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

Consensus Statement of the participants of the International Seminar

Poster Presentation at the 12th Annual AIDS Conference, Geneva Switzerland, June 1998.

Published in the Lancet 24th October 1998

We agree on the following:

It is unacceptable for anyone to suffer or die from lack of access to adequate or appropriate treatment and care.

We are therefore committed to reducing the inequities in the availability of treatment and care for people with HIV.

We recognise that discussion of anti-retrovirals and access to treatment highlights the increasing inequality between and within developing and developed countries.

We understand the following:

people with HIV/AIDS must play an integral part in the design, development and implementation of all policies and programmes relating to their treatment and care.
care is a comprehensive package that includes support, psychosocial care and treatment provided to individuals, families and communities to improve quality of life. Community participation is an essential part of this comprehensive package.
treatment includes preventive, curative, and palliative interventions and effective traditional or complementary health care.
drugs are one element of treatment. Drugs in this context include those for prevention, primary care (including opportunistic infections), palliative drugs, anti-retrovirals and other supplies necessary for treatment.

Improving the quality of and access to primary health care is a fundamental first step.

The principle of equitable access to treatment is central. We understand this to mean:

treatments which are available for other people must also be available to people with HIV.
decisions and policies about making treatments available for the first time in any particular country should be considered carefully within the context of national health policy and capacity.

We agree that there is a right to relief from pain and other distressing symptoms.

We agree that palliative care needs wider application in the HIV/AIDS context.
In particular this implies training of health professionals in parallel with making available affordable drugs for pain control including oral morphine.

We recognise that anti-retrovirals are being used in most countries, often inappropriately. Governments and NGOs have the responsibility to recognise this reality.

When considering anti-retrovirals for interruption of vertical transmission, the need for the following should also be considered:

comprehensive treatment for sexually transmitted diseases.
ante-natal care, safe childbirth and postnatal care for mother and child.
treatment of opportunistic infections in women including pregnant women.
prevention of transmission for women including pregnant women.
safe blood supply including appropriate use of transfusions among postnatal women and new-born children.

We agree that different approaches are needed in different settings.

However the following are common to all settings:

the need for adequate training, education and information, e.g. for: people living with HIV/AIDS; health and social workers (including traditional healers and complementary practitioners); the family; the community and political and religious leaders

regarding

palliative care (which includes psycho-social care and counselling); sexually transmitted diseases and prevention strategies; opportunistic infections and anti-retroviral treatments.

The need for :

There is a need to have a better understanding of the roles of different actors (e.g. political, activist, and commercial) concerned with access to care so that they work together and avoid the negative effects of unco-ordinated action or prejudice, whether on the basis of HIV infection or other grounds such as sexual orientation, ethnic origin, colour, displacement or route of infection.
It is important to recognise the different roles of international and national NGOs, civil society organisations, people infected with HIV and those affected by HIV in order to understand and value their different standpoints in relation to:

National governments have a responsibility to develop, disseminate and implement national policies relating to access to care and treatments and rational drug use.
Civil society organisations (including national and international NGOs, people with HIV/AIDS, people affected by HIV/AIDS and community based organisations) have a responsibility to respect and co-ordinate their work in line with national and international policies but to advocate for change when policies are inconsistent, inadequate or detrimental.
Civil society organisations (including national and international NGOs, people with HIV/AIDS, people affected by HIV/AIDS and community based organisations) should be included in the development of national policies.