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

French Government proposal for International Solidarity Fund to supply antiretrovirals

Eric Chevallier
Technical Adviser
Ministre de l'Emploi et de la Solidarité
Secrètariat d'Etat à la Santé
Republic of France

Introduction
The International Therapeutic Solidarity Initiative was presented by the French President and Minister for Health at the Abidjan Conference in 1997. The Memorandum outlining the Initiative can be found by writing Mr Chevallier's office

The purpose of the initiative is to get access to care on the international agenda. It had been felt for a long time that greater political commitment is needed on AIDS and that a commitment should be made to put it on the international agenda. In Abidjan it was agreed that there is a need for an international movement on AIDS to move from prevention only strategies to a mix of prevention and care. Also there is a strong need to establish an international effort to raise additional funds from both private and public sectors for access to care, including drugs and ARVs.

Over the last six months, meetings have been held with UN and political leaders, including the Canadian Prime Minister, American officials, President of the World Bank, and UN Secretary-General to discuss how to put care on their health and AIDS agendas. These meetings also tried to determine how to make additional funds available for care without diverting funds from prevention or possible vaccine efforts.

Initially, political leaders were reluctant. However, it was realised that something could be done, especially around the area of mother to child transmission. This area is important so long as more is also done for both mother and children who are still infected with HIV after delivery. The AIDS epidemic is still rapidly increasing. But efforts for prevention cannot be sustained unless there are links to access to care. Over the next six months, we are able to have several donors agree an additional budget line for mother to child transmission at the least, and we will set up an international fund to prevent mother to child transmission by early next year. In the meantime, demonstration projects in a few countries in Africa and South-east Asia have been planned to provide drugs to between 500 and 2,000 pregnant women per country during and after pregnancy.

Some ask do ARVs provide a false hope? The answer is no, it has been shown in countries where ARVs are available and used effectively that mortality from AIDS can decrease substantially, for example, in France, in 1997, the mortality rate from AIDS declined by 50%.

Discussion:
There was concern as to how the additional funds for the treatment programme would be obtained without taking funds from other programmes. Mr Chevallier said that the European Parliament has been asked for a new budget line for the initiative which would not come from the health budget. Donors are being brought together around the issue of HIV/AIDS treatment since it has become apparent that the epidemic has shown great differences between North and South. It is a now good time for a strong effort on this issue.

Mr Chevallier addressed a question on mother to child transmission by stating that while there is consensus on the prevention of mother to child transmission, there is disagreement as to whether treatment should continue after a birth.

Mr Chevallier said that the method for the management of the initiative is for idea sharing. It is an open process. The French Government has met with NGOs in Paris and held a meeting with major donors to decide what can be done. Working groups, which include representatives of NGOs and UNAIDS, have been established to identify projects and select countries, based on where projects can be carried out with an ethical baseline and where there are teams that can implement them.

Other issues raised in the discussion section included:

Since most pregnant women have not been tested, who would pay for the testing? Mr Chevallier explained that initially projects would take place where testing of the first 2,000 women could be carried out. For example, Côte d'Ivoire has testing facilities and UNAIDS, UNICEF and the World Bank are already working there.
Although Latin America has not been included in the initial demonstration projects, it certainly will be included later.
One view was that while the vertical transmission of AIDS should be halted, we shouldn't lose sight of the bigger issue of male to female transmission.

Introduction to the: AIDS : MEMORANDUM FOR AN INTERNATIONAL THERAPEUTIC SOLIDARITY

Presented by the French President and the Ministry of Health at the Abidjan Conference 1997.

Since the emergence of new therapeutic possibilities, the inequality of access to treatment for people living with HIV/AIDS is gaining ground between countries of the North and the South hemispheres.

For economic and structural reasons, these countries are denied the treatments which serve as the only hope for these sick people. We should not passively accept such an injustice.

Moreover, inaction leads to human, economic and social costs which could jeopardise the precarious balance in developing countries.

Already, the pharmaceutics industry has shown its will to commit itself to significantly reducing the price of drugs now inaccessible in Southern countries.

But only a world-wide co-operative effort will permit the realisation of this objective of improving access to care for those infected.

The goal of this initiative is to facilitate access to HIV-related drugs, including antiretrovirals, within a comprehensive response to the epidemic.

For more information or a full copy of the Memorandum, contact Eric Chevallier