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11-15 - Building a Response to HIV/AIDS Building Assuring...

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Unformatted text preview: Building a Response to HIV/AIDS: Building Assuring Access to Prevention, Treatment & Care Shelley White African World Perspectives November 15, 2007 How to Respond? Prevention HIV/AIDS Poverty, Gender Inequality, Stigma, Conflict… Treatment & Treatment Care Care Prevention Considerations Prevention Education… for behavior change & risk reduction: sexual risk (ABC) sexual iinjection drug risk njection Risk to fetus condoms needle exchange medications/services for pregnant women & newborns testing centers Material supplies/services… and their distribution: and Empowerment & structural change… how to address the underlying inequality? address Treatment & Care Considerations Treatment Medications (ARVs) Affordability Easy Administration: Fixed Dose Combinations Easy (FDCs) (FDCs) STD Treatment Addressing gender, race/ethnicity, economic Addressing inequalities inequalities Addressing food security, nutrition… Primary care services Holistic care/structural approaches Ongoing prevention services HIV Medications: An American History HIV 1981 – AIDS first identified 1981 1987 – First HIV medication introduced: AZT 1987 AZT was a cancer medication, retested for effectiveness AZT on HIV; Burroughs Wellcome (pharmaceutical company) won patent to sell it exclusively at $10,000/yr won US government support for patent rights set the stage for US privileging corporate rights in the face of the epidemic privileging 1995 – Highly Active Antiretroviral Therapy 1995 (HAART) available (triple drug “cocktail”) (HAART) Combination of three classes of medications became gold Combination standard of HIV treatment in the US standard American AIDS death rate dropped 47% in 2 years By 2000, AIDS-related death rate in US/Europe fell 70% HIV Medication Effectiveness HIV 1995: Introduction of HAART Americans’ Perception that HIV/AIDS is the Most Urgent Health Problem in the U.S. Most 1995 –2006* *Kaiser Family Foundation survey: Nationally representative telephone survey, >18yrs. “With the falloff of mortality in the northern hemisphere, With the public engagement with HIV/AIDS diminished.” -Greene, p.190 Trade-Related Aspects of Intellectual Property Rights (1995) TRIPS and Medication Access TRIPS TRIPS is one of the 20 agreements of the WTO Patent Protections: 20 years (compared with 5-17 previously) On both product and process (the latter prevents generic mfg) On and (the Least Developed Countries – 2006 deadline Doha Agreement – extended to 2016 for LDCs Compulsory License – governments can allow use of Compulsory patented invention without patent-holder permission to address national emergency address Parallel importation – importation without consent of patentholder (can search for cheapest available brand-name holder medication through resale from an intermediary country) medication Transition Periods: WTO Doha Round (2001) – Other major outcomes: Other WTO A Two-Tiered Global HIV/AIDS Strategy Global 1990s: estimated cost of fighting the global AIDS 1990s: pandemic with brand-name drugs: $3 billion/year pandemic “The drugs were not expensive; the patents The were.” –Greene, p.195 –Greene, Two Tiered Approach: Wealthy Nations: Prevention and Medical Treatment Wealthy and Poor Nations: Prevention Only – Medication Access Poor too technical, too expensive… too End of 20th Century, less than 2% of all people living with HIV/AIDS had medication access living South Africa and Medication Access South 1997: Nelson Mandela passed the Medicines and 1997: Related Substances Control Amendment Act (“The Medicines Act”) (“The 3 mo. later, Pharmaceutical Manufacturers’ mo. Association of South Africa sued the government (representing 39 pharmaceutical companies) (representing 1998-1999: U.S. temporarily cut off aid to S.A.; U.S. 1998-1999: Trade Representative pressured S.A. to repeal act; Vice President Gore visited S.A. to negotiate