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Note: This document is from the archive of the Africa Policy E-Journal, published by the Africa Policy Information Center (APIC) from 1995 to 2001 and by Africa Action from 2001 to 2003. APIC was merged into Africa Action in 2001. Please note that many outdated links in this archived document may not work.

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.africaaction.org

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

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

SUMMARY CONTENTS:

This posting contains a press release and the declaration from last month's conference launching the Pan-African HIV/AIDS Treatment Access Movement. The declaration sums up the present impasse, reflected yet again in the minimal attention given to AIDS at the Johannesburg Summit:

"We are faced with enormous barriers: national governments do not prioritise HIV/AIDS treatment; donor countries refuse to fulfil commitments to mobilise necessary resources; pharmaceutical companies deny access to essential medicines and diagnostics by charging exorbitant prices; structural adjustment programmes, driven by the World Bank and International Monetary Fund, destroy public health-care systems; and debt to rich countries hampers financing of vital social services, including health-care. Community mobilisation and civil society action are essential for forcing action and ensuring greater accountability from all these institutions."

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Africa Action Note

See the September 3 Africa Action press release with a statement by Salih Booker on Secretary of State Powell and the World Summit on Sustainable Development:
http://www.africaaction.org/desk/sb0209a.htm

Treatment Action Campaign
http://www.tac.org.za

For more information, please contact:

In Cape Town, Sipho Mthati +27 (0)72 424 7180 In Johannesburg, at the WSSD Mark Heywood +27 (0)83 634 8806 In Johannesburg, at the WSSD Winston Zulu +27 (0)72 267 9985

Monday 26 August 2002

Press release

AIDS Activists from 21 African countries launch Pan-African HIV/AIDS Treatment Access Movement

26 August 2002 (Cape Town) - Against the backdrop of the World Summit on Sustainable Development (WSSD) in Johannesburg, South Africa, over 70 African AIDS activists from 21 countries met in Cape Town from 22-24 August to inaugurate the Pan-African HIV/AIDS Treatment Access Movement (PHATAM). PHATAM's co-founders are two of the world's leading AIDS activists, Zackie Achmat of the Treatment Action Campaign (TAC) in South Africa and Milly Katana, lobbying and advocacy officer of the Health Rights Action Group in Uganda and member of Board of the Global Fund to Fight AIDS, TB, and Malaria. PHATAM is dedicated to mobilising communities, political leaders, and all sectors of society to ensure access to antiretroviral (ARV) treatment, as a fundamental part of comprehensive care for all people with HIV/AIDS in Africa.

"We are angry. Our people are dying," said Milly Katana. "We can no longer accept millions of needless AIDS deaths simply because we are poor Africans. We know ARV treatment is feasible in our countries and are launching a movement to demand ARV treatment that won't take 'no' for an answer."

PHATAM representatives will attend the WSSD to submit a Declaration of Action with demands of African governments, wealthy country governments, multilateral institutions, and the private sector, including the pharmaceutical industry. "The world leaders meeting in Johannesburg must recognise that without a healthy population we cannot have development. Health is a prerequisite for sustainable development-and access to AIDS treatment in Africa is the key to improving health," said Zackie Achmat. "We are united in our commitment to ensure that millions of lives are saved on our continent. The role of the Movement is to hold national and international bodies accountable to obligations such as the immediate development and implementation of national HIV/AIDS treatment plans."

At PHATAM's inaugural meeting, activists assessed the gaps in their countries' HIV/AIDS policies and programmes, noting in particular the scarcity of ARV treatment programmes. "It's true you have African governments, even wealthy countries, talking about mother-to-child-transmission prevention-which is vital as it provides the entry point to both treatment and prevention-but we're asking 'What about the mothers and the rest of the family?'" continued Katana. "We need to find treatment for them quickly-like yesterday-to save their lives and to reverse the tide of the growing orphan epidemic in Africa."

PHATAM called for African countries to implement the World Trade Organisation's Declaration, signed at the Doha Ministerial Meeting, on the TRIPS Agreement and Public Health, and insisted that the U.S. and other wealthy countries allow countries with limited pharmaceutical manufacturing capacity to purchase low-cost, generic versions of patented medicines from exporting countries once WTO rules on patents have been fully implemented.

"Pharmaceutical industry profiteering and patent abuse has caused enough death and suffering across our continent. Our governments must take the cue from the WTO, which has finally put public health ahead of the patent rights of the super-profitable pharmaceutical companies," said Dr. John Wasonga of the Kenya Coalition for Access to Essential Medicines. "But we need every possible option to save our people, from local production of quality generic ARVs to buying medicines in bulk that have been exported from generic companies in Asia, Latin America and other places. We cannot afford to squander money on costly patented medicines while our people are dying."

