for AIDS treatment, inclusive of antiretroviral drugs.

(The statement is slightly abridged for this e-mail posting. The full text will be available in the on-line archive of this posting at

Another posting today has other recent documents related to funding and priorities for the Global Fund.

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This international experts meeting was held in Paris at the invitation of the French Ministry of Foreign Affairs, with the support of UNAIDS Secretariat and WHO.

1 December 2001

Paris, France


I. Introduction and Purpose of the Document

With an estimated 40 million people infected with HIV worldwide and 26 million accumulated deaths, HIV now stands as the worst infectious disease pandemic in recorded history. The threat imposed by HIV is reflected not only in the tragedy of each individual case and his/her affected loved ones but on the global scale of human health and the potential for demographic, economic and political destabilization in many countries. Access to HIV prevention and care services have long been championed by international organizations, governments, non-governmental organizations and community groups. However, we are far short of providing HIV-infected people worldwide with appropriate care. In the last two years, an extraordinary juxtaposition of events has given us an opportunity that must be seized. Since the International AIDS Conference in Durban in July 2000 and the United Nations General Assembly Special Session (UNGASS) in June 2001, the world is mobilized as never before to address the issue of HIV/AIDS in developing countries. The tools which can change the course of the epidemic are in our grasp. The benefits of treatment in terms of preventing illness and death from HIV infection have now been well demonstrated. Access to HIV medications must now be ensured for the millions of infected persons in the developing world within the broader context of appropriate care, prevention and support. Current resource allocations are woefully inadequate, substantially less than 25% of the annual estimated need, to meet this goal. Future generations will judge us harshly if we fail moving rapidly toward the minimum 7-10 billion dollar per year allocation that was called for in June 2001.

The purpose of this document is two-fold. The first is to set forth a clear framework for improving and accelerating access to care for HIV-infected women and men in the developing world. In particular, the document proposes near-term goals that are achievable. Specific priorities are outlined with a timeline of 18-36 months. The second purpose is to serve as a start for mobilizing organizations and people to an ongoing, progressive, sustainable action plan that will help to make the UNGASS declaration become a reality.

This document is the product of a year long consultative process involving 155 experts from 27 countries and 57 national and international organizations. It is the consensus of the participants who convened in Paris at the invitation of the French Ministry of Foreign Affairs, UNAIDS and WHO on 29 November - 1 December 2001.

II. Current Status of HIV/AIDS Care in Developing Countries (Including Achievements Thus Far)

A. Prevention, Care and Support (Emphasizing Synergy)

As already shown by successful local and community responses to HIV/AIDS, prevention and treatment are synergistic : access to HIV treatment enhances the effectiveness of prevention as well as voluntary counselling and testing (VCT) programs. Prevention, or the reduction of new infections in the seronegative population, should not be pitted against care for those who are already HIV-infected. The idea that prevention could be more effective than treatment ignores their interdependence and indivisibility.

There is no disputing that targeted prevention strategies that take into consideration poverty, discrimination, inadequate education and gender inequality are effective in reducing HIV transmission. However, they will not be able to curb the pandemic in the absence of parallel efforts toward persons living with HIV. It is estimated that 9 out of 10 HIV-infected persons in sub-Saharan Africa do not know their serostatus. This is unlikely to change unless access to adequate care in case of a positive test result is offered. In addition, availability of effective care and treatment options reduces HIV-AIDS related stigma and increases societal and local responses to the epidemic.

B. Economic Opportunities and Constraints

Assuming that 20%-25% of the HIV-infected persons world-wide are symptomatic and/or in an advanced stage of immunodeficiency, 7.5 to 9 million living in developing countries are in urgent need of antiretroviral treatment (ARV). In contrast, a total of only about 200,000 HIV-infected persons, of whom 100,000 live in Brazil, use these treatments. This is less than 3% of those in need. At current discounted prices of antiretroviral drugs plus other costs of treatment (1,200 US$ per patient per year for both) the availability of 240 million US$ in 2002 would result only in a doubling of the number of treated persons, a positive but only a small step forward.

Clearly there is an urgent need for supplemental resources if additional lives are to be saved. In order to reach at least a third to one half of the 7.5 to 9 million people estimated to be in immediate need of treatment, additional funding is required for the Global Fund to Fight Against AIDS, TB and Malaria and from international co-operation, the private sector and insurance, as well as public budgets from national governments.

