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Date: Sat, 20 Sep 2003 16:17:24 -0500
From: Africa Action <[log in to unmask]>
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Subject: Africa: Treatment Access Updates

AFRICA ACTION
Africa Policy E-Journal
September 20, 2003 (030920)

Africa: Treatment Access Updates
(Reposted from sources cited below)

This coming week the 13th International Conference on AIDS and STIs
in Africa (ICASA) convenes in Nairobi, Kenya from September 21-26,
under the theme "Access to Care." [see
http://www.icasanairobi2003.org/index.php]. On September 22, the
United Nations convenes a high-level meeting on the implementation
of the 2001 Declaration of Commitment on HIV/AIDS [see
http://www.unaids.org].

Meanwhile, the U.S. Senate, under pressure from President Bush, has
rejected an amendment to provide $3 billion instead of $2 billion
for the first year of President Bush's promised $15 billion
HIV/AIDS initiative. The U.S. is currently spending an estimated $1
billion a week in Iraq, and Congress is currently considering a
request from President Bush for an additional $89 billion.

This posting contains excerpts from several documents and
additional links to these and other recent developments related to
access to treatment. Another posting today contains a set of
talking points released earlier this week by Africa Action,
detailing the broken promises of the Bush administration on
HIV/AIDS.

Below find an opening report from Nairobi from the Nigeria-AID
eforum, a report on demands by Kenyan AIDS activists for more rapid
action to make anti-retrovirals available, and the key points of a
summary campaign platform on these issues from HealthGap USA.

Also last week the United Nations Economic Commission for Africa in
Addis Ababa launched its new high-level Commission on HIV/AIDS and
Governance in Africa [for details see http://www.uneca.org/chga]

+++++++++++++++++end summary/introduction+++++++++++++++++++++++

ICASA 2003: Community forum kicks off

September 20, 2002

Nigeria-AIDS eForum http://www.nigeria-aids.org

Olayide Akanni Nigeria-AIDS eForum correspondent Nairobi, Kenya
Email: [log in to unmask]

NAIROBI, KENYA - 20/09/03: Only just about ten percent of the
expected 4000 delegates are in town, but as far as these are
concerned, the 13th International Conference on AIDS/STIs in Africa
(ICASA) is on - and the official opening hasn't even held yet.

Some 400 people from all over Africa are attending the pre-ICASA
community forum, a 2-day event that will climax with the opening
ceremony of the conference proper on Sunday at the Kenyatta
International Conference Centre, Nairobi.

Even though most of the nearly 4000 delegates expected at the ICASA
are just about now preparing to leave their respective countries to
descend on host city Nairobi, the participants at the community
forum are already seeping into the ICASA experience.

On Friday, the community forum was declared open by the First Lady
of Kenya, Mrs. Lucy Kibaki.

Welcoming participants to Kenya, she called for the development of
innovative strategies that will lessen the burden HIV/AIDS places
on African women. Women, she said, bear the brunt of social and
cultural practices that fuel the spread of HIV on the continent and
she charged representatives of community based groups to actively
engage women in their progamme implementation.

"Women should not be viewed as mere recipients of such initiatives.
They must be carried along in order to help them lessen the social
and economic burdens AIDS has placed on them. Communities must also
come up with strategies through which they can partner with their
national governments to reduce AIDS related stigma and
discrimination", she said.

Kenya's Health minister, Hon. Charity Ngilu in her keynote address
urged the delegates to utilize the community forum to proffer
solutions to the challenges of stigma and discrimination and care
of orphans, among other key issues that continue to pose a
challenge to mitigating the impact of HIV/AIDS on the continent.

She announced the commencement of a plan by the Kenyan government
to provide treatment for 6000 people living with HIV at the cost of
$20 per month. She noted however that the impact of such treatment
initiatives would be limited without community support of PLWH.

Also speaking at the event, secretary-general of the Network of
African People Living with HIV (NAP+), Mr. Mike Anganga challenged
participants to ensure that "accurate information reaches people
before they are infected with HIV and not while they are on their
death beds."

"PLWH need to make decisions based on knowledge rather than fear",
he said.

Earlier in his opening remarks, chair of the Community Forum, Mr.
Allan Ragi, had expressed the hope that delegates would utilize the
forum to strengthen existing networks, build strong alliances with
pharmaceutical industry and other stakeholders to facilitate access
to care for PLWH on the continent.

The forum also featured roundtable discussion sessions on a variety
of topics include: such as access to care, stigma and
discrimination, social support, youth involvement and prevention,
gender and sexuality as well as resource mobilization.

The 2-day event is jointly organized by the African Council of AIDS
Service Organisations (AFRICASO), NAP+, Kenyan AIDS NGOs Consortium
and the Society for Women and AIDS in Africa (SWAA).

**************************************************************

Activists Demand Better Access to Antiretrovirals

UN Integrated Regional Information Networks
(http://www.irinnews.org]

September 19, 2003

Nairobi

A lobby group, the Kenya Coalition for Access to Essential
Medicines, is demanding that the government provide affordable or
free antiretrovirals (ARV) for Kenyans.

