MEMORANDUM

Accountability and Action to Stop AIDS Now!

People living with HIV/AIDS around the world call for:

The international community has an opportunity to change the course of history by using HIV treatment programs to bolster prevention efforts and improve overall health systems throughout the developing world. Treatment and care for 40 million people living with HIV/AIDS and comprehensive, effective prevention cannot wait. We demand real access for all!

Each day 8000 people living with HIV/AIDS die, and 13,000 become HIV positive. HIV/AIDS is now a leading cause of death among people ages 15 to 59 worldwide. Since the XIV International AIDS Conference, 10 million people have become newly infected with HIV. By 2010, 100 million people will be infected with HIV worldwide--45 million new infections in only 5 years.

In the four years since the XIII International AIDS Conference in Durban, South Africa, political leaders from developed and developing countries and multilateral institutions have become willing to talk about the AIDS crisis. But they have refused to move beyond "breaking the silence." They have refused to translate their talk into actions that will help turn the tide against the AIDS pandemic, and they have consistently broken their own AIDS promises.

Generic competition has slashed the cost of triple combination therapy to as little as $138 per year. But only 450,000 people living with HIV/AIDS in poor countries have access to life saving combination antiretroviral treatment. 6 million people worldwide are so immune compromised they need immediate access to HIV treatment or they will die.

How many more have to die before our leaders take life saving, emergency measures to save lives?

We reject silence in the face of ideologically motivated attacks on prevention, and attacks on the use of quality generic medicines pre-qualified by the World Health Organization. These brunt of these attacks are borne by the world's most vulnerable people--women, drug users, men who have sex with men, young people, migrants--who are given empty promises instead of pills, incarceration and forced drug treatment instead of real harm reduction, and the command to "just say no" to sex instead of access to free male and female condoms, comprehensive and appropriate sex education, and reproductive health services.

WE DEMAND THAILAND'S PRIME MINISTER THAKSIN SHINAWATRA:

Ensure sustainable coverage for antiretroviral therapy under the national health care plan, by integrating treatment for AIDS (and chronic liver disease; both currently excluded) into the national health care budget, thus no longer requiring annual budgetary approval.

Ensure the security and independence of Thailand's medicine policies:
Refrain from signing any free trade agreement that in any way negatively impacts the public health of Thai citizens or undermines Thailand's ability to produce affordable generic medicines for local use or for export, in particular the U.S.-Thai Free Trade Agreement, which will delay and obstruct generic competition, and will drive up the cost of essential medicines in Thailand.

Demonstrate the integrity and courage of the Thai government by using public health safeguards that are affirmed in international trade agreements concerning intellectual property rights and public health, for example by issuing compulsory licenses of patented pharmaceutical products in order to increase access to affordable medicines in Thailand.

Urgently implement effective HIV prevention policies and programs, focusing on underlying conditions of risky behavior, for example the accessibility and availability of condoms. Increase the budget for condom distribution to all groups, not only through paid condom dispensing machines but the free and continuous, unlimited distribution of condoms in order to minimize obstacles to widespread use, such as cost and negative attitudes. Develop and fully support age- and developmental stage-appropriate sex education curricula to be implemented at educational institutions throughout the country.

End drug suppression policies that promote and endorse human rights abuses, and urgently promote national HIV prevention and programs for injecting drug users using a harm reduction approach, including the use of evidence-based interventions such as long term methadone maintenance therapy and needle/syringe exchange programs, as well as providing equity in accessing antiretroviral therapy programs. Injecting drug users are the only group in Thailand in which new HIV infections are increasing, and prevalence has not decreased in 15 years; the government of Thailand must fund, develop, and implement these strategies and programs immediately.

WE DEMAND NATIONAL GOVERNMENTS IN DEVELOPING COUNTRIES:

Keep your promises. Fulfill the political commitments made in the Declaration of the United Nations General Assembly Special Session on HIV/AIDS and the Abuja Declaration of the African Summit on HIV/AIDS, Tuberculosis, and Malaria in Abuja, Nigeria to protect the human rights of people living with HIV/AIDS and people at greatest risk of infection including the right to health, and increase domestic health expenditures. Create new laws and enforce existing laws that protect and promote the social, economic and human rights of people living with HIV/AIDS in order to help eliminate stigma, bigotry and discrimination.

Treat the people in clinical need. Ensure equitable access to treatment of HIV/AIDS, including antiretroviral treatment, through the public health system, as part of a comprehensive continuum of HIV care. This continuum of care should also include the treatment and prevention of opportunistic infections (OIs) and sexually transmitted infections (STIs); reproductive health services; nutritional support; palliative care; and comprehensive harm reduction including substitution therapy, methadone maintenance and detoxification, and needle exchange.

