The Guardian December 5, 2001

New hope for people living with AIDS

While the AIDS crisis continued to escalate throughout the year 2001, 
the countries of the world met in two different forums, for the first time 
coming to agreements that provide hope for those living with the disease 
and for those governments and organisations fighting the epidemic.

In the first universal approach to combating HIV/AIDS, the General Assembly 
of the United Nations met in a Special Session in June this year to 
unanimously adopt a Declaration of Commitment on HIV/AIDS.

The Declaration of Commitment is not legally binding on the 189 
signatory countries, but rather is a "blueprint" setting rigorous 
timetables for countries to pass legislation and implement strategies to 
address medical, political, economic and human rights issues surrounding 

In particular, the Declaration focuses on the need to protect the rights of 
people living with HIV/AIDS, educate youth and address the inequities 
suffered by women. For example, the Declaration sets a deadline of the year 
2005 by which time countries must:

* develop strategies to reduce HIV prevalence among young men and women 
aged 15-24 by 25 per cent, with the number of infants infected reduced by 
20 per cent;

* introduce legislation to protect and respect the rights of people living 
with HIV/AIDS to information, quality care, confidentiality and privacy;

* provide education and reproductive health services to increase capacities 
of women and young girls to protect themselves from risk of infection; 
principally through gender-sensitive prevention;

* and develop national strategies to ensure that orphans and children in 
families affected by HIV/AIDS are enrolled in school and have access to 
health and social services on an equal basis with other children.

Poverty a major barrier

The Declaration also clearly recognises: "that poverty, 
underdevelopment and illiteracy are among the principal contributing 
factors to the spread of HIV/AIDS".

It notes: "with grave concern that HIV/AIDS is compounding poverty and is 
now reversing or impeding development in many countries and should 
therefore be addressed in an integrated manner."

In support of the Developing nations in their struggle against the 
pharmaceutical companies, the Declaration recognises that the 
availability and affordability of drugs, and access to related technology 
are "significant factors to be reviewed and addressed", and that "the 
impact of international trade agreements on access to or local 
manufacturing of essential drugs and on the development of new drugs needs 
to be evaluated further".

It recognised that the lack of affordable drugs was hindering the fight 
against AIDS in the poorest countries and, with a clear nod to countries 
like Brazil, South Africa and India, the Declaration stated it 
welcomed: "the efforts of countries to promote innovation and the 
development of domestic industries consistent with international law in 
order to increase access to medicines to protect the health of their 

Stating the position that many Developing countries find themselves in, 
Guyanan Minster for Health, Dr Leslie Ramsammy said, "The hesitancy and 
slowness in granting debt relief is an ally to the scourge of HIV/AIDS in 
the world.

"For countries such as Guyana, the real possibility that HIV/AIDS can 
destroy our already fragile economic base necessitates that debt relief is 
not merely the reduction of the debt burden, but forgiveness of our debts.

"HIV/AIDS has begun to erode the significant social progress that Guyana 
has made in the last decade. Unless Guyana can urgently access additional 
funds, our capacity to introduce and sustain programs for surveillance, 
voluntary counselling, testing, capacity building for trained 
professionals, building of the health infrastructure and treatment, 
especially obtaining anti-retrovirals will continue to be severely limited.

"If my country is to continue to survive as a viable nation, these new and 
additional resources must be found urgently."

Gender equality vital

Addressing the urgent need to elevate the status of women in society around 
the world, Geeta Rao Gupta, President of the International Centre For 
Research On Women said, "There can be no debate after this session about 
the role that gender inequality plays in HIV/AIDS... Gender inequality is 
now fatal.

"Gender norms that restrict women's access to productive resources such as 
education, land, income, and credit, create an unequal balance of power in 
society... and greatly compromise women's ability to protect themselves 
against infection, cope with illness once infected, or care for those who 
are infected.

"In the coming decade let us resolve that we will work harder to protect 
women's basic right to safety and bodily integrity; that we will reduce the 
gender gap in education; that we will improve women's access to economic 
resources, assets, and opportunities;

"Let us resolve that we will invest in girls and women because it is the 
right thing to do and the smart thing to do for women, households, 
communities and entire nations  and because without that investment we 
will never contain this disease."

