Access to Treatment for HIV in Developing Countries

International Seminar on Access to Treatment for HIV in Developing Countries
5-6 June 1998 London, UK

To make the consensus statement a reality, the following actions have been suggested as of 23 June 1998

Information Provision
Monitoring drug availability
Increasing access to oral morphine
Research on national drug policies and the influence of pharmaceutical companies
Impact on Women
National level partnerships
Ethics in relation to prescribing through for-profit systems

Other areas of interest

Recommendations

1. Information provision

It was agreed that there is a need for:

A number of organisations present at the Seminar expressed an interest in following this up. These are:

Healthlink Worldwide (formerly AHRTAG) (UK), National AIDS Manual (UK), Kenya AIDS NGO Consortium, Participants from Jamaica, Indonesia, Trinidad, Colombia, Philippines, Venezuela, Zambia all expressed interest on working to prepare this information.

It was suggested that the UNAIDS Intercountry Teams in W. Africa, S. Africa, Asia/Pacific could also contribute to this through their existing information services.

The key contact for taking this forward is the NATIONAL AIDS MANUAL (NAM), UK. A meeting occured in Geneva which looked at developing partnerships, which also involved Healthlink Worldwide (formerly AHRTAG). Potential partnerships with others, especially those from developing countries is welcomed.

Contact
Keith Alcorn at NAM Email: keith@nam.org.uk or on fax 00 44 171 627 3101

NB Health Services and HIV/AIDS at Medical Mission Institute in Germany has produced "Recommendations on home based care in resource-poor countries". Contact Klemens Ochel, MMI, Germany Email: miss041@rzub.uni-wuerzburg.de or fax 49 931 8048 525

2. Monitoring drug availability

A mechanism needs to be developed for monitoring drug availability. This requires further definition of which drugs and which systems. The Consortium Working Group in partnership with the Essential Drugs Project will continue as main contact point for this - please send us information on current systems and areas of concern. Initially, we will work through existing contacts to find out what monitoring systems exist and who is interested in developing this area of work.

Contacts will be made with other key agencies including WHO Drug Action Programme

Contact
Essential Drugs Project email: edp@gn.apc.org or on fax 44 181 318 1419

3. Increasing access to oral morphine

25% of PLHA will have pain which will require oral morphine. Participants endorsed the need for a campaign to demystify medical use of oral morphine and distinguish it from non-medical use and campaign for legalisation.

This is included in the Consensus Statement which was distributed through email and through the Geneva Conference (Poster number 44268, July 2). The Consensus Statement can be used as an advocacy tool to start with.

It was also felt that there needs to be greater discussion as to the reasons why morphine is such a contentious issue. Potential Partnerships for legal drug reform could include:

Legal/ethical networks
International drug users action group
International harm reduction network

Potential partnerships:

The Consortium Working Group will contact UNDP to discuss partnership with the Law and Ethics Regional networks.

In addition, participants can help to draw the attention of governments and NGOs working with HIV to the WHO Book on Cancer Pain Relief. This will help to enable learning from other conditions to be transferred to HIV. This will also link into the IAPAC Commitment in Vancouver.

Contact
UK NGO AIDS Consortium, Email: info@aidsconsortium.org.uk Fax: 44 171 401 8231

4. Research on national drug policies and the influence of pharmaceutical companies

New research or dissemination of existing research on national drug policies and the involvement and impact of pharmaceutical companies is needed, to explore the extent to which pharmaceutical companies may influence national drug policies.

Links need to be made between those concerned about drug policies and the influence of pharmaceutical companies in relation to HIV and the existing body of work on this in relation to drugs for other conditions.

Health Action International has worked extensively on this subject. They can be contacted at: hai@hai.antenna.nl http://www.haiweb.org/

5. Impact on Women

It was agreed that there are human rights and ethical issues around programmes on vertical transmission and the impact these have on women. This should be addressed through a meeting between women's organisations and AIDS organisations on an equal basis. UNAIDS could be involved in this as a facilitator, but should not take the lead.

At present there is no lead agency identified for this - please contact the Consortium if you would like to take it forward in any way.

6. National level partnerships

Partnerships to work on access to treatment at national level need to be strengthened, especially between NGOs and PLHA groups to encourage better involvement of people both infected and affected by HIV.

The Zambian Network of People living with HIV wants to take this forward in Zambia.

Contact
David Chipanta at napnzp@zamnet.zm

7. Ethics in relation to prescribing through for-profit systems

More work needs to be done to develop professional ethics where prescribing may be influenced by financial benefit.

For follow up on this issue:
Contact
BMA Foundation for AIDS Email: hilary@bmaids.demon.co.uk

Other areas of interest

There were some areas where it was felt more work was required but that none of the organisations present at the seminar were the right ones to be lead agencies

Such areas included:

Regional skills building for PLHA on issues around quality of life.
Organisations need to press for legalisation of marijuana for medical use by people with AIDS. A possible partnership would be with US Public Health Association.
There is a need for education and awareness raining on the social/recreational use of drugs/culture and nature of this.
Co-operation on training between countries e.g. Kenya, Uganda.
Monitoring current issues around access to treatment through the email mailing list established by the Global Conference. All Seminar participants should use it for follow up - if the list is used beyond the Geneva conference in June 1998, it will be kept going and will be a springboard for the XIII World Conference in Durban in 2000.

To join the Access to Treatment Mailing list, send an email to "treatment-access@hivnet.ch" (without the quotation marks) and add the word JOIN in the subject line. To send a message to the list, send it to the above address. For anonymous postings, add the word "anon" to the subject line.

Recommendations

There were some recommendations which were put forward as actions which should be taken by others.

In the UN System as a whole, UNAIDS should advocate for the involvement of people infected with HIV and people affected by HIV and NGOs in all projects related to HIV which are funded by UN agencies.
It was suggested that AIDS Action (published by Healthlink Worldwide - formerly AHRTAG) should be disseminated via electronic means.
There is a need to develop a code of good practice to support donors in integrating their national and international policies with their priorities.

Although not the major focus of the seminar, the use of ARVs in preventing mother to child transmission was discussed . There was some concern about the policy document on breastfeeding prepared by UNAIDS UNICEF and WHO which was distributed before the results of relevant trials in Abidjan were available.

Two results of the Seminar were seen as particularly valuable for widespread dissemination by participants:

a) Group 3 framework for political action developed by at the seminar.

b) UNAIDS and WHO Guidance Modules on Antiretroviral Treatments, available from the Office off HIV/AIDS and Sexually Transmitted Diseases, World Health Organization, 1211 Geneva 27, Switzerland or http://www.unaids.org