International health charities have accused George Bush's administration of trying to block developing countries' access to cheap AIDS drugs by questioning the quality of "three in one" generic combination drugs. At a meeting last month in Gaborone, Botswana, the US global AIDS coordinator, Randall Tobias, said that the World Health Organisation's drug pre-qualification programme is not a sufficiently stringent approval process to ensure consistency and quality of fixed dose combination drugs. Médecins Sans Frontières and other non-governmental organisations working with AIDS patients in Africa accused the US government of trying to escape the 2001 Doha agreement on affordable drugs by the side door.
Equity and HIV/AIDS
Less than 10% of HIV-positive individuals in South Africa will be eligible to receive antiretroviral therapy if World Health Organisation guidelines which mandate the use of anti-HIV therapy in patients with a CD4 cell count below 200 cells/mm3 are followed, according to a French-funded study published in the May 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study also found that this would have only a limited impact on the spread of HIV.
Stigma and discrimination are still huge obstacles to progress on AIDS: the association of HIV/AIDS with marginalised populations has consistently been a major factor impeding action. Furthermore, the involvement of HIV positive people in policymaking and programme delivery is essential to success, and such involvement requires partnership and respect, not sympathy and tolerance. This is according to an article by the International HIV/AIDS Alliance (2003) that presents an assessment of the successes and failures of the global response to AIDS from 1993-2003.
A United Nations plan to provide three million HIV-infected patients in Africa with anti-retroviral drugs by 2005 is in danger of collapsing owing to lack of funds, UN and World Health Organisation officials said. Some countries, particularly the United States, are balking at supporting the project, Aids workers say, partly because the plan intends to use a form of medicine called fixed-dose combination antiretroviral drugs whose use is opposed by large pharmaceutical companies.
US officials attending a major conference on anti-AIDS drugs in Botswana this week have dismissed allegations that they want to use the meeting to question the quality and safety of more affordable generic fixed-dose combinations (FDCs) of antiretrovirals. "We want to see use of internationally accepted scientific principles that will be used in evaluation of Fixed Dose Combination drugs for HIV, tuberculosis and malaria. The concern is the risk of resistance, because good drugs are not good enough with this disease," said Dr Mark Dybul, head of the US government's President's Programme for AIDS Relief (PEPFAR).
This recently published national policy document has eight chapters covering, inter alia, a multi-sectoral response to HIV/AIDS; issues of prevention, treatment and care; the empowerment of People Living with HIV/AIDS and of vulnerable populations; traditional and religious practices and services; HIV/AIDS in the workplace and research questions. Will also be of interest to organisations outside Malawi.
"We, members of the Pan African Treatment Access Movement (PATAM) who have gathered here in Harare from 3-5 March 2004 to draw up civil society strategies to ensure rapid scale-up of anti-retroviral therapy in Southern Africa understand that everyone in the world is vulnerable to HIV infection and know that HIV-positive people in Africa, particularly women and other vulnerable groups, experience great challenges that must be addressed urgently. We know and understand that there are numerous factors and actors that hamper the provision of affordable life-saving medicines. Some of these include profiteering by pharmaceutical companies, inequitable international trade relationships, poverty, extreme stigma, imbalance of power within patriarchal societies, macroeconomic policies that constrain spending for health care and other social services and a lack of commensurate political commitment by our governments and other leaders to match the scale of the HIV/AIDS pandemic."
The shortfall in extending antiretroviral therapy (ART) to HIV positive people in Southern Africa is "enormous", with mostly educated, urban males benefiting from existing programmes, says a new report. The report was compiled by the Regional Network for Equity in Health in Southern Africa (Equinet) and Oxfam GB, and focuses on equity in health sector responses to HIV/AIDS.
This report (April 2003) was commissioned by the National Emergency Response Committee on HIV/AIDS and UNAIDS. It examines various biologic, behavioural and socio-economic drivers and discusses the impact of the pandemic on health care, education, agriculture and the private sector. It concludes with some innovative responses. This report should be of interest to persons outside of the immediate Swaziland context.
Recognising the need for an Africa-wide movement, a Pan- African Treatment Access Movement (PATAM) has been founded. Zackie Achmat of the Treatment Action Campaign (TAC) of South Africa, and Milly Katana, lobbying and advocacy officer of the Health Rights Action Group in Uganda were among the founders. PATAM is a social movement comprised of individuals and organisations dedicated to mobilising communities, political leaders and all sectors of society to ensure access to anti-retroviral therapy, as a fundamental part of comprehensive care for all people living with HIV and AIDS in Africa. Since its inauguration on August 22, 2002, the movement has been growing. On March 4-6, PATAM will be hosting its third regional conference on Access to Treatment in Harare, Zimbabwe.