"What we want to see is an expanded programme to treat as many
people as possible," said Gitura Mwaura, Chairman of the coalition.
"We believe the government has the resources, and can do
something," he said. "Its priorities need to change."

Of the some three million people living with HIV in Kenya, at least
10 percent are in urgent need of ARVs, while only between 7,000 and
10,000 are able to access them - mainly through mission hospitals,
the private sector, or NGOs who sponsor the drugs.

Buying imported generic ARVs costs up to 3,500 ksh (US $45) per
month, which is way beyond the reach of the vast majority of
Kenya's 32 million people, over half of whom live on less than a
dollar a day.

The government has committed itself to providing ARVS for 20
percent of those in need by 2005, but has no comprehensive national
treatment plan in place, mapping out detailed procurement plans,
supply chains, training for medical personnel and essential
monitoring for all those in need of the drugs, says Mwaura. "Though
they're [the government] talking about treatment, we don't seem to
see much concrete action."

Meanwhile, an estimated 700 people died of AIDS every day in 2002,
or over 200,000 people during the course of the year.

Through the UN's Global Fund to Fight AIDS, Tuberculosis & Malaria
the government plans to treat 3,000 people from December - namely
TB patients, mothers and their families, ministry of health workers
and emergency cases including rape. A further 6,000 will be able to
access ARVs this year in 28 district hospitals around the country,
at half of the purchase price or in some cases for free, the
Director of Medical Services in the MoH, Dr Richard Muga, told
IRIN.

But this is just a drop in the ocean, say activists.

Aside from the lack of a national strategy in place to treat and
monitor all of those in need, the ministry of health's technical
capacity has also been called into question. A pharmaceutical
tender produced last month for 2004-2005, inviting suppliers to
quote prices for drugs including ARVS, had "serious errors" in it,
the coalition reported, despite readily available guidelines from
the World Health Organisation and Kenya's own Essential Drugs Lists
and Treatment Guidelines.

The tender asked for a combination ARV pill that did not exist, the
wrong dosage for another ARV regime, and left out other essential
items - paediatric doses, ARVs for people with TB, for use after
rape or immediately after infection, or second-line ARVS for use
where initial drugs do not work.

The coalition welcomed the fact that ARVs were on the tender list
for the very first time, Mwaura said, but added "If that tender is
anything to go by, then we certainly have a serious problem
regarding the technical advice on offer to the ministry".

"In a country faced with a massive co-epidemic of HIV and
Tuberculosis, it is absolutely unacceptable for incorrect and
non-existent drug combinations to be tendered for from the highest
technical office of the Ministry of Health."

Since 7 June the coalition has been trying unsuccessfully to meet
the Kenyan minister of health, Charity Ngilu, to discuss a national
treatment plan - which the government is reportedly working on -
and to offer its expertise. To date it has not been granted a
hearing.

Meanwhile, the government is delaying in granting permission to a
Nairobi firm, Cosmos, to start producing generic ARVs at home,
which would push the monthly price down to 2,500 ksh (US $32). Dr
Prakash Patel, managing director of Cosmos, told IRIN that due to
a "grey area" in international law he was waiting - for several
months - to receive a letter from the Ministry of Health and the
intellectual property office to allow him to begin large-scale
production.

"We are asking the Kenyan government to give us the go-ahead," he
told IRIN.

Government initiatives, or the absence thereof, have also been
heavily criticised on other fronts. The National AIDS Control
Council - which spent only 6 percent of its budget on programmes in
2000-2001, and a staggering 94 percent on overheads and salaries -
has been under investigation for corruption and mismanagement this
year, while the cabinet committee on AIDS had produced little by
way of concrete results, said Mwaura.

"We would like to see some more concrete action on the ground," he
said. "We need some political will."

***************************************************************

Health GAP (Global Access Project)

04-Stop-AIDS:
an Urgent Presidential Agenda to Halt the Scourge of AIDS

Paul Davis
e: [log in to unmask]
t: +1 215.833.4102 (mobile)
f: +1 215.474.4793
http://www.healthgap.org

September 15, 2003

This platform for the 2004 US Presidential Race will be taken to all
of the candidates --including President Bush. Let's show the leader
of the United States from 2004-2008 that organizations the world over
demand an end to the Global AIDS crisis.

The platform will not be used to endorse any candidates. All of the
candidates will be urged to adopt the provisions below.

For now, we are only collecting endorsements from organizations. We
will collect endorsements from individuals later. Please send
*ORGANIZATIONAL* endorsements, along with the city, state and
country of your NGO to: [log in to unmask]

THANKS

Health GAP USA

04-Stop-AIDS: an Urgent Presidential Agenda to Halt the Scourge of
AIDS

20 August 2003

In the face of a pandemic that threatens global security while
devastating economies and destroying the social fabric of nations,
the leader of the most powerful country must have a comprehensive
plan to stop global AIDS. With more than three million deaths
expected this year, AIDS must become the highest priority foreign
policy issue for any credible candidate seeking the 2004
presidential nomination.

