HIV/AIDS treatment access movement. Declaration of Action

[Guest guest]

Over 70 delegates from 21 African countries met in Cape

Town from 22 to 24 August to begin developing a pan-African

HIV/AIDS treatment access movement. At the end of the

meeting, the following Declaration of Action was adopted by

all delegates.

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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. It

is only through active involvement of PLWAs in all policy

and implementation decisions related to HIV/AIDS that we

will achieve our goals.

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 ation 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.

Therefore, 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 to be developed by the WHO

* 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.

Olayide Akanni

Email: larayide@...