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A Dark Policy on AIDS

Shefali Oza

This World AIDS Day, Dec. 1, 40 million people across the world will be among those not affected by the expansion of new AIDS prevention campaigns -- because they are already infected with HIV. These 40 million people, 95 percent of whom have no access to antiretroviral drugs, have joined countless other persons in a quest for increased access to medicines. But for years, this quest has been a battle against intellectual property and trade laws.

That battle appeared to come to a progressive conclusion a little more than one year ago in Doha, Qatar. There, trade ministers signed the Doha Declaration, officially stating that global intellectual property law should not prevent persons in any country from accessing medicines. The Declaration was heralded as a new era for those with HIV. But when we hear about the state of the AIDS pandemic this Sunday, we will hear that the situation has not improved.

Behind the closed doors of trade meetings over the past month, the U.S. trade representative has slowly repealed the Doha Declaration’s mandate. In early November, he drafted the Free Trade Area of the Americas proposal, an expansion of the North American Free Trade Agreement (NAFTA) for the rest of the Western Hemisphere. The patent protections in this agreement are far beyond the scope of those set by the WTO; they provide 20-year patent lifetimes and introduce a number of new exclusive arrangements that no other country in the world recognizes. Just a month after proposing this new free trade agreement, the U.S. Trade Representative flew to Sydney, Australia, where he pushed trade ministers to reverse the Doha Declaration’s mandate by forcing a repeal on generic exportation laws. That fight is continuing behind closed doors today, and we will see its results at the WTO council meeting on Dec. 10.

All of this may seem like progress for the research and development of future drugs. After all, isn’t that what the pharmaceutical industry has been telling us for years about patent protection? But recent evidence suggests otherwise. Pharmaceutical lobbyists have argued that patents are necessary in promoting innovation and providing incentive for innovators to bear the cost of innovation. Yet they do not mention that the top AIDS drugs were produced under publicly-funded research and development efforts through the clinical trial stage. They do not mention that they sell these drugs at between 75 and 98 percent above production price (according to Harvard Medical School’s latest survey). And they do not mention that while they make more profits as a percentage of revenue than any other Fortune 500 industry (19 percent), companies like Merck spend just five percent of the profit on R&D while spending 13 percent on advertising. (Pfizer similarly spends 15 percent on R&D and 35 percent on marketing, while Bristol-Myers spends 12 percent on R&D and 27 percent on marketing, according to Fortune and the industry’s latest SEC filings.)

And so this leads us to one conclusion: generic medicine access is legitimate and necessary. For the nearly 40 million people who would die without it, generic access is a key to survival. The catastrophes of AIDS will not be solved by prevention alone; the prevention efforts must be paralleled with greater access to treatment. Does this contention seem ridiculous? The evidence suggests otherwise. HIV rates are so high in some African locales that death rates are undermining the labor force and promoting instability in countries where antiretroviral treatment will be the only measure to prevent total social collapse. In fact, providing appropriate HIV treatment has been deemed immediately feasible in even the poorest locales, such as the Central Plateau of Haiti, and with generic medicine use would cost less than three percent of what it would using patented medicines. AIDS drug prices come down significantly with generic competition, and multinational companies operating in Africa have started to provide them to workers.

Many Americans think that treatment should be ignored in favor of “prevention-only” initiatives and argue that if Africans didn’t get HIV in the first place they wouldn’t need treatment. But this contention is no longer accepted by the public health community, which calls this idea a false dichotomy. Prevention is essential, but in an environment where HIV equals a death sentence, little other than stigma and blame can arise from prevention-only programs. Reports from the recent international conference on AIDS revealed that offering appropriate treatment is the only way to save whole societies where nearly all adults are already infected with HIV, and would leave countless orphans if they do not receive treatment.

As the government of Brazil has shown by providing antiretrovirals to all of its infected constituents, treatment dramatically reduces stigma, denial and blame and improves prevention efforts by taking the death sentence message away from the disease. As one South African woman recently said: “When they heard I was positive, people were scared to come into my [AIDS education] office and they treated AIDS as something which was removed from them. They had no information; they didn’t know much. ... One day, after seeing how unfair it would be to die and leave my three kids with all the stigma of HIV/AIDS, I decided I am going to live.” The woman received appropriate AIDS treatment and found that once others in her community realized that she had a treatable disease, and not the plague, she received “much traffic in [her] office, because people are more aware.”

While the policies of politicians like South Africa’s Thabo Mbeki are slowly changing for the better -- South Africa now has several pilot antiretroviral treatment projects -- attention must be paid to the role of international trade agreements as well. The Free Trade Area of the Americas and other proposals by the U.S. Trade Representative are undermining the chance for over 40 million people to survive. It is our responsibility to keep our trade representative accountable to our desires. This World AIDS Day, let’s rethink our priorities and make an effort to change U.S. policies on AIDS.