Realising the Right to Health

A Global South dialogue on HIV/AIDS and access to treatment, “Realising the Right to Health”, was held in Mumbai, India 18 - 21 March 2005.

The meeting was initiated by the Lawyer’s Collective HIV/AIDS Unit, which has done extensive work on treatment access in India including launching the Affordable Medicines and Treatment Campaign. The successful gathering was attended by nearly 60 participants (22 Indian and 35 international) including many of the world’s leading community-based treatment activists from groups such as the International Treatment Preparedness Coalition, the Indian Network for PLWHAs (INP+), Medecins Sans Frontieres, Health GAP, ACT-UP Paris, India’s Alternative Law Forum, and the Treatment Action Campaign of South Africa. The workshop was made possible by financial assistance from UNAIDS and the Swedish International Development Agency.

The focus of the workshop was on the collaboration between treatment activists in the Global South. “We hoped to create an opportunity,” said organiser Vivek Divan, “to exchange knowledge, ideas and strategies that can hopefully evolve into a much stronger demand for the right to health.” In organising the workshop, the Lawyer’s Collective noted that responsibility for healthcare has been transferred from national governments to the private sector, and that international trade regimes are affecting the way people with AIDS can access medicines, treatments and diagnostics. “In the last decade,” stated the organisers, “HIV/AIDS has brought out these inequities more starkly than any other health crises in the South. The burden of this epidemic is being felt entirely there. The countermeasures and solutions to it, too, must necessarily come from there.”

The four day program started by locating treatment access within a discussion of new drugs and treatment for HIV/AIDS, the prevention technologies of microbicides and vaccines, and the broader context of the right to health that includes efforts to improve and increase TB and Malaria treatment. Day two focused on the financing and delivery of treatment programs with case studies from countries including Brazil, Nigeria, Nepal and Namibia, and discussions of the Global Fund, PEPFAR, and the WHO 3x5 initiative. Day three considered intellectual property issues, pricing and competition, and developing understanding of the pharmaceutical industry, both brand-name and generic. The final day involved identification of legal and advocacy strategies, and group discussions to identify ways forward.

By chance, the meeting coincided with a problematic Patent (Amendment) Bill which the government drafted to satisfy their recent inclusion under the World Trade Organisation’s Trade Related Intellectual Property (TRIPs) regulations. In fact, the proposed legislation, which was to alter the current Indian Patents Act, went far beyond what is required by TRIPs and threatened future access to AIDS treatments by making difficult the production of and access to generic drugs.

During the meeting, participants identified a real fear that necessary changes to the Bill would not be made, and nor would opposition parties block it. Advocacy strategies were identified. A sign-on letter was drafted. Action was taken. Two representatives from South Africa and Venezuela joined Indian representatives and flew to Delhi to lobby parliamentarians and other decision-makers with the aim of convincing opposition parties to block the bill, forcing it to be sent to a Joint Party Parliamentary Committee for further discussion and public representations. A press conference was held on the final day of the conference to highlight international opposition to the Patents (Amendment) Bill as well as the fact that this amendment could affect people with AIDS all around the world.

In the end a revised form of amendment to the Patent Act was approved by parliament. While it is far better than it might have been, concerns remain that some parts of the Act are not specific enough, leaving options open to pharmaceutical companies to delay compulsory licensing of new products, particularly much-needed second line regimens for those who need to switch to new medications. It is predicted that the effects of the Act will result in higher costs and less access to life-saving medications but it will take time to see how and when this will happen.

The activity around the Patent Act gave a sense of urgency, focus and energy to the meeting, as well as some satisfaction that perhaps the meeting’s actions contributed to the less-than-perfect but better-than-it-might-have-been outcome. Still, many at the meeting expressed concern about the lack of a coherent treatments access movement in India and asked how to support Indian PLWHA to drive this movement. With only 5,000 PLWHA on treatment in the country through government programs but the second largest number of HIV positive people in the world, India’s progress compares poorly with other countries.

Other outcomes of the meeting will take time to develop.  In the final session, expertly chaired by TAC’s Mark Heywood and the Alliance’s Mandeep Dhaliwal, a number of actions were proposed including monitoring the progress of the Global Fund grants (disbursement has been extremely slow in many countries), and the formation of a working group to share information, develop and implement advocacy strategies for health care workers delivering HIV/AIDS treatment.

By Andy Quan, Meeting Participant, Australian Federation of AIDS Organisations.