Prevent new infections. Dramatically scale up access to male and female condoms, comprehensive sex education, sterile needles and other life-saving prevention tools. Scale up access to mother to child transmission prevention, in the framework of expanding access to treatment for mothers and their families, in all antenatal clinics. Provide post-exposure prophylaxis (PEP) for sexual assault and occupational exposure. Forced interventions, such as forced illicit drug treatment or mandatory HIV testing, are ineffective and unethical; national prevention strategies must promote and protect the human rights of people with HIV and people at greatest risk of infection.

Ensure equal access to treatment and prevention services. Mobilize the financial, human, technical, and political resources necessary to ensure equitable access to vital health care services. Eliminate repressive policies curtailing access to care for vulnerable and marginalized populations, including children, injecting drug users (IDUs), sex workers, sexual minorities, women, migrants, the incarcerated, and those in remote rural areas. Support the meaningful involvement of people living with HIV/AIDS at all levels of decision-making about policies, programs and implementation strategies affecting their lives.

Use the rights reaffirmed in the Doha Declaration on the TRIPS Agreement and Public Health (the "Doha Declaration"). Issue compulsory licenses for patented drugs, including drugs for second line treatment of HIV. Adopt pro-public health policies regarding intellectual property rights. Ensure that regional and bilateral trade agreements do not exceed the standards set in the Doha Declaration and do not restrict the right to locally produce or import low-cost quality generics. Request technical assistance from the World Health Organization and other independent experts to evaluate the impact of Free Trade Agreements on public health systems and access to treatment.

Invest in the empowerment of women and girls. Create and enforce policies that reduce the vulnerability of women and girls to HIV infection and needless death, including greater access to male and female condoms; greatly expanded access to HIV, STI and reproductive health education and services; and programs to prevent mother-to-child transmission while ensuring treatment for mothers and family members. Create and enforce laws that promote women's social, economic and political rights and work towards the elimination of all forms of gender-based violence and sexual coercion. Eliminate school fees and other barriers to girls' education and take immediate steps to increase enrollment and retention rates of girls in school.

Stop the crisis among orphans and vulnerable children. Address the needs of children orphaned by HIV/AIDS, children living with HIV/AIDS, and other vulnerable children by implementing policies that provide total support to orphans and children infected and affected by AIDS, through free enrollment in school, housing, and access to free health care and social services.

Urgently improve the human rights situation of cross border migrant workers,who are at disproportionately high risk of infection, in every region of the world through recognition of the value of migrant work and promotion and protection of their basic human rights, including the right to health. Ignoring the reality of migrant labor and the importance of providing them social welfare and services, including antiretroviral treatment, allows for the continued exploitation of and profiteering from migrant labor. Leaders must protect their rights and ensure their access to HIV care, treatment, and prevention.

WE DEMAND DONOR GOVERNMENTS:

Massively scale up financing of the fight against AIDS and investments in health infrastructure.Provide annual, adequate financing for the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) and other financing mechanisms, commensurate with donor countries' share of the global economy. At minimum total financing must result in $10.5 billion in new annual funding for AIDS alone by 2005, increasing to $15 billion by 2007. Ensure that all funding and program support for expanding access to testing, treatment and care is based on the promotion of human rights and address gender and other equity issues in delivery.

Stop delaying the launch of a new call for proposals at the GFATM. In order for the fifth round of proposals to be launched in 2004 and the sixth round in early 2006, donors must commit now to cover the cost of renewals of previous rounds and plus the two rounds for a total of $3.3 billion.

Stop undermining confidence in generic medicines, particularly fixed dose combination generic AIDS medicines, that have been proven safe, bioequivalent and clinically effective. These medicines are cheaper than brand name equivalents, and assure more people can gain access to treatment.

Stop forcing poor countries to trade away health and access to medicines in trade negotiations. End bilateral and multilateral trade policies and pressures that prevent countries' from taking appropriate measures to address HIV/AIDS and other public health problems. Immediately abandon efforts to undermine the Doha Declaration, including intellectual property rights provisions in bilateral trade agreements that exceed the requirements of the WTO such as the U.S.-Thai Free Trade Agreement (FTA), the Free Trade Areas of the Americas (FTAA) the U.S.-Southern African Customs Union (SACU) FTA, the U.S.-Morocco FTA, and other bilateral and regional negotiations.

