2. Health Professional Students AIDS Advocacy Network Treat the People: Access to Essential AIDS Medications A Primer for Health Professional Students

3. The AIDS Advocacy Network: Drop the Debt, Treat the People, Donate the Dollars  A network of health professional students dedicated to working together to stop the AIDS pandemic  Coordinated national and regional events throughout the year – in cooperation with other major organizations www.amsa.org/global/aids

4. Background on the AIDS Pandemic  Worldwide, approx. 38 million infected  95% of people living with HIV reside in the developing world  Over 8,000 people die each day as a result of complications from AIDS  The epidemic is growing: in the last 2 years, the number of children infected has tripled from 1.3 Million to 3.2 Million.

5. Why are Essential AIDS Medications “Essential?”  Infections in prime economic and reproductive year  AIDS devastates not only individuals but families, communities, local economies  HAART treatment can reduce AIDS-related mortality  Less than 5% of those infected worldwide have access to these HAART  A treatment for AIDS is available…but not for everyone.

6. Barriers to Treatment  Lack of Funding  Debt Service and Effects of Structural Adjustment Programs  Health systems devastated by natural and man-made disasters  Access to Medications

7. Factors Affecting Access to AIDS Medications  Healthcare worker education  Healthcare Infrastructure  International trade policies  Government importation policies  User fees in primary care systems  On-the ground costs of medicines  Trade: Patents and trade regulations keep AIDS medication prices high. We’ll talk about trade first…

8. Trade and Intellectual Property: Definitions and History  Intellectual property and patents protect exclusive rights on such things as medications.  Promote R&D innovation because they will offer large monetary returns for such innovation.  Generic medication is “interchangeable” with original drug and produced without license from the originator.

9. Pills, Patents, and the Pandemic  Patents on AIDS drugs create monopoly conditions where prices are kept high because of lack of competition.  When generics are introduced, prices are reduced.  Because of lower prices, developing nations are beginning to be able to afford treatment for individuals living with HIV/AIDS.

10. Brazil: The Case for Generic Medications  In 1997, Brazil introduced a plan for universal treatment of HIV/AIDS.  Brazil decided to locally manufacture generic versions of patented medications.  The results: *50% decreased mortality from HIV *HIV incidence has leveled off since the introduction of the program *Government savings of $472 Million between 1997- 1999, as a result of reduced hospitalizations and opportunistic infections.

11. US Government Use of Generics In Treatment Plans President’s Emergency Plan for AIDS Relief (PEPFAR) Feb 20, 2004 Expand prevention, treatment and care services by building on existing programs; focus on prevention through abstinence Identify new partners and build capacity for long-term success; Amplify the worldwide response to HIV/AIDS by working through international partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria http://www.globalhealth.gov/PEPFAR_factsheet_022304.shtml

12. Trade and Intellectual Property: Definitions and History  So why doesn’t every country produce or import generic medications so they are able to afford to treat their populations?  One major reason is the enforcement of patents on AIDS medications.

13. Trade and Intellectual Property The Players: World Trade Organization (WTO) PhARMA World Health Organization (WHO) http://www.ftaa-alca.org/alca_e.asp http://www.who.int/en/ http://www.wto.org/

14. Trade Related Intellectual Property Rights (TRIPS)  In 1995, the WTO put TRIPS into effect.  TRIPS regulates and enforces international patents including those on drugs.  TRIPS compliance deadlines: *Already in effect for developed nations *2006 for middle-income nations such as Brazil and India (who currently produce many generic drugs) *2016 for least developed countries (LDCs)

15. TRIPS Continued  Does TRIPS compliance prevent access affordable generics?  Article 31 of TRIPS allows for “compulsory licensing” “parallel importing” http://www.wto.org/english/tratop_e/trips_e/trips_e.htm

16. TRIPS Plus  Why are developing nations not taking advantage of these tools?  US and other developed nations, encouraged by strong pharmaceutical lobbies, use bilateral pressure to force countries to become “TRIPS Plus” and eliminate some of the flexibility offered by the TRIPS agreement.  Example attempts to use generic medicines abroad: South Africa Brazil Thailand

17. The Doha Declaration  The Doha Declaration, adopted in Nov 2001, declares that “the TRIPS Agreement does not and should not prevent Members from taking measures to protect public health…in particular, to promote access to medicines for all.”

18. India Under Pressure to Stop Manufacturing Generic Drugs US Trade Representative Wants India to Comply with TRIPS Plus According to the Doha Declaration, it is perfectly legal for India to manufacture generic ARV’s and still be compliant with TRIPS The US Trade Representative is putting pressure on India to go beyond TRIPS and comply with TRIPS Plus This would mean that India would not be able to produce new ARV’s generically due to the enforcement of “data exclusivity”

19. Where Does This Leave Us? HIV is preventable… HIV/AIDS is treatable… Yet 3 million people on our planet died of AIDS last year… Eight thousand died yesterday… 15,000 more will become infected today… World health organization statistics

20. What You Can Do: Today’s Action Join AAN: Keep informed and active! Visit www.amsa.org/global/aids/ Visit www.fightglobalaids.org to find out more.www.fightglobalaids.org

21. Conclusion Securing access to affordable AIDS medications is a crucial step in stopping the global AIDS pandemic. Our Future. Our Crisis. Fight Global AIDS.

22. http://www.accessmed-msf.org/index.asp