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

The following questions were sent to each of the registrants ahead of International Seminar to facilitate their thinking and to help them choose a theme group. Details on the results of these discussions are located on the pages indicated after the group number.

Group 1: The relationship of treatments and drugs to the concept of care
 

• How does the supply of drugs (in particular Combination Therapy) relate to the commitment to care and treatment? Does the symbolic value of drugs blind us to other humane and meaningful care issues?

• Given that the fight for ARVs has provoked a great deal of international attention, how has this helped raise issues about the current inequality about access to treatment between industrialised and developing countries?  and how does the fight for the right to ARVs relate to the ability of governments/local communities/health care providers to respond to basic care issues?
• Who is driving the debate and who has control? What is the current philosophy of care of NGO's and is there any consensus? Does this involve the explicit procurement and provision of medication? Does this have to change around mother to child transmission and treatment for PLHA's and if so why?
• The reality of lack of resources can stifle and/or ground us -  How do we respond?  How do we determine priorities in allocating resources?· What options do we have for more collaborative work with a common objective?

Group 2: The current health care systems (government, non-profit and private sector) and how these relate to care for people with HIV/AIDS
 

• How are care and treatment currently made available? Do they reach everyone in need, and if not what are the current gaps and obstacles to provision of care and treatment?
• Who are the key players in this? How do government, NGO, activist and private sector interact? What role is there (if any) currently and in the future for commercial interests including the pharmaceutical companies?
• Can current systems be adapted to allow for delivery of new ARV treatments and the supporting services to go with it?
• If a change in systems is required, what would realistically be needed?
• What about sustainability?

Group 3: The differences and similarities between community development principles and current treatment activism strategies

A community development approach would be driven by the needs recognised by affected communities in their own circumstances:

• Is this happening with the demands for the latest HIV treatment, or are such demands coming from a northern perspective without taking into account the different needs of a southern perspective?
• Is it appropriate for demands for HIV treatment to take into account the different circumstances of people in developing countries, or should demands be for the highest standards for everyone?
• How do these different approaches take into account the maximisation of quality of life for people affected?
• How do they take into account the need for training and development of infrastructure?
• If resources are allocated to treatment in response to activist demands, does this mean that resources for essential support services at community level will be or should be reduced?

Group 4: Learning from the experience of other diseases and essential drugs strategies
 

• National drug policies and essential drug programmes aim to provide a safe and sustainable drug supply to meet overall national public health priorities equitably, and to ensure the rational use of all drugs in both the public and private sectors. How do the available treatments for HIV/AIDS fit?
• Can lessons from the drug and non-drug treatments of cancer be applied to HIV/AIDS? What are the minimum conditions for ARVs to be provided safely and sustainably and what is the cost of the total package? How should palliative care be delivered? Do alternative treatments have a place?
• What should be learnt from the failures and successes of TB programmes in terms of development of drug resistance, adherence to treatment and Directly Observed Therapy (DOTs)?

Group 5: The relationship of treatment and drugs to the links between care and prevention and public health issues

There is a close link between care and prevention. Prevention without care increases the isolation and exclusion of those infected, denies respect to those infected and implies that those who are infected have themselves to blame. This is counter productive, since it makes those uninfected or untested more convinced that "AIDS doesnít happen to people like me" thus making prevention messages ineffective.
 

• How does treatment link into this?
• How should we think about allocation of resources as treatments become more available?
• With better treatment will it be easier to maintain the links which we already know about between care and prevention, or will the links become weakened because of a focus on treatment?
• What measures and policies will help to keep the links strong while making the most of available, accessible treatment?

• What priority should be put on provision of AZT for preventing mother to child transmission?
• Does treatment which reduces viral loads reduce infectivity? What are the implications for public health policy?
• Effective treatment for TB both prevents the spread of TB and alleviates the effects of HIV. What are the implications for resource allocation?
• Treatment of sexually transmitted diseases has been shown to reduce the incidence of HIV transmission. What are the implications for resource allocation?