President Bush has offered strong rhetoric on AIDS, promising by
2008 "nearly $10 billion in new money to turn the tide against AIDS
in the most afflicted nations of Africa and the Caribbean" in his
State of the Union address in January 2003. Unfortunately, that
rhetoric has yet to translate into effective action. Meanwhile, the
Bush Administration continues to under-fund the Global Fund to
Fight AIDS, Tuberculosis and Malaria (GFATM). The Global Fund,
launched in 2001, should be supported by the U.S. as the premier
financing vehicle to deliver comprehensive prevention and treatment
for the scourge of these three diseases. Yet the Fund has already
been forced to downsize its mission and scope, seeking fewer
proposals from impoverished nations due to a lack of funds from the
U.S. and other donors.

To be a serious and credible candidate for President, Democratic
and Republican contenders must commit to an ambitious and
comprehensive plan to effectively stop the global AIDS pandemic. In
order for a stop AIDS plan to be effective, such a plan will
require significant new cash pledges from the U.S. as well as real
and verifiable commitments to new policies. The undersigned
organizations urge all candidates to adopt the following policies:

1. Donate the Dollars: at least $30 billion by 2008

Candidates must commit at least $30 billion to fight global AIDS
over their four-year term in office. By 2006, annual contributions
should reach at least $6 billion. Regular payments to the Global
Fund should be made annually at levels equal to at least 33% of the
Fund's projected needs. These donations should support rapid
utilization and expansion of existing physical and human capacity
in developing countries.

2. Treat the People: commit to treat those in immediate clinical
need

Candidates must support prioritization of treatment of people with
HIV who are in immediate clinical need, as well as pledge to commit
the resources and personnel required to the Global Fund and other
initiatives to reach the WHO goal of at least three million people
with HIV on antiretroviral treatments by 2005, 7 million by 2007,
and towards universal treatment for all people with HIV/AIDS by
2012.

3. Support trade policies that ensure access to affordable generic
drugs

Candidates must commit that the U.S. will cease inserting
provisions in bilateral and regional trade agreements that limit
countries' ability to take appropriate measures to address HIV/AIDS
and other public health problems. The U.S. must not prevent
countries from exporting generic medicines to nations that have
issued a compulsory license to meet public health needs, or
countries where no patent is in effect. US Trade policy should
promote access to affordable medicine for all developing countries.

4. Drop the Debt

 Candidates must pledge to use the power of the U.S. Treasury, as
the largest donor to the IMF and the World Bank, to fully cancel
the debts of the world's poorest countries, and put an end to the
imposition of structural adjustment policies such as user fees and
privatization of health care, education, and water.

5. Disease prevention policies must be guided by science, not
politics

Candidates must pledge the U.S. support for effective science-based
prevention strategies, rather than politicized and unscientific
approaches such as abstinence-only interventions. The U.S. must
commit adequate resources and ensure access to a global supply of
HIV prevention commodities and programs to avert 29 million of the
most preventable new adult HIV infections projected between now and
2010.

6. Stop the crisis amongst orphans and vulnerable children

Candidates should commit billions of additional U.S. global AIDS
spending for addressing the needs of children orphaned or
vulnerable due to HIV/AIDS. The U.S., working with other nations,
should ensure the implementation of national policies to provide
total support to orphans and children infected and affected by AIDS
through enrollment in school, housing, and access to health and
social services by 2005.

7. Invest in the empowerment of women and girls

Candidates should pledge U.S. support for policies to reduce the
vulnerability of women and girls to infection and needless death
such as: greater access to female condoms; the development of
vaginal microbicides to prevent sexual transmission of HIV by 2008;
greatly expanded access to HIV, STD and reproductive health
services; and programs preventing maternal-to-child transmission
while ensuring treatment for mothers themselves.

8. Fight tuberculosis and malaria as part of a comprehensive plan
to combat HIV/AIDS

Candidates must uphold the targets set out with leaders of other
wealthy nations in the G8 Okinawa 2000 agreement: to reduce
tuberculosis deaths and prevalence of the disease by 50% by 2010
and to reduce the burden of disease associated with malaria by 50%
by 2010. For successful treatment of malaria, the U.S. should help
finance the implementation of artemisinin-based combination therapy
(ACT) in areas of high resistance to first-line treatments.

 9. Ramp up research and development

Candidates must commit to considerable new resources towards
developing effective vaccines, microbicides, simplified
antiretroviral treatment and monitoring tools adapted for use in
resource-poor settings as well as novel and adaptive treatments for
tuberculosis and malaria.

[for additional explanatory background, initial signatories, and
notes, see http://www.healthgap.org]

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Date distributed (ymd): 030920
Region: Continent-Wide
Issue Areas: +economy/development+ +health+

************************************************************
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