PMID: 11816178

Issn Print: 0269-9370

Publication Date: 2001/01/01


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Access and activism: the ethics of providing antiretroviral therapy in developing countries

Tido von Schoen Angerer; David Wilson; Nathan Ford; Toby Kasper

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Last years XIII International AIDS Conference in Durban, South Africa, marked a paradigm shift. Held for the first time on the continent worst affected by AIDS, the conference focused the eyes of the world on the plight of the more than 30 million people living with HIV/AIDS in poor countries. Leading scientists, government agencies and activists all argued that it is no longer acceptable that the vast majority of people with HIV/AIDS are left without treatment. Thanks to determined advocacy by people living with HIV/AIDS, non-governmental organizations (NGO) and other pressure groups, the provision of affordable treatment, in particular, antiretroviral therapy (ART), is now a worldwide concern.
The public health importance of intellectual property rights first came to public prominence in May 1998 during the World Health Assembly, the annual gathering of member states of the World Health Organization (WHO). Activists in developed and developing countries began testifying to the negative impact of global trade agreements on access to drugs. Public concern was further amplified during the protests around the World Trade Organization (WTO) meeting in Seattle, December 1999 [1]. Since then, activism has concentrated on the right of developing countries to produce and import affordable generic antiretrovirals.
But access to antiretroviral treatment, and indeed the prophylaxis and treatment of opportunistic infections, remains vastly insufficient in developing countries. Last year, only six developing country governments (Brazil, Argentina, Uruguay, Mexico, Chile and Costa Rica) were providing antiretroviral treatment for the majority of people for whom treatment is indicated [2].
The price of antiretroviral drugs has been dramatically reduced, largely thanks to public pressure and increased generic competition. As the cost of antiretrovirals comes down, treatment moves within reach of greater numbers of people living with HIV/AIDS. But cost is not the only issue. This paper begins by reviewing the essential role played by activism in challenging the view that antiretroviral treatment is not possible in developing countries. It then reviews existing experiences with ART in developing countries and explores the challenges of wider implementation that lie ahead.
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