"While a necessary component of the response to HIV/AIDS, prevention will never be enough," added Winston Zulu of the Network of Zambian People Living with HIV/AIDS (NZP+). "When will the world wake up to the fact that 16 million Africans have already died of HIV/AIDS? This is only the beginning if we continue down the prevention-only path. This movement will make treatment, which we all know strengthens prevention efforts, our priority demand."

Delegates also emphasized the need for nutritional support, treatment of opportunistic infections, rebuilding of public health care and elimination of new HIV infections but agreed that treatment with ARVs must be prioritised.

"HIV/AIDS treatment education is power," said Olayide Akanni of the Nigeria Treatment Access Coalition. "Africans will work together to create simple, accessible treatment information on all aspects of HIV/AIDS care and treatment. We must be empowered with the life-saving information we need to demand proper treatment from our health-care providers, governments, and workplaces."

"People with HIV/AIDS in Africa are fed up with the international community's broken promises," said Dr. Eric Goemaere, Head of Mission for MTdecins Sans FrontiFres (MSF) in South Africa, which is now providing ARV therapy in Khayelitsha, a poor township in the Western Cape. "They are tired of hearing about pilot projects. The time to scale-up is long overdue and this will only be possible with political action at the national and international level. This community-based movement must provoke the necessary political response."

Immediate actions of PHATAM include:

9 October: PHATAM is calling for a Global Day of Protests to demand that donor countries make contributions proportionate to their wealth to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Activists will also call for the prioritisation of treatment by the GFATM and the active involvement of people with HIV/AIDS in GFATM Country Coordinating Mechanisms.

17 October: PHATAM will participate in a Global Day of Action Against Coca-Cola and other multinational companies to demand ARV treatment for all HIV-positive workers and their families.

1 December, World AIDS Day: PHATAM is calling for a Global Day for Access to HIV/AIDS Treatment.

Countries represented: Botswana, Burundi, Cote d'Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia, and Zimbabwe.

Convening organisations: AIDS Consortium - South Africa; AIDS Law Project (ALP) - South Africa; AIDS Law Unit: Legal Assistance Centre - Namibia; Catholic AIDS Action - Namibia; Coping Centre for People with AIDS (COCEPWA) - Botswana; Kara Counselling and Training Trust - Zambia; MTdecins Sans FrontiFres (MSF); Network of Zambian People Living with HIV/AIDS (NZP+) - Zambia; Network of Zimbabwean Positive Women - Zimbabwe; Treatment Action Campaign (TAC) - South Africa; and Women and AIDS Support Network (WASN) - Zimbabwe.

PAN-AFRICAN HIV/AIDS TREATMENT ACCESS MOVEMENT: DECLARATION OF ACTION

August 25, 2002

We are angry. Our people are dying.

Without treatment, the 28 million people living with HIV/AIDS (PLWAs) on our continent today will die predictable and avoidable deaths over the next decade. More than 2 million have died of HIV/AIDS in Africa just this year. This constitutes a crime against humanity. Governments, multilateral institutions, the private sector, and civil society must intervene without delay to prevent a holocaust against the poor. We must ensure access to antiretroviral (ARV) treatment as part of a comprehensive continuum of care for all people with HIV who need it. In this regard, at a minimum, we call for the immediate implementation of the World Health Organisation goal to ensure antiretroviral (ARV) treatment for at least three million people in the developing world by 2005. Together with our international allies, we will hold governments, international agencies, donors and the private sector accountable to meet this target.

We represent activists and organisations from 21 African countries that met in Cape Town, South Africa, 22-24 August 2002, and launched a Pan-African HIV/AIDS Treatment Access Movement dedicated to mobilising our communities and our continent to ensure access to HIV/AIDS treatment for all our people who need it.

We have heard reports on the state of HIV/AIDS treatment and prevention interventions throughout the continent. Remarkable achievements have been registered in every region resulting in some countries significantly reducing new infections and improving care for individuals, families and communities affected by HIV and AIDS. However, there was a consensus that current efforts are insufficient. The AIDS epidemic has exposed many of the problems facing Africa, including poverty, socio-economic and gender inequality, inadequate health-care infrastructures and poor governance. We insist that access to ARV therapy is not only an ethical imperative, but will also strengthen prevention efforts, increase uptake of voluntary counselling and testing, reduce the incidence of opportunistic infections, and reduce the burden of HIV/AIDS-including the number of orphans-on families, communities, and economies.

