Last month’s deal at the World Trade Organisation (WTO) in Geneva allowing access to cheap medicines for developing countries has been hailed as historic by supporters - but as disappointing by sceptics.
The agreement follows years of tortuous negotiations to allow poor countries in Africa, Asia and Latin America to import cheap generic copies of anti-HIV drugs.
Under the terms of the deal poor countries will now for the first time be allowed to import cheap versions of drugs, their active ingredients and diagnostic kits, and also break patents on new drugs.
But developing countries will have to provide evidence that they cannot produce the drugs themselves, show that the drugs are needed, and ensure that they do not then smuggle cheap drugs out of their countries back onto the lucrative western market.
And the deal does nothing to resolve the contentious question as to what happens after 2005 when generic makers will be forbidden by the intellectual property rules of the WTO (the so-called ‘TRIPS’ agreement) to breach patent laws on new drugs.
The rich industrial countries have agreed that they will not import cheap drugs themselves under the deal.
The deal was hailed as “historic” by WTO director general Supachai Panitchpakdi.
WHO’s new director Dr Jong Wook Lee also welcomed the agreement, with caution.
“I want to be optimistic,” he said. “It is a good, positive development. There are many conditions attached to it, but we can solve them.”
“The proposed deal is largely cosmetic,” said Oxfam’s Celine Charveriat, “and it will not make a significant difference to the millions of sick people who die unnecessarily in the Third World every year.”
“It offers little comfort for poor patients,” said Ellen Hoen of Médecins Sans Frontières. “Global patent rules will continue to drive up the price of medicines.”
But the international pharmaceutical manufacturers have said the deal is a balanced one and denied that it forces too much red tape on poor countries.
HIV beauties will tour BotswanaBotswana held an unusual beauty pageant last month in an effort to destigmatise the Aids epidemic. 31-year-old Kgalalelo Ntsepe, who is openly HIV positive, is pictured carrying a bouquet and wearing a crown of flowers after being named the winner of the ‘HIV Stigma Free’ competition. “I’m going to go around the country to talk to people to say that being HIV positive does not mean you have done something wrong. You are still who you are,” said Ntsepe, who works as a counsellor with HIV positive youth. |
After years of pressure the South African government has finally agreed to supply antiretroviral HIV drugs to its devastated population.
A ministerial agreement in August asked the Department of Health to develop a plan by the end of September showing how and when the drugs will be made available to at least some of the five million South Africans with the disease. Currently about 600 South Africans a day die from Aids.
The government’s plan to provide ‘100 per cent’ of antiretrovirals needed by 2008 marks a U-turn after many years of opposition to the drugs. The move, which has been universally welcomed, followed a Treasury report that the public provision of the drugs is now affordable.
Government ministers had blocked anti-HIV drugs for public hospitals for years, inspired, it was believed, by a denial of the link between HIV and Aids by President Thabo Mbeki.
Leading South African Aids campaigner Zackie Achmat, chairman of the Treatment Action Campaign, said the move was the best news after four dark years.
“We will wait to see the actual operational plan before celebrating,” he said. “But for all of us living with HIV and our families this is the first sign of hope.”
Outspoken health minister Manto Tshabalala-Msimang said she did not know whether the end of September deadline would be met and stressed that it is important not to lump together people with full-blown Aids with those with the virus.
“We are going to muster all our energy to do all we can to prolong the gap between the two,” she said. “It is not necessary that people die of Aids. We can manage HIV.”
 Ugandan President Yoweri Museveni speaking at the United Nations Photo: courtesy UN |
A study by UNAIDS reveals a further downturn in the reduction of HIV/Aids prevalence and incidence in Uganda.
“It is estimated that 8.3 per cent of the adult population in Uganda was living with Aids at the end of 1999,” said author Betty Amaliak. “But recently, the figures have shown a further decline to 6.2 per cent.
“Data from antenatal clinics show continuous declines, particularly among pregnant women. Counselling and testing sites report decreased HIV infection rates in both men and women. Condom usage has also been reported to be on the increase.”
Uganda was the first African country hit hard by the disease. It has lost over 800,000 adults; about 1.5 million out of its 21 million people are living with HIV, and thousands of children have been orphaned.
However, the Ugandan government, headed by President Yoweri Museveni, has made an impressive effort, along with charities and non-governmental organisations, to set up programmes that have created awareness around HIV and extended services for people with disease.
In 1992, the country’s Mildmay Hospital reported that Uganda’s HIV prevalence rate in antenatal surveillance sites had reached 29 per cent. By 2002 this had been reduced to less than 5 per cent.
Good leadership, political will and a commitment to invest in health and education are cited as key factors in this turnaround, the Mildmay report said.
And the World Health Organisation (WHO) says: “The high level of government commitment and openness with which the problem has been tackled has assisted in the reduction of prevalence of the disease.”
More women are infected with HIV than men, and violent sexual behaviour is a contributing factor in the spread of the disease. But there is still no legislation protecting women against sexual violence in the country.
Evelyn Matsamura, writing for the Inter Press Service, said: “In a society where women are still valued as property, and do not have equal decision-making powers and status within the family, the existence of rape and brutal attacks on them by their spouses has become the stimulant for HIV/Aids infections.”
Matsamura went on to say: “In a country where marital rape is not considered a crime, the practice has not only crumpled the rights of Ugandan women, but become a barrier in the fight against the disease.”
“Sexual abstinence is difficult in a culture where widows are inherited by a brother of their dead husband,” said Dr Sewamkambo, dean of Makerere University.
Another challenging factor for such a poor country, with 80 per cent of its population depending on agriculture, is the cost of treatments.
Recently President Museveni talked about the cost of the epidemic and how a country with limited resources can respond.
“We lose an estimated $702 million to the Aids epidemic and another $348 million to malaria,” President Museveni told last year’s Commonwealth health ministers meeting in Kampala.
“Comparing it with what we earn from coffee, this loss is several times bigger.”
 photo: courtesy uganda embassy |
Only a few in the country can afford the high costs of treatments and less than 5,000 people with HIV out of 1.5 million with the disease receive anti-HIV drugs.
Noerine Kaleeba, a policy officer with UNAIDS, says that even if anti-HIV drug prices fall further, people with the disease in Uganda will still not be able to afford antiretrovirals and may have to wait to see if and when the $15 Billion pledged by US President Bush will be delivered or not.
On the ground in such a diffuse country, receipt of HIV services depends on the geographical locality of the individual. Some rural areas face a lot of constraints, such as isolation, poor hospitals, and a lack of trained manpower as well as a lack of effective medications.
The on-going 20-year civil war in the north of Uganda has also greatly contributed to the further spread of the disease. James Ayebale