Victory at Doha

Hard on the heals of the Brazilian and South African legal victories, and 
armed with the backing of the United Nations, many governments and NGOs 
descended on the WTO Ministerial Conference in Doha, intent on overturning 
the severe restriction placed on them by the Trade Related Aspects of 
Intellectual Property Rights (TRIPS) agreement.

Taking the position of the UN Special Session to the WTO Conference, UNAIDS 
(Joint United Nations Program on HIV/AIDS) issued a statement saying:

"The extraordinary scale of the AIDS epidemic and the glaring global 
inequity in access to HIV treatments calls for a radically new way of doing 
business based on the ethical imperative of ensuring that the fruits of 
science benefit all, including the poorest.

"This new way of doing business must ensure that much needed innovation in 
HIV-related pharmaceuticals and technologies continues, while making new 
HIV medicines  including those under patent  truly affordable...

"Global intellectual property rules must support, not undermine, the public 
health and development of poor nations, including the fight against AIDS."

Although the TRIPS agreement itself was not actually amended in any way 
during the Doha session, a Declaration on Public Health adopted by 
the Conference was a clear victory.

Mark Ritchie, President of the Institute for Agriculture and Trade Policy, 
described the win, "Over a decade of organizing by NGOs combined with 
strong efforts by several Developing country governments lead to the 
adoption of the special section, over the objection of the US, Switzerland, 
Germany and the United Kingdom.

"Use of the current WTO rules of trade covering intellectual property 
rights, including patents, to impede public health objectives were 
specifically repudiated."

The stated purpose of the Declaration was to provide "guidance for 
interpreting TRIPS and for Developing countries to use its public health 
safeguards to the fullest extent".

The most significant outcome of the WTO Declaration was that Least 
Developed Countries were now allowed a blanket extension to the year 2016 
before they had to offer patent protection to pharmaceutical companies.

The original TRIPS agreement had obliged those countries to offer 
protection by the year 2006, with extensions only allowed on approval on a 
case by case basis.

Also, while the WTO Declaration blithely insisted that the TRIPS agreement 
had always contained clauses that allowed governments to protect public 
health without fear of retribution, it now offered further "clarifications" 
on the issue, that included:

* where TRIPS stated that countries could "adopt measures necessary to 
protect public health ..." the Declaration reinforced the primacy of public 
health interests. It stated that the TRIPS agreement "can and should be 
interpreted and implemented in a manner supportive of WTO Members' right to 
protect public health and, in particular, to promote access to medicines 
for all."

* where the TRIPS agreement had always permitted governments to grant 
compulsory licences to manufacture essential drugs in the case of a 
national emergency, the Declaration "states this in more clear and plain 
terms so that WTO Members can issue compulsory licences with greater 
confidence and certainty".

* where the TRIPS agreement used the term "national emergency", or 
"circumstances of extreme urgency", this was explicitly defined in the 
Declaration as meaning "public health crises, including those relating to 
HIV/AIDS, tuberculosis, malaria and other epidemics".

"The huge profile given to the issue changes the political climate, 
building on the victories in the South Africa and Brazil cases," said 
Michael Bailey of Oxfam. "We would have liked to see stronger wording, but 
the declaration does have a clear political statement that public health 
concerns must override commercial interests."

"Countries can ensure access to medicines without fear of being dragged 
into a legal battle", said Ellen 't Hoen of Medecins Sans Frontieres. "Now 
it is up to governments to use these powers to bring down the cost of 
medicines and increase access to life-saving treatments."

Australia has been fortunate in the AIDS crisis, being one of the very few 
countries in the world where number of people infected with the HIV virus 
represents less than 0.2 per cent of the population.

Progressive social policies implemented by State and Federal Labour 
Governments in the early 1980s  safe-sex campaigns, sex education in 
schools, needle exchange programs, and active outreach to workers in the 
sex industry  helped contain the virus.

But Australia must not become complacent in the fight against HIV/AIDS, 
either domestically or internationally. We have a vital and urgent role to 
play in assisting other countries to replicate our success.

Peter Piot, UNAIDS Executive Director says, "Humanity's future depends on 
how smart we are in working together, in pooling knowledge and in 
overcoming difference. So far, the evidence from AIDS is that we are not 
smart enough.

"But I am confident that we are getting there."

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