The recognition of the human rights to life, dignity, equality, freedom and equal access to public goods including health-care are the fundamental principles of a successful response to the epidemic. In this regard, we reaffirm the Universal Declaration of Human Rights and the African Charter on Human and Peoples' Rights. Furthermore, we recognise that the rights of women, children and youth are particularly vulnerable in Africa. Treatment and prevention strategies for HIV/AIDS must consider their particular needs. Critically, the rights of people with HIV/AIDS (PLWAs) must be protected, including equal access to social services and to medical insurance plans. Discrimination and stigmatisation threaten our dignity and hamper efforts to address the epidemic. Our experience as African PLWAs has been that of token involvement, not meaningful participation, in decision-making processes. It is only through active involvement of PLWAs in all policy and implementation decisions related to HIV/AIDS that we will achieve our goals.

Alleviating the effects of the AIDS epidemic will require political leadership and greater accountability from national governments, international organisations, the private sector, especially the pharmaceutical industry, and wealthy countries, particularly the United States and the European Union. We are faced with enormous barriers: national governments do not prioritise HIV/AIDS treatment; donor countries refuse to fulfil commitments to mobilise necessary resources; pharmaceutical companies deny access to essential medicines and diagnostics by charging exorbitant prices; structural adjustment programmes, driven by the World Bank and International Monetary Fund, destroy public health-care systems; and debt to rich countries hampers financing of vital social services, including health-care. Community mobilisation and civil society action are essential for forcing action and ensuring greater accountability from all these institutions.

Health is a prerequisite for sustainable development. The AIDS epidemic presents an immense challenge to health-care systems in Africa. Sustainable economic development can only be possible through the implementation of sound social security policies that target the poor and include HIV/AIDS treatment and prevention programmes.

A humanitarian crisis due to lack of food security presents an immediate threat to many Africans and the gravity of this situation is exacerbated by the HIV epidemic. We therefore call for emergency food aid to address this crisis. The delivery of this food aid should not be hampered by unreasonable conditions imposed by donor or recipient governments. Food security requires active intervention and planning from the state to ensure sustainable production and equitable distribution in a manner that benefits society. Farmers and other agricultural workers and nutritional experts must be consulted.

We make the following key demands of national governments in Africa, donor countries, multilateral institutions, pharmaceutical companies, and the broader private sector:

We demand that National Governments in Africa:

• Create and implement clear, legally binding HIV/AIDS policies and plans including antiretroviral treatment as part of a comprehensive continuum of care, which should be brought to scale and include:N
• Prevention: Expand distribution of male and female condoms, and invest in research for microbicides and vaccines
• Voluntary Counselling and Testing (VCT): Ensure accessibility to VCT centres in rural and urban areas. This will promote openness and assist prevention and treatment efforts
• Prevention of Mother-to-Child-Transmission (MTCT)/Parent-to-Child-Transmission (PTCT): Immediately implement programmes that integrate MTCT/PTCT into all antenatal care facilities, as they serve as an important entry point for care. Successfully implemented MTCT/PTCT prevention programmes should be linked to existing and future ARV treatment programmes, and must provide women with all information necessary to make informed choices about feeding options
• Post-Exposure Prophylaxis (PEP) for sexual assault survivors and occupational exposure:N
• Treatment of opportunistic infections (OIs): Treat aggressively all OIs, including tuberculosis (TB), Kaposi's Sacoma, thrush, and meningitis; expand access to key drugs such as fluconazole, acyclovir, and cotrimoxazole; and monitor resistance and side-effects (especially with cotrimoxazole)
• Treatment of TB: Revise diagnostic protocols; improve diagnosis; devote resources to research for new, easier to use drugs; and utilise existing TB clinics to scale-up ARV programmes
• Treatment of sexually transmitted infections (STIs): Ensure access to appropriate, vigourous treatment of STIs and education
• Nutritional support: Ensure adequate nutritional information, education, and support to affected individuals and families
• Palliative care: Ensure clinic-linked home-based end of life care
• Clinical trials: Ensure that all clinical trials abide with universal ethical guidelines and that pharmaceutical companies guarantee treatment for life for all trial participants. This standard must be developed by the WHON
• Fulfil commitments made at the Abuja Summit to dedicate at least 15% of annual national budgets to improve health, particularly HIV/AIDS, TB, and malaria because of the overwhelming burden of death and disease on our families, communities and economies. This should include ensuring retention of skilled health-care workers through sufficient remuneration
• Implement the Doha Declaration on the TRIPS Agreement and Public Health, and take steps to increase local production of generics through south-south collaboration (including technology transfer with Brazil, Thailand, India and other countries manufacturing generic medicines)N
• Ensure inclusion of ARVs on national essential drug lists at primary care levelN
• Intensify treatment education and promote treatment literacy for PLWAs, communities, and health-care workersN
• Apply to the GFATM with comprehensive proposals that expand or launch ARV treatment programmes using the lowest cost, quality drugs available to ensure equitable and sustainable accessN
• Promote equity, transparency and accountability in the allocation of national health and HIV/AIDS budgets. Non-partisan resource allocation is indispensable for effective health care interventionsN
• Eliminate taxes on all essential medicines and diagnostics

