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E-DRUG: E-DRUG AIDS 98 treatment-access forum, [email protected]



As we have mentioned on this and other mailing lists, the UK NGO AIDS 
Consortium is holding an International Seminar on Access to Treatment for 
HIV in Developing Countries 5 - 6 June (Friday and Saturday) in London, 
UK.

The first day will feature a series of presentations by speakers from PWA 
groups, activists, healthcare workers in the field, and representatives 
from WHO, UNAIDS and the French Government, on issues surrounding Access 
to Treatment to HIV.

On the morning of the second day, the participants will meet in five 
smaller groups (chosen by themeselves) to discuss five themes (listed 
below) in more detail, and to identify key themes and guiding principles. 
Our hope is that by the end of seminar, we will have found areas of 
consensus which will be a basis to move forward and areas where there is 
not yet agreement.

Below we have listed descriptions of the five theme groups and some 
questions to consider. I would ask that if the members of this mailing 
list have useful contributions on any of these themes, we would welcome 
your comments. Please send them as soon as possible, since if we receive 
your contributions before 5pm GMT on Thursday 4 June, they will be 
incorporated into our discussions on Saturday 6 June.

We will be communicating the results of the seminar on this mailing list 
next week. If you would like any more information on the seminar, please 
feel free to contact us directly at the address below.

Sue Lucas Siobhan Wilson
Co-ordinator Project Officer

UK NGO AIDS Consortium
37-39 Great Guildford Street
London SE1 OES, UK
Tel: 44 171 401 8231
Fax: 44 171 401 2124
Email: [email protected]
Interim Report available at:
www.bmaids.demon.co.uk/ukaidscon/accrpt.htm

FIVE THEME GROUPS

Group 1

The relationship of treatments and drugs to the concept of care

* How does the supply of drugs (in particular Combination Therapy) relate 
to the commitment to care and treatment? Does the symbolic value of drugs 
blind us to other humane and meaningful care issues?

* Given that the fight for ARVs has provoked a great deal of 
international attention, how has this helped raise issues about the 
current inequality about access to treatment between industrialised and 
developing countries?

* and how does the fight for the right to ARVs relate to the ability of 
governments/local communities/healthcare providers to respond to basic 
care issues? Who is driving the debate and who has control?

* What is the current philosophy of care of NGO's and is there any 
consensus? Does this involve the explicit procurement and provision of 
medication?

* Does this have to change around mother to child transmission and 
treatment for PLHA's and if so why?

* The reality of lack of resources can stifle and/or ground us - How do 
we respond? - How do we determine priorities in allocating resources?

* What options do we have for more collaborative work with a common 
objective?

Group 2

The current health care systems (government, non-profit and private 
sector) and how these relate to care for people with HIV/AIDS.

* How are care and treatment currently made available? Do they reach 
everyone in need, and if not what are the current gaps and obstacles to 
provision of care and treatment?

* Who are the key players in this ?How do government, NGO, activist and 
private sector interact? What role is there (if any) currently and in the 
future for commercial interests including the pharmaceutical companies?

* Can current systems be adapted to allow for delivery of new ARV 
treatments and the supporting services to go with it?

* If a change in systems is required, what would realistically be needed?

* What about sustainability?

Group 3

The differences and similarities between community development principles 
and current treatment activism strategies.

A community development approach would be driven by the needs recognised 
by affected communities in their own circumstances:

* Is this happening with the demands for the latest HIV treatment, or are 
such demands coming from a northern perspective without taking into 
account the different needs of a southern perspective?

* Is it appropriate for demands for HIV treatment to take into account 
the different circumstances of people in developing countries, or should 
demands be for the highest standards for everyone?

* How do these different approaches take into account the maximisation of 
quality of life for people affected?

* How do they take into account the need for training and development of 
infrastructure?

* If resources are allocated to treatment in response to activist 
demands, does this mean that resources for essential support services at 
community level will be or should be reduced?

Group 4

Learning from the experience of other diseases and essential drugs 
strategies.

* National drug policies and essential drug programmes aim to provide a 
safe and sustainable drug supply to meet overall national public health 
priorities equitably, and to ensure the rational use of all drugs in both 
the public and private sectors. How do the available treatments for 
HIV/AIDS fit?

* Can lessons from the drug and non-drug treatments of cancer be applied 
to HIV/AIDS? What are the minimum conditions for ARVs to be provided 
safely and sustainably and what is the cost of the total package?

* How should palliative care be delivered? Do alternative treatments have 
a place?

* What should be learnt from the failures and successes of TB programmes 
in terms of development of drug resistance, adherence to treatment and 
Directly Observed Therapy (DOTs)?

Group 5

The relationship of treatment and drugs to the links between care and 
prevention and public health issues.

There is a close link between care and prevention. Prevention without 
care increases the isolation and exclusion of those infected, denies 
respect to those infected and implies that those who are infected have 
themselves to blame. This is counter productive, since it makes those 
uninfected or untested more convinced that "AIDS doesn't happen to people 
like me" thus making prevention messages ineffective.

* How does treatment link into this?

* How should we think about allocation of resources as treatments become 
more available?

* With better treatment will it be easier to maintain the links which we 
already know about between care and prevention, or will the links become 
weakened because of a focus on treatment?

* What measures and policies will help to keep the links strong while 
making the most of available, accessible treatment?

Treatment is also used directly for prevention

* What priority should be put on provision of AZT for preventing mother 
to child transmission?

* Does treatment which reduces viral loads reduce infectivity? What are 
the implications for public health policy?

* Effective treatment for TB both prevents the spread of TB and 
alleviates the effects of HIV. What are the implications for resource 
allocation?

* Treatment of sexually transmitted diseases has been shown to reduce the 
incidence of HIV transmission. What are the implications for resource 
allocation?

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--------------------------------------------
Carolyn Green
3 Leslie Grove, Croydon, Surrey CR0 6TJ, UK
telephone: +44(0)181 686 3831
email:  [email protected]



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