Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

682 Abstracts ThPeG8399-ThPeG8403

XIV International AIDS Conference

ThPeG8399 Legal and ethical aspects of the treatment access
debate: A human rights perspective
E.T. Crone. Yale Law School, 265 College Street, #2G, New Haven, CT 06510,
United States
Issues: This presentation will be part of the ongoing development of model legislation and policy in the area of treatment access with respect to HIV/AIDS.
Description: We have witnessed a dramatic and unprecedented shift in the accessibility of HIV/AIDS treatment within the past two years. Anti-retroviral therapy,
once considered out of reach for the majority of those suffering from HIV/AIDS
around the world, is now a more real possibility for many Inherent in this changing landscape is a range of challenging legal and ethical considerations such as
intellectual property regimes, constitutional guarantees, laws regulating the provision of health care and the reality of who specifically will have access to medicines
in resource poor regions.
Access to HIV/AIDS drugs is a matter of life or death. A few of the questions
that will be considered during this presentation include: When equality and equity
are in conflict, can public health and human rights concerns be reconciled? What
should be the guiding principles in policy and legislation? And how can equitable
distribution be ensured?
Lessons learned: Ensuring that HIV/AIDS drugs are accessible and available to
those in need requires consideration of a range of complex factors ranging from
the actions of multi-national organizations such as the World Trade Organizations
and the international pharmaceutical industry to the case by case decisions of
treating physicians and clinics in resource poor settings. Wavering patent protection, dropping drug prices or robust constitutional provisions for the right to health
are alone insufficient.
Recommendations: Stepping outside of the clinical debate, access to antiretroviral therapy necessitates a consideration of intellectual property regimes,
national legislative frameworks and the allocation of budgetary resources. More
critical consideration must be given to what practical legislative and programmatic
provisions are needed.
Presenting author: Elizabeth Tyler Crone, 265 College Street, #2G, New Haven,
CT, 6510, United States, Tel.: [phone], E-mail: elizabeth.crone@yale.
edu
ThPeG8400 The role of the South African Government and
Pharmaceutical Companies in the access to
antiretroviral drugs in South Africa
SM. Cleary. University of Cape Town, health economics unit, anzio road,
observatory, 7925, South Africa
Issues: A key issue in accessing affordable antiretrovirals in South Africa is domestic intellectual property rights legislation. This research undertook a thorough
investigation of South African patent legislation for pharmaceutical drugs and
compared this to the Trade in Intellectual Property Rights (TRIPS) Agreement
of the World Trade Organisation.
Description: Using a game theoretic framework, this research analyses the
South African government's attempt to introduce the Medicines and Related Substances Control Amendment Act of 1997. In its original form, this had the potential to legislate TRIPS-compliant compulsory licensing and parallel importation of
medicines. The Office of the United States Trade Representative believed that this
legislation contravened TRIPS, and accordingly instituted trade pressure against
South Africa. Through the work of activists, this was dropped by mid-1999. On the
domestic front, the Pharmaceutical Manufacturers' Association - local umbrella
group of multinational pharmaceutical companies - instituted legal action against
the South African government. In April 2001, this case was settled out of court,
and a new Medicines Act was drafted which has the potential to legislate parallel
importation of medicines but not compulsory licensing.
Lessons learned: These proceedings attracted enormous media and activist
attention, leading to what has been called a public relations disaster for multinational pharmaceutical companies. In response, there has been a marked reduction in the prices of antiretroviral drugs in South Africa. This case illustrates
the value of activism. Civil pressure contributed to decreases in the prices of antiretrovirals even though political will was lacking.
Recommendations: Further activism is required if antiretroviral treatment is to
be offered to HIV-positive South Africans. In the interests of affordability, the government should be encouraged to take advantage of the flexibility of TRIPS.
Presenting author: susan cleary, health economics unit, anzio road, observatory, 7925, South Africa, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeG8401 Pharmaceutical access for the HIV-infected in
China: An policy analysis of WTO rules
M. Wang. USIP, Harvard University, United States

Issues: Does free trade affect access to affordable medication for the HIVinfected populations in developing countries? This project analyzes the case of
China in terms of its policies on pharmaceutical access within the free trade
framework of the World Trade Organization. The rate of HIV infection in China
has reached an epidemic level. According to China's Ministry of Health, the infected population has reached 1 million. China so far is still search for ways to
find affordable medications for the HIV-infected.

