Impact of Free Trade Agreements on People Living With HIV

Thirty years into the AIDS epidemic, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, the UN organized a High level Meeting on AIDS from 8–10 June 2011 in New York to review progress and set targets and commitments for the coming years on HIV prevention, treatment care and support. Member States are expected to adopt a new Declaration that will reaffirm current commitments and commit to actions to guide and sustain the global AIDS response to “Zero New Infections – Zero Discrimination – Zero AIDS Related Deaths”.

A recent study of 1763 couples of whom 97% were heterosexual in 13 sites across different countries including India, Africa and Brazil has shown that treatment may in fact be the best form of prevention with a nearly 96% reduction in HIV transmission between sero-discordant couples being reported if the HIV-positive partner was on treatment before their health declined.

Thailand and other international actors are calling for 15 million people living with HIV to be on treatment by 2015. The target of 15 million people represents 80% of those who will be in need of treatment by 2015 i.e. 18.3 million PLHIV will actually be in need of treatment.

For developing countries like India that are scaling up their treatment for HIV as well as TB, targets are the most important mechanism to ensure continued international funding and commitment to treatment programmes. Unhindered supply of affordable medicines is crucial to all such programmes. Yet, it seems that Free Trade Agreements (FTAs) agreements are threatening to undermine access to affordable medicines for millions of people, putting the profits of multinational pharmaceutical companies ahead of people’s right to health around the world. New HIV, AIDS and TB medicines, Hepatitis C treatments, cancer medicines, essential medicines, life saving medicines for many chronic diseases are all under threat.

In 2001, World Trade Organization (WTO) members agreed to the Doha Declaration which affirmed that the Trade- Related Aspects of Intellectual Property Rights (TRIPS) Agreement “can & should be interpreted & implemented in a manner supportive of WTO member’s right to protect public health &, in particular, to promote access to medicines for all.”

However, the implementation of the TRIPS Agreement is already restricting access to newer medicines in the Global South; FTA negotiations are threatening to make an already bad situation, worse. Studies show that FTAs with US resulted in 79% of 103 off-patent medicines not having any generic equivalent in Jordan & in price differences of up to 845,000% in the same therapeutic segment in Guatemala.

The US is now trying to push TRIPS-plus measures in the Trans-Pacific Partnership Agreement negotiations on Vietnam, Malaysia, Chile, Peru and possibly Thailand.

The ability of India and other countries with domestic manufacturing capacity to make low-cost medicines dictates who can and cannot access life-saving medicines. Restricting generic production costs lives.

The UN, as well as developing countries, is keen to mitigate the impact of patents on access to AIDS treatment. In this context the zero draft had proposed key language on patent barriers which developing countries like Thailand, Brazil, and Africa are seeking to strengthen. Governments need to use public health safeguards when they face IP barriers in producing or purchasing affordable medicines for HIV/AIDS. In addition, developing countries should ensure that TRIPS-plus provisions are kept out of FTAs, as they pose a danger to the sustainability of AIDS treatment.

HIV treatment programs are likely to be affected in future due to trade barriers, regulations, policies and practices as well as bilateral and regional trade agreements that impose strict intellectual property protections under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. All this might seriously limit access to affordable and effective HIV prevention and treatment products, diagnostics, medicines and commodities and other pharmaceutical products.

The Delhi Network of Positive People (DNP+) has joined hands with networks of People living with HIV, health groups, and treatment activists from around the world in calling for an immediate moratorium on all Free Trade Agreements (FTAs) and TRIPS-plus measures.

The 'Bangkok Declaration on Free Trade Agreements and Access to Medicines' endorsed by groups and individuals from Asia, Africa and Latin America declares opposition to the increasingly rapid spread of FTAs that put the profits of multinational pharmaceutical companies ahead of people's right to health around the world. The Declaration states that these "agreements are threatening to
fundamentally and permanently undermine access to affordable medicines for millions of people. New HIV/AIDS medicines, Hepatitis- C treatments, cancer drugs and life saving medicines for chronic diseases are all under threat."

The 'Bangkok Declaration' comes at a crucial time as the EU, traditionally considered a champion of human rights, is taking aggressive positions on the draft Declaration of Commitment on HIV that is being negotiated among UN member states in New York. "We are seeing an unusual position being taken by the EU which is refusing to commit to any treatment targets and at the same time is working with the US to remove or significantly dilute any language in the text related to increasing access to safe, effective and affordable generic medicines," said Matthew Kavanagh of Health GAP (Global Access Project), who is following the negotiations in New York.

Rose Kaberia of the East African Treatment Access Movement (EATAM) has challenged an anti-counterfeit legislation in Kenya that increases enforcement of medicine patents. According to her, "The greater enforcement of medicine patents has resulted in the seizure of generic medicines including ARVs by the EU which were on their way from India to Africa and Latin America. We cannot afford any such laws in the fight for Universal Access.

Globally, developing countries caught in the TRIPS regime are struggling to provide second line treatment. Countries have adopted absurd eligibility criteria or are rationing newer, expensive HIV drugs that are patented in their countries. "With funding drying up as well and fewer avenues for decreasing the prices of ARVs, many countries are reluctant to adopt the new WHO guidelines for treatment. Any policy options to get generic supply for developing countries are being taken away in FTA negotiations with the EU, US and Japan," said Lorena Di Giano of the Argentinean Network of Women living with HIV/AIDS.

"In 2001 generic medicines made it possible for us to hope for healthier lives, to get back to work, to watch our children grow up. A decade later the EU, US and Japan want to take that hope away all in the name of their multinational pharmaceutical companies," said Loon Gangte of Delhi Network of Positive People( DNP+). "Enough is enough. Our lives are not for sale." he said.

Countries must have every legal and policy option at their disposal to provide treatment in the most affordable and sustainable manner. Civil society groups, people living with HIV, and all communities facing communicable, chronic and/or non-communicable diseases in the North & the South should join forces to halt trade agreements that restrict access to generic medicines, and widen the gap between the rich and the poor, not only between countries but also within countries.Shobha Shukla - CNS(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is also the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: http://www.citizen-news.org