We demand that Donor Countries (members of the Organisation of Economic Development and Cooperation or OECD and middle-income countries):

• Fulfil existing commitments to adequately fund the Global Fund to Fight AIDS, Tuberculosis and Malaria and other HIV/AIDS financing mechanisms with at least $10 billion of new funding annually as a proportion of GDPN
• Implement the Doha Declaration in good faith and resolve the problems of production for export in a way that ensures that countries with insufficient manufacturing capacity have the right to import quality generics in the most efficient manner
• Immediately stop pressuring developing countries to: focus primarily on prevention interventions, procure drugs from proprietary companies only, and scale back proposals to the GFATMN
• Cancel debt and ensure reinvestment into social services, particularly health-careN
• Increase investments into research and development for better drugs, diagnostics, vaccines and microbicides

We demand that Multilateral Institutions (including WHO, WTO, UNAIDS, UNICEF, the Global Fund, etc.):

• Immediately develop a strategic plan including specific targets and timelines to achieve the goal of providing ARV treatment for at least 3 million people by 2005N
• Provide technical assistance to African countries to develop and implement sound treatment programmes and proposalsN
• Demand independence from member states to fulfil mandates without political interferenceN
• Define a research & development agenda that will meet the needs of resource-limited settings including simplified treatment regimens (ARV therapy, TB); simplified diagnostic and monitoring tools (for ARV therapy, TB, management of OIs); microbicides; and vaccines
• Develop international ethical guidelines for clinical trials that guarantee life-time treatment free of charge for all trial participants

Pharmaceutical industry profiteering and patent abuse has already caused and continues to cause death and suffering across our continent and elsewhere. Excessive prices have ensured that this continent with the greatest disease burden has the lowest access to essential medicines.

Therefore, we demand that the Pharmaceutical Industry:

• Unconditionally reduce prices of drugs, diagnostics, and monitoring tools
• Immediately stop blocking the production and importation of generic drugs by developing countries
• Issue non-exclusive voluntary licenses upon requestN
• Provide free treatment for life for all participants in clinical trials and abide by international ethical standards to be developed by the WHO

We demand that the Private Sector (including multinational corporations, parastatals, large corporations, and other private sector entities):

• Contribute to the social good through social investments to address HIV/AIDSN
• Implement comprehensive HIV/AIDS workplace policies, including provision of HIV/AIDS education, VCT, psycho-social support, and provide treatment, including ARV therapy, for all workers
• Adopt non-discriminatory hiring and promotion policies and practicesN
• Ensure that private medical insurance provides appropriate care and treatment for PLWAs

AND we commit ourselves to:

• Develop a community-based response to the AIDS pandemic in Africa that places PLWAs at the centre and ensures the involvement of PLWAs in key decision-making processes that will affect our livesN
• Mobilise our communities, our political leaders, and all sectors of society throughout the continent to ensure access to ARV treatment for all who need it, starting with the immediate implementation of the WHO goal to ensure ARV treatment for at least three million people in the developing world by 2005
• Work with our governments, wherever possible, to develop national treatment plans that include ARV treatment as part of a comprehensive continuum of care, with the concrete goal of providing ARV treatment for at least 10% of the predicted number of PLWAs by 2005N
• Advocate for local production and importation of generics, regional procurement of medicines, and other strategies to ensure equitable and sustainable access to the lowest cost quality drugs, diagnostics, and monitoring toolsN
• Hold our governments, donors, international agencies, and the private sector, particularly the pharmaceutical industry, accountable to implement sound policies and programmes and meet identified targets by carefully monitoring progress and raising our voices in protest when necessary, together with our international allies
• Promote treatment literacy for PLWAs, communities, and health-care workers by developing and disseminating simple, accessible treatment education information on all aspects of HIV/AIDS care and treatment
• Share information and expertise with each other to support capacity-building for increasing access to treatment at the local, national, and regional level
• Mobilise for a Global Day of Action on the Global Fund to Fight AIDS, Tuberculosis and Malaria on 9 October 2002 to demand more money from donor countries, prioritisation of treatment in national proposals and funding decisions, increased transparency and monitoring of fund disbursements, and active involvement of PLWAs in Country Coordinating MechanismsN
• Mobilise for a Global Day of Action Against Coca-Cola, the largest private employer in Africa, and other multinationals on 17 October 2002 to demand ARV treatment for all HIV-positive workers and their families
• Mobilise for a Global Day for Access to HIV/AIDS Treatment on 1 December, World AIDS Day, 2002

We know this is an immense challenge. Millions of lives are at stake. We must succeed.