A number of national and smaller pilot programs in middle-income (Argentina, Brazil, Chile, Thailand, etc.) and low-income (Cote d'Ivoire, Senegal, Uganda, etc) countries have demonstrated a comparable feasibility, efficacy and adherence with antiretroviral treatment to those obtained in high-income countries.

The Brazilian experience, which ensures universal access and enhances domestic drug production, shows that ARVs can be cost-saving for the health care system : extra costs of drugs are more than offset by further savings due to the reduced number of episodes of opportunistic infections and consequently reductions in hospitalization (according to the Brazilian Ministry of Health net savings through ARV use amounts to more than 140 million US$ per year). ...

Even if they do not save money per se, new health interventions are considered as cost-effective in the North as soon as their marginal cost per additional life-year saved is below twice the GDP per capita (50,000US$ in OECD countries). Applying the same criterion to developing countries with lower GDPs, means that antiretroviral treatment should also be considered cost-effective for eligible patients in low-resource settings. Moreover, human and social benefits from increased life-expectancy and quality of life of HIV-infected patients go far beyond their direct economic impact for treated patients and include improved social and human development for their families, communities and country as a whole.

III. Key Issues and Opportunities

The care of HIV infected persons is multidimensional and the components must be clearly delineated. In this context, it is important to re-emphasize that prevention of new infections and care of those already infected are tightly linked and synergize with one another. National AIDS programs and international agencies have outlined many of these critical features and it is not the point of this draft declaration to reformulate these documents. Rather, it is to highlight the most critical areas which require resources, at the country level, in order to scale up the most effective programs for access to care.

1. Uniform availability of voluntary counselling and testing (VCT). Where this does not exist, appropriate measures should be taken immediately to scale up these programs. Proper assessment of an individual's HIV status permits educational measures to help negative persons remain negative and positive persons to enter into care. The latter, in turn, facilitates prevention efforts through interventions to prevent secondary transmission whether this be behavioral modification or entry into mother-to-child transmission prevention programs in the case of pregnant women. Increased testing capacity will also contribute to ensure a safe blood supply. A key element of strengthening VCT programs is the parallel availability of antiretroviral drugs. The hope of accessing life saving therapy will encourage more people to seek VCT services and thereby directly assist the prevention efforts.

2. Scaling up of MTCT prevention programs. One of the greatest achievements of the past decade is the demonstration that MTCT of HIV can be dramatically reduced by antiretroviral drugs. In the developed world the rate of infection of newborns is less than 2 percent and is near zero in women who receive proper antenatal care. Attaining this degree of success in the developing world will be difficult because of the absence of uniform access to antenatal care and the need for breastfeeding. In spite of these difficulties, reductions of MTCT by 50 percent have already been demonstrated in the developing world through the use of nevirapine or short-course zidovudine (AZT). These programs must be put in place in every health care setting. ...

3. Opportunistic infection (OI) prophylaxis and treatment. The proper management and prevention of opportunistic infections has been proven to have a positive impact on morbidity. Uniform access to drugs, such as antituberculous drugs and cotrimoxazole, is a cost effective intervention that is a mandatory component of care. Antiretroviral therapy is by itself the best prophylaxis for opportunistic infections. Scaling up antiretroviral treatment will progressively reduce the need for anti-OI drugs.

4. Improving access to antiretroviral therapy. The revolution in care in the developed world is unquestionably linked to the availability of powerful combinations of antiretroviral drugs. Dramatic reductions in morbidity and mortality have been well documented and this benefit needs to be made broadly available to persons in the developing world. It should be re-emphasized that antiretroviral therapy is already being used in the developing world, although on a small scale in low-income countries, with the demonstration that it is feasible and effective. Further, drug adherence appears to be comparable to the developed world and the concern for the spread of drug resistance is not a valid reason to delay introduction of therapy anywhere. ... Conversely, failure to expand treatment in a systematic way will certainly increase the risk of non-rational prescription and use of antiretrovirals ensuring a greater incidence of drug resistance. ...

Antiretroviral treatment programs need to be scaled up as rapidly as possible simultaneously with provision of health care worker and facilities capacity to permit and facilitate care delivery. Programs which build on existing MTCT prevention (e.g., MTCT "plus") and tuberculosis control programs are key entry points for antiretroviral therapy programs. ...