Description: China has become a member of the World Trade Organization since
November, 2001. However, the WTO presents a difficult framework for China to
negotiate affordable drugs for its HIV populations because of the free-trade principle of WTO. It will make it difficult for the Chinese government to demand compulsory licensing or similar practices to provide anti-retroviral treatment that affordable to the HIV-infected populations. This project reviews China's current policies
on pharmaceutical access for HIV-infected populations as well as analyzes how
the WTO's rules affect the provision of affordable medicine for the HIV-infected in
China.
Lessons: The developing countries can resort to a different trade framework
when it comes to the provision of affordable medication for the HIV-infected population. This framework might subscribes to the argument that HIV medication is
a public health issue and public health is an exception to the WTO rule.
Recommendations: 1. China needs to infer the public health argument for negotiating affordable HIV-related medicine. 2. China needs to engage in multi-lateral
negotiations for affordable treatment for the HIV-infected populations with other
WTO members as well as foreign pharmaceutical companies. 3. China needs
to come up with indigenous solutions, such as providing incentives for the local
pharmaceutical companies for R&D effort that leads to invention of affordable
cures.
Presenting author: Meiling Wang, 524 South 45th Street, Philadelphia, PA
19104, United States, Tel.: [phone], Fax: [phone], E-mail: meilingwang49@ hotmail.com
ThPeG8402 Mobile populations and their social conditions as
epidemic STD/HIV-AIDS vectors
D. HernAndez Rosete, S.M. Cuadra Hernndez, C.M. Rueda Neri. Centro de
Investigaci6n en Sistemas de Salud del/Instituto Nacional de Salud Pablica, Av
Universidad 655, oficina 212, Col. Santa Maria Ahuacatitl/n, CP 62508,
Cuernavaca, Morelos, Mexico
Objective: To analyze empirical evidence gathered along the Chetumal border
region (southeast Mexico) on the representation of STD/HIV-AIDS as a socially
invasive phenomenon attributed to mobile populations.
Method: This is a qualitative study carried out from January 18 and February 23,
2001, based on 64 in-depth interviews conducted with three source types: local
population (21), mobile populations in the region (22) and organizations detected
in the city (21).
Results: One aspect of the mobile population's vulnerability to HIV-AIDS infection
in Chetumal is that it is symbolically linked to the disease. It was determined that
strangers in this region are perceived as transmitters. This social perception has
repercussions on the quality of life among mobile population groups, due to processes of stigmatization through discrimination and socially accepted violence.
Conclusions: This representation gives way to the practice of violence and discrimination, which are not only in violation of Human Rights, but condition particular forms of living related to HIV-AIDS vulnerability.
Presenting author: Daniel Hernandez Rosete, Av. Universidad 655, oficina 212,
Col. Santa Maria Ahuacatitlan, CP 62508, Cuernavaca, Morelos, Mexico, Tel.:
+52+777+3110111 extensi6n 2654, Fax: +52+777+3111156, E-mail: danielshr
@hotmail.com
ThPeG8403 Migration adding vulnerability to HIV/AIDS: Gujarat
Tribal community experience
A.A. Patel, D. Teraiya, N.D. Mehta, U.A. Pandya. Project Support Unit, Gujarat
State AIDS Control Society, N-301, Shrinandnagar-3, Vejalpur, Ahmedabad
380051, Gujarat, India
Issues: Gujarat being an industrial state of India, migration from rural to urban is
common phenomena. The migration pattern observed can be classified as permanent and seasonal. The later one is identically seen in the tribal community.
Culturally, multi partner sex is normal practice in tribal community. Their interaction with urban groups due to the nature of work makes them vulnerable. When
they return to their villages, members are at risk. Sexual health services in tribal
areas are minimal hence vulnerability multiplies rapidly.
Descriptions: Approximately 1/3rd population of the state is tribal community.
Employment opportunity factor along with illiteracy and less technical knowledge,
makes them cheap labour force. It is difficult to trace them and follow up. Also
being contract cum bonded labour, the accessibility to any health service is very
difficult. Many times they set up temporary shelter at the place of work either in
or out side the city.
Lessons learnt:
- The activities of behaviour change and enabling environment implemented simultaneously at workplace and residence help to keep track of floating populations.
- Labour contractors can play the key role to influence such community.
- Efficient co-ordination among various partners implementing such project at

city, district and state level is must to ensure services.
Recommendations:
1. Research on migration patterns, health seeking behaviours and preferences
should be understood.
2. Services to be made available in migration route.
3. Identification of CBO to deliver services at workplace and their permanent residence and effective co-ordination among them is essential.