Vice Protests in South Africa and the U.S. ensued Sept. 1999: drug industry withdrew lawsuit Shifts in the Global Approach: Shifts Drug Manufacturing 2000: Cipla company of India started 2000: manufacturing generic ARVs generic Supplies medications to as many as 50% of Supplies PLWHA in developing world PLWHA Supplies meds to 1 in 3 PLWHA in Africa Fixed Dose Combinations (FDCs) more easily Fixed manufactured by generic drug manufacturers manufactured Average treatment regiment: US: ~$12,000/year Elsewhere: ~$300/year Shifts in the Global Approach Demonstrating Effective Treatment in Extreme Poverty CDC policy through 2002: “Multi-drug resistant (MDR) TB [and HIV] is too expensive to treat in poor countries; it detracts attention and resources from treating drug-susceptible disease.” –Kidder, p.146 treating Partners In Health: Successful treatment of multidrug resistant TB and HIV in Haiti, Peru, Russia Presenting results at global policy meetings: ii.e. CDC address February 1997: Paul Farmer: “why do you .e. qualify my talk as provocative? I just said we should treat sick people, if we have the technology.” –Kidder, p.147 sick June 2002: CDC adopted new policy prescription for June dealing with MDR-TB dealing Still, Limited & Unequal Access Still, 2006 – Coverage Rate* for ARVs: Botswana: >95% Rwanda: 82% Kenya: 44% Uganda: 41% South Africa: 33% Lesotho: 31% Zimbabwe: 15% Nigeria: 15% Angola: 10% Sudan: 1% *number of people estimated to be receiving antiretroviral therapy divided by the total number of people estimated to need treatment Global Fund (2002) Global to Fight AIDS, TB, and Malaria Public-Private Multilateral Approach Partnership with UNAIDS and WHO Goal over 5 years: 1.8 million people to receive ARV meds 62 million to get HIV testing 1 million orphans to receive care $4.7 Billion through 2008 (so far) Active in 93 countries– global approach with focus on Active regions with highest disease burden/lowest resources regions 61% of funds to Sub-Saharan Africa in 1st 2 rounds Funding: Geographic Focus: Global Fund Principles Global A financial instrument, not an implementing financial agency agency Relies on knowledge of local experts; coordinated Relies with pre-existing health and social programs with Aims to strengthen underlying health systems Aims and existing poverty-reduction strategies and Support programs that reflect national ownership Comprehensive risk-reduction approach to HIV Comprehensive prevention: prevention: Focus on young people ABC model PEPFAR (2004) President’s Emergency Plan for AIDS Relief President’s US bilateral program for global AIDS US Goals: Goals: 2 million people to receive ARV meds million 7 million new infections averted 10 million people with care services (OVC) $15 Billion in 5 years 55% to treatment 15% to palliative care 20% to prevention 20% 10% to orphan care Funding Geographic Focus: 14 countries, most in Africa 14 Geographic PEPFAR Policy Issues PEPFAR Drug purchasing: Initially, no FDCs, no generics Still, all drugs must have FDA approval 1/3 on abstinence until marriage (2004-56%) Condoms for select groups – CSWs, discordant Condoms couples, substance abusers, truck drivers (not young people) people) Prevention funding: No funds for needle exchange No funds for organizations without explicit policy No opposing prostitution, sex trafficking opposing Reauthorization: 2008; To learn more: pepfarwatch.org; avert.org Trends in US Spending Trends Source: http://www.kff.org/hivaids/upload/U-S-Government-Funding-for-Global-HIV-AIDS-Through-FY-2005.pdf Assessing Fair Share: 2004 Assessing Country Share of World Share of Global Share Share GDP Resources for GDP HIV/AIDS HIV/AIDS 28.9% 17.4% 11.5% 2.3% 6.7% 1.9% 5.2% 7.7% 5.0% 2.2% 4.1% 0.2% 2.4% 3.1% U.S. Japan Germany U.K. France Italy Canada Source: http://kaiserfamilyfoundation.org/hivaids/upload/Financing-the-Response-to-HIV-AIDS-in-Low-and-Middle-Income-Countries-Funding-forHIV-AIDS-from-the-G7-and-the-European-Commission-Report.pdf ...
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