5. Psychosocial Support. A key element of care for all HIV infected persons is psychosocial support, including palliative care. The high incidence of depression and other emotional illnesses should be acknowledged in order for hope to be nurtured. Good quality care requires sufficient numbers of properly trained health care workers, traditional healers, religious and community leaders and volunteers to help patients and their families to develop the best ways of coping at all stages of HIV disease, and particularly with end of life issues. Appropriate psycho-social support will more than ever be needed to facilitate access and adherence to treatment.

IV. Framework for Implementation of Priority Programs

A. Approach for Efficient Implementation

While a demand-driven, participatory, and progressively decentralised approach will enable broadening of health care services, a central capacity is also needed at national levels for protecting people's rights, promoting price reductions for HIV/AIDS drugs and services, quality control of drug and service delivery, monitoring and evaluation.

In order to create systems for delivering care to significantly more people, training of personnel will be critical. In addition to supporting clinics, hospitals and homecare programs, countries need to aggressively work toward transforming existing volunteer and community-based organisations into AIDS service organizations. Latent capacities to demand and provide for care and treatment are widespread in families, communities, and organizations. ...

Once reference centres in large cities are functioning, these centres should be used to train people working in smaller cities or rural communities as is being done in Brazil, Cote d'Ivoire Senegal and Uganda. One innovative model for providing care is "Association-Based Treatment" (e.g., Burundi, Zimbabwe, Venezuela). Within this model the financial and material treatment resources are controlled and managed by the associations of people living with HIV/AIDS, together with doctors and other providers. In this context HIV infected women and men are directly involved in the decision making process and organization of all aspects of HIV care.

Without medicines, reagents for diagnostic testing and monitoring, improved human resources will be compromised and ineffective. Therefore, how to offer international support to augment local and national procurement efforts will be critical. Since the availability and sources of commodities will vary dramatically, international funding sources should not attempt to dictate where and how drugs and other inputs will be purchased.

Decisions on how to procure should be left to the country which may decide to: conduct national tenders to foster competition between generic and proprietary companies, take advantage of regional procurement organizations or future international buying arrangements managed by UNICEF (or other international, intergovernmental or private procurement organisations). Efforts to build local capacity for drug production, procurement and management of rational drug delivery should also be supported by international funds. Creating drug production capacity within developing countries can be an important factor in increasing access to medicines.

Patents must not constitute a barrier to access. The use of safeguards (such as compulsory licensing) to override patents is legal within the TRIPS international trade agreement and has been strongly reinforced in the 14 November 2001 WTO ministerial conference declaration on the TRIPS agreement and public health. ...

To offer treatment to the highest number of people possible, it is essential that funds be used to buy quality commodities at the best possible price. Using the lowest cost suppliers, whether proprietary or generic companies, will increase the number of people who can be treated and will allow for greater investments in other important components of care and prevention. Increased competition is a powerful tool to reach this goal. ...

V. Conclusions

* A real opportunity to impact on the HIV/AIDS epidemic now exists

* Care, treatment, and prevention of HIV/AIDS are strongly linked.

* Care constitutes an entry point and a key element for effective prevention.

* In low and middle income countries a wide array of life-prolonging care and treatment interventions are feasible and cost-effective today.

* The sharp drop in the prices of antiretroviral drugs in these countries has dramatically improved their cost-effectiveness. Several nationwide and smaller ARV programs have shown adherence levels and efficacy outcomes of therapy that are similar to those in the developed world.

* Governments, the private and not-for profit sector, and the international community must now commit the required financial resources commensurate with the need as identified by the UNGASS declaration.

* Failing to seize this opportunity to expand care and treatment will perpetuate untold human suffering and increase poverty and inequity on a worldwide scale.

We propose that this declaration be circulated to all international and national partners in the fight against HIV/AIDS with the view toward endorsement by appropriate forums, governments and concerned organizations. We hope that it will serve as a basis for immediate action.


Prof. Scott HAMMER, Columbia University, New York USA (

Prof. Jean-Paul MOATTI, Universite de la Mediterranee, Marseille France - (

Prof. Ibrahim NDOYE, Institut d'Hygiene sociale, Senegal (


[full list available in on-line archive of this posting]


Message-Id: <> From: "Africa Action" <> Date: Mon, 10 Dec 2001 20:11:12 -0500 Subject: Africa: AIDS Policy Updates, 1/2

Editor: Ali B. Ali-Dinar

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