Support fair trade, drop the debt, and end macroeconomic policies that increase poverty and accelerate the AIDS pandemic. Cancel debt owed by developing countries and end structural adjustment policies that starve social services, including school and health care user fees and caps in social spending. Support rural economies by dismantling agricultural export subsidies and other unfair trade practices.

Stop the poaching of health care workers from resource poor countries. Support and fund the training, recruitment and retention of a new corps of health care workers in poor countries. Support and fund wage increases for developing country health care workers,

Implement disease prevention policies guided by science, not politics. Support effective, science-based prevention strategies, rather than politicized and unscientific approaches such as abstinence-only interventions. Ensure access to a global supply of HIV prevention information, programs, and commodities to avert 29 million of the most preventable new adult HIV infections projected between now and 2010. Stop restricting bilateral aid from funding effective prevention programs; provide funding for comprehensive sexual and reproductive health education, services, and technologies.

Increase funding and coordination of research and development. Commit considerable new resources toward research and development of effective vaccines and microbicides, simplified antiretroviral treatment and monitoring tools adapted for use in resource-poor settings, diagnostics, pediatric formulations of existing and new therapies, a vaginal and rectal microbicide by 2008, and novel and adaptive treatments for tuberculosis and malaria.

WE DEMAND MULTILATERAL INSTITUTIONS INCLUDING WHO, THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA, AND UNAIDS:

Immediately scale up the delivery of quality technical assistance. Technical assistance and capacity building is a vital part of treatment scale up efforts. WHO, UNAIDS and other technical agencies must coordinate the delivery of technical assistance for national HIV/AIDS treatment and prevention plans, quality assurance and program monitoring procedures, procurement strategies, and training and recruitment of healthcare workers.

Implement an aggressive plan for raising and disbursing funds necessary to sustain massive scale up of treatment, prevention, and community-based treatment literacy and advocacy efforts, guided by people living with HIV/AIDS.

Tell donor countries how much they owe. Multilateral agencies must clearly state not only global spending needs, but also an estimate of each donor country's fair share, how much they have contributed, and how much they owe.

Provide countries with evaluations of the impact of free trade agreements on public health and access to medicines, as per existing institutional mandates.

Eliminate barriers preventing women from accessing life saving care and services as part part of any and all prevention, treatment, or care initiative, such as WHO and UNAIDS' "3 by 5" initiative.

Immediately implement recommendations to strengthen Country Coordinating Mechanisms (CCMs) in order to increase the meaningful participation of people living with HIV/AIDS and eliminate conflicts of interest that slow down disbursement of grants.

Develop and disseminate practical tools to support treatment scale up, such as a consensus document regarding best available information about adapting antiretroviral treatment for pediatric use.

Add methadone to the WHO Essential Drugs List to facilitate access to this essential substitution therapy and educate WHO country representatives on components and importance of harm reduction.

WE DEMAND THE INTERNATIONAL AIDS SOCIETY (IAS):

Support and endorse publicly our advocacy efforts. The International AIDS Conference could be an invaluable forum for the sharing and debate of key scientific and community issues. But the prohibitively expensive cost of registration means it will always be an elite gathering. The IAS must support free registration for all indigent people, and dramatically increase the number of available scholarships--for community members, researchers, and health care providers.

WE DEMAND MULTINATIONAL RESEARCH BASED PHARMACEUTICAL COMPANIES:

Immediately reduce the price of essential anti-HIV/AIDS medications to a level affordable to the populations of developing countries, including lower and middle-income countries in Latin America, Former Soviet Union and Eastern Europe.

Immediately invest in expedited research and development of pediatric formulations for all marketed AIDS treatments as well as emerging products and where pediatric medicines for children exist, implement the same price discounts as applied to medicines indicated for adult use.

Cease all actions aimed at preventing states from exercising their rights to use safeguards reaffirmed by the Doha Declaration, whether through litigation or through pressure exerted by other governments, such as compulsory licensing and parallel importing to protect the health of their populations.

Publish on a drug-by-drug basis the actual costs of research and development, active ingredients, manufacturing costs, and all other relevant information necessary for an objective evaluation of the pricing structure for all essential HIV/AIDS medications.

Negotiate with governments of developing countries in good faith, toward serious action aimed at addressing a global health-care crisis--not with the media aimed at confusing cosmetic gestures with real solutions.

Eliminate all conditions from your drug donations and concessionary price reductions. Donations should apply to all developing countries and to all relevant medical conditions, without restriction; should be implemented without delay; should entail no arbitrary time limitations; and should guarantee no interruption in supply.Do not require any conditions that would adversely affect governmentsâ efforts to employ compulsory licensing, parallel importing, or other legal mechanisms to protect public health.

 

 

 

 


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