WHO shows the way, governments must follow

To treat earlier, is to treat better

The new WHO’s recommendations encourage countries to begin antiretroviral treatment (ART) on adults living with the HIV, as soon as their CD4 lymphocyte (immune system cells) rate is below 500cells/mm³. Treating the people suffering from HIV earlier [1] allows, on one hand, to improve the prognosis of a good health by decreasing the chances of comorbidity and, on the other hand, to lower their viral load, which statistically lessens the possibility to transmit the virus to another.
WHO also advises to improve the therapeutic follow-up care by improving the access to biological follow-up care, such as viral load and CD4 lymphocyte measurement. These follow-up examinations enable the measurement of virologic and immune responses and the earliest identification possible of therapeutic failures, which require a change in treatment.
Last, WHO recommends providing every HIV-positive child under 5, every pregnant or breast-feeding HIV-positive woman and every HIV-positive person whose partner is not infected, with treatment.

WHO should have gone further

As the International Treatment Preparedness Coalition (ITPC), the Aids and Rights Alliance for Southern Africa (ARASA) and the Asia Pacific Network (APN+) [2] underlined it, the WHO’s recommendations are missing some crucial points. It is especially the case about the ways of involving communities in every step of the healing process, of including recommendations concerning the HIV/Hepatitis C co-infection or even of the screening of children under 18 months.

The ball is in the politicians’ court

In order to make these good intentions come true, politicians will need to show a real political will to overcome this epidemic. The number of people qualified for the ART, thanks to the new recommendations, shifts from 15 million to 26 million, although only 9.7 million people effectively have access to these treatments. Besides, in many countries, transgender, sex workers, homosexuals and drug users are discriminated and have not access to prevention and treatments. As for the biological follow-up examinations, they are seldom performed in the Southern countries due to their high cost and the lack of equipment in laboratories (especially in rural areas).

Considering that the States of the African Union still have not fulfilled their commitment taken in 2001 in Abuja to allocate 15% of their national budget to health, and that the Global Fund to Fight AIDS, Tuberculosis and Malaria strives to find the additional $5 billion it needs for the next 3 years, one has difficulty to imagine how the WHO’s recommendations could be effectively implemented.

Lowering the treatments’ price is possible

Besides the financing matter, pharmaceutical patents keep impeding the universal access to treatments. Even though the arrival of generic medicines on the market resulted in a drop in price for first- and second-line treatments, third-line treatments remain unaffordable in poorer countries because of patents. Yet, more and more patients grow resistant to first intention treatments. The WHO, UNAIDS and UNDP have published [3] recommendations promoting the use of the TRIPS flexibilities [4] in order to improve access to HIV medicines. These flexibilities include the possibility, for the least developed countries [5], to import cheaper generic versions of medicines and not to grant pharmaceutical patents.

In 2 months, the WTO’s “Decision of 30 August 2003” will celebrate its 10 years, in which decision the paragraph 6 provides the mechanism of importation of generic medicines under patents for countries without the production capacity. This mechanism, prohibitive when considering its complexity, was only used once in 10 years. It is time to assess the situation and make some reforms to allow developing countries to import more easily the medicines their people need.

In order for the WHO’s new recommendations not to fall into deaf ears, Act Up-Paris (France) and Positive Génération (Cameroun) demand:

Of Southern Countries:
–  That they ratify and implement the WHO’s new therapeutic recommendations concerning HIV
–  That they fulfill the commitment taken in Abuja to allocate 15% of their national budget to health
–  That they use the flexibilities of the TRIPS agreement to their fullest extent in order to make the access to treatments and biological follow-up examinations easier for ill people
–  That they cease to criminalize the most vulnerable peoples and that they ensure them the same access to treatments as the rest of their population

Of Northern Countries:
–  That they fulfill their commitment on international solidarity against Aids by providing the Global Fund with $15 billion for the coming 3 years
–  That they authorize, within their national legislations, the making of generic versions of patented medicines meant for developing countries
–  That they cease to negotiate free-trade agreements with even more restrictive provisions than the ones in the TRIPS agreement, which may impede the access to generic medicines