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Note: This document is from the archive of the Africa Policy E-Journal, published
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Africa: Treatment Access Updates
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
+++++++++++++++++++++Document Profile+++++++++++++++++++++
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
+++++++++++++++++end profile++++++++++++++++++++++++++++++
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
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)
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 AIDSrelated
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 fullyinformed
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:
Individuals endorsing statement (as of Nov. 19)
Professor Quarraisha Abdool Karim, Epidemiologist, Nelson Mandela
School of Medicine, University of Natal, Durban and past national
Director of HIV/AIDS and STD Programme, Department of Health; Mr.
Zackie Achmat, Chairperson, TAC; Dr Steve Andrews, GP with special
interest in HIV; Mr.Ralph Berold, University of Witwatersrand,
HIV/AIDS Co-ordinator; Ms. Edna Bokaba, Registered Nurse, HOSPERSA;
Dr Brian Brink, Board of Health Care Funders; Justice Edwin
Cameron, Supreme Court of Appeal; Mr. Henri Carrara,
Epidemiologist; Professor Sharon Cassol, Molecular Virologist,
Nelson Mandela School of Medicine, University of Natal, Durban;
Professor Salim S. Abdool Karim, Epidemiologist and Head of
Research, University of Natal Durban; Dr. David Coetzee,
Epidemiologist, Department of Community Health, University of Cape
Town; Dr. Karen Cohen, Clinician, University of Cape Town; Dr.
Francesca Conradie, Clinician, Wits HIV Clinical Research Unit; Dr.
Shaun Conway, Physician, International Association of Physicians in
AIDS Care; Professor Hoosen Coovadia, Head: HIV/AIDS Research,
Nelson Mandela School of Medicine University Natal Durban; Ms.
Sharon Ekambaram, AIDS Consortium; Professor Gerald Friedland,
Director AIDS Program, Yale School of Medicine; Dr. Eric Goemaere,
Medecins Sans Frontieres, Head of Mission, South Africa; Professor
Gary Maartens, Senior HIV Physician, Groote Schuur Hospital; Rev.
J.P. Heath, Aids Co-ordinator, Anglican Church; Mr. Mark Heywood,
Head of the AIDS Law Project; Dr. Prudence Ive, Physician, HIV
Clinical Trial Unit, Wits Health Consortium; Ms. Jenifer Joni,
Attorney AIDS Law Project; Ms. Anita Kleinsmidt, Attorney AIDS Law
Project; Ms. Mapule Khanye, Director, AIDS Consortium; Mr. Teboho
Kekana, TAC NEC Member; Ms. Nonkosi Khumalo, TAC Executive
Secretary; Mr. Stephen Laverack, HIV/AIDS Education Awareness
Consultant; Sister Tshidi Mahlonoko, Registered Nurse; Ms. Thembeka
Majali, TAC Co-ordinator; Sister Nondala Noziphiwo. Registered
Nurse; Ms. Tsakane Mangwane, Southern African Catholic Bishops
Conference HIV/AIDS Office; Dr. Nyameka Mankhayi, Psychologist;
Dr. Des Martin, Chairperson Southern African HIV Clinicians
Society; Mr Willie Madisha, President COSATU; Sister Zola
Mathebula, Registered Nurse; Professor James McIntyre, Chris Hani
Baragwanath Hospital; Ms. Tanya van Meelis, CEPPAWU Researcher; Ms.
Anneke Meerkotter, Researcher, Community Law Centre, University of
Western Cape; Dr. Tammy Meyers, Chris Hani Baragwanath Hospital;
Dr. Clarence Mini, NAPWA Board Member; Ms. Precious Modiba, Senior
Researcher, Centre for Health Policy; Mr. Tumi Modise, HIV
Co-Ordinator, National Council of Trade Unions; Ms. Teboho
Motebele, Attorney AIDS Law Project; Mr. Dan Mullins, HIV/AIDS
Co-Ordinator OXFAM; Archbishop Njongonkulu Ndungane; Dr. Lana
Oatway, Ethembeni Clinic; Mr. Lew Oatway, Ethembeni Clinic; Ms.
Annie Parsons, SHARPP; Ms. Joyce Pekane, Vice-President COSATU;
Sister Penny Penhall, Registered Nurse; Mr. Pholokgolo Ramothwala,
TAC Co-ordinator; Dr. Leon Regensberg, AID for AIDS; Sister Sue
Roberts, Registered Nurse, Helen Joseph Hospital; Dr. Ian Sanne,
Specialist HIV/AIDS Physician, University of Witwatersrand Health
Consortium; Ms. Mercedes Sayagues, Advocacy and Media Officer
OXFAM; Ms. Judy Seidman, Graphic Artist; Mr. David Shaproski,
OXFAM; Mr. Christopher Shaw, Registered Nurse Saint Mary's Hill
Hospital; Dr John Sim, Virologist; Ms. Theo Steele, Campaigns
Co-ordinator Cosatu; Dr. Francois Venter, Johannesburg General
Hospital Infectious Diseases Clinic and Wits Health Consortium;
Professor Robin Wood, Senior HIV Specialist and Infectious Diseases
Specialist, Somerset Hospital; Mr. Zamokuhle Zwane, TAC Organiser
Organizations endorsing statement (as of Nov. 19)
AIDS Law Project
AIDS Consortium
Board of Healthcare Funders
Church of the Province of Southern Africa
Congress of South African Trade Unions (Cosatu)
Federation of Unions of South Africa (Fedusa)
HIV Clinicians Society
Hospersa
Medecins Sans Frontieres
National Council of Trade Unions (NACTU)
Oxfam GB
Southern African Catholic Bishops Conference
University of Witwatersrand Health Consortium
Ethembeni Clinic
This material is being reposted for wider distribution by
Africa Action (incorporating the Africa Policy Information
Center, The Africa Fund, and the American Committee on Africa).
Africa Action's information services provide accessible
information and analysis in order to promote U.S. and
international policies toward Africa that advance economic,
political and social justice and the full spectrum of human rights.
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