The struggle for treatment access

US government policy has violated the human rights of people living with HIV and AIDS through its ‘moral’ restrictions prioritising abstinence-only sex education, restricting condom distribution, and stigmatising sex workers.

The government’s close ties with pharmaceutical companies and manipulation of trade in essential medicines have also infringed on the human right to health.

Organisations including the Treatment Action Campaign in South Africa, the Health Global Access Project Coalition, ACT UP (Aids Coalition to Unleash Power), Oxfam, and Médecins Sans Frontières have campaigned to promote access to essential medicines for HIV and AIDS and other life-threatening diseases as a human right.

In Brazil, access to essential medicines is considered a fundamental human right and state-owned pharmaceutical companies manufacture generic AIDS drugs for free distribution. In India and, later, Thailand, manufacturers not yet bound by restrictive patent laws, began producing lower cost anti-retroviral drugs for both the domestic and international markets.

At the 2001 World Trade Organisation ministerial meeting in Doha, Qatar, a bloc of Southern countries secured a declaration affirming that trade rules should not prevent member countries from providing access to medicines for all. The US government did not oppose the declaration outright but undermined it unilaterally. For instance, the US President’s Emergency Plan for AIDS Relief stated that 60 percent of funds should go towards free treatment. But since the USA simply used the money to pay pharmaceutical companies for non-generic drugs that would be freely distributed, it has subverted the movement for universal access.

Technocratic approaches ignore the deeply gendered, racial, and sexual dimensions of HIV and AIDS, as well as the social, economic, and cultural conditions necessary to combat the pandemic

The US government has also engaged increasing numbers of developing countries in bilateral free trade agreements. Through these agreements the US trade and patents regime, known as TRIPS-Plus, requires signatory countries to give up their rights to produce or import cheaper generic drugs and to extend the patents of US drug makers or risk losing billions of dollars in trade with the USA.

These clashes highlight the connections between broad, macro-economic facts, human development, and health-related rights. Yet the preoccupation with treatment and its economic dimensions has contributed to sanitising and desexualising the politics of AIDS, presenting new challenges to sexual rights and gender justice activists.

World Bank and World Health Organisation economists have sought to reconcile market systems with principles of social inclusion while avoiding sexual controversies. They focus on technocratic approaches such as biomedical quick fixes — the recent emphasis on circumcision, for instance. These ignore the deeply gendered, racial, and sexual dimensions of HIV and AIDS, as well as the social, economic, and cultural conditions necessary to combat the pandemic. Tensions between the different strategies for addressing the epidemic have been obvious.

• How can economic frameworks be applied to principles such as the right to sexual self-expression and freedom from abuse, or discrimination based on sexual and gender orientation?
• Why should treatment and prevention, social and economic rights, and sexual rights be kept separate?

The fight against HIV and AIDS needs to overcome the tensions between different strategies, and to reintegrate economic justice (access to goods and services) with erotic justice (the affirmation of bodies, pleasures, and desire).

Rosalind Petcheskey
City University of New York, 695 Park Avenue, New York, NY 10065, USA
rpetches@igc.org

Access to drugs in Thailand

Thailand shows what TRIPS-Plus means in practice. More than a million men, women, and children have been infected by HIV in Thailand. Half a million people have died and around 20,000 new infections still occur each year.

Yet there is hope because a public health offensive combines aggressive outreach, prevention, and condom distribution strategies (for example, putting condoms in bars and clubs where sexual transactions are set up or occur) with a growing treatment access programme.

Thailand’s government pharmaceutical organisation produces high quality generic versions of expensive commercial HIV drugs and drugs to treat deadly infections. This has made it possible to treat 80,000 HIV-positive people who otherwise would have died.

In November 2006, the provisional Thai government issued a compulsory license on Efavirenz, an important HIV drug under patent to the US-based drug company Merck. It did so in the face of legal threats from Merck and pressure from the US trade representative. In May 2007, as a result of strong advocacy efforts by NGOs working on intellectual property rights, the Brazilian government also issued a compulsory license of the same drug.

Rosalind Petcheskey