[e-drug] Pan-African HIV/AIDS Treatment Access Movement

[martad@xsinet.co.za]

E-DRUG: Pan-African HIV/AIDS Treatment Access Movement
-------------------------------------------------------

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

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.  PLWAs must be included in all key
decision-making processes related to policies, programmes, and
implementation strategies.  It is only through our active involvement that
we can succeed at addressing the AIDS pandemic.

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:
-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:
-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
WHO

�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)

�Ensure inclusion of ARVs on national essential drug lists at primary care
level

�Intensify treatment education and promote treatment literacy for PLWAs,
communities, and health-care workers

�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 access

�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 interventions

�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 GDP

�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 GFATM

�Cancel debt and ensure reinvestment into social services, particularly
health-care

�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 2005

�Provide technical assistance to African countries to develop and implement
sound treatment programmes and proposals

�Demand independence from member states to fulfil mandates without
political interference

�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.

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 request

�Provide free treatment for life for all participants in clinical trials
and abide by international ethical standards






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/AIDS

�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 practices

�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 lives

�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 2005

�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 tools

�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 Mechanisms

�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.

Co-Founders: Zackie Achmat, Treatment Action Campaign (TAC) in South Africa
and Milly Katana, Health Rights Action Group in Uganda and a Board member
of the Global Fund to Fight AIDS, TB, and Malaria, representing NGOs of the
developing world.

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;
M�decins Sans Fronti�res (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.


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