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

Introduction

In early June 1998, the UK NGO AIDS Consortium, funded by UNAIDS and UNDP, held an International Seminar on Access to Treatment for HIV in developing countries with 87 participants from over 24 countries and 30% from Latin America, Africa or Asia. The result of this seminar is the consensus statement and action points, and this final report of the proceedings.

The UK NGO AIDS Consortium is a grouping of development organisations which are based in the UK and work in or have extensive experience of supporting work in developing countries. While Consortium members have a development focus, the seminar included a broader range of organisations, including strong representation from the major PLHA support groups.

Background to the seminar

In July 1996, Sue Lucas, Co-ordinator of the Consortium, was invited to take part in a "think tank" with UNAIDS and WHO on what was then referred to as ëaccessibility of HIV-related medicinesí. She asked for a consultation meeting with Consortium members to clarify what the NGO position might be on this question with regard to developing countries and to see what role the Consortium might play in tackling the issues. The consultation meeting was the first session of what became the Access to Treatment Working Group. The original purpose was to clarify the thinking on what treatments are available, what the priorities might be from a developing country perspective, and to see what general principles and mechanisms might be involved in financing the supply of drugs and treatment.

Access to Treatment was a major topic raised at the Vancouver AIDS Conference in 1996. Other organisations, such as GNP+ and UNAIDS were addressing the same issue. It became clear to the Working Group that the issues involved were complex and contentious and that discussions were being hampered by a lack both of information and of understanding of the broad issues involved. Not only were there the questions of human rights, lack of economic resources, rich-world/poor-world split, marginalization and stigmatisation, but there were also the complex issues of health technologies and infrastructures and the relationship between treatment and care. We knew that there was relevant experience already available in the areas of palliative care, end-of-life issues, and the treatment of other illnesses, such as cancer and tuberculosis. We also wanted to address the concepts involved in rational drug use and health economics.

Accordingly, the Consortium Working Group organised a series of five evening workshops for Consortium members and associates in the Autumn of 1997. The report of these workshops is available through the Consortium or on the world wide web http://www.bmaids.demon.co.uk/ukaidscon/

The purpose was to broaden our understanding of treatment, since we found that each individual had considerable experience in his or her own field, but knew too little of the other issues involved or the cumulative impact that may result. Input from the various speakers at the workshops progressively led to an improvement in our knowledge base and consequently made it possible, through our discussions, to take the debate onto a more informed level. We felt, as a result, better equipped to take a more holistic and reasoned view of the many complex issues involved in access to treatment.

The International Seminar

These workshops identified some key issues which needed to be debated by a larger and much more international group who could then continue to contribute to the global debate about the issues surrounding care and access to treatment for HIV and AIDS.

There are complex obstacles to improving access to treatment and standards of care for people with HIV in developing countries. The fact that these issues are very difficult and complex should not prevent us from trying , but it is important to understand the obstacles in order to make progress in overcoming them.

Schedule of the two days
The first day, participants were presented with 12 speakers who raised many issues, set the scene and prepared everyone for the main work, which would take place in five participatory theme groups on the following day. Participants chose which theme group to join, with the size ranging from 10 - 20 persons per group. A more detailed list of questions posed to the participants is in the appendices.

Group 1: The relationship of treatments and drugs to the concept of care.
Group 2: The current health care systems (government, non-profit and private sector) and how these relate to care for people with HIV/AIDS.
Group 3: The differences and similarities between community development principles and current treatment activism strategies.
Group 4: Learning from the experience of other diseases and essential drugs strategies.
Group 5: The relationship of treatment and drugs to the links between care and prevention and public health issues.

Throughout the discussions of these five groups and the feedback process, a consensus statement was developed by all of the members of the seminar. The next step was the creation of action plans (personal and group) to which participants (including the organisers and funders) could make commitments for their organisations on how to put what we had learned into practice.