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Declaration
of action
Pan-African HIV/Aids Treatment Access Movement (PATAM)
August 22, 2002
"We are angry.
Our people are dying".
Without treatment,
the 28 million people living with HIV/AIDS (PLWAs) on our continent
today will die predictable and avoidable deaths over the next decade.
More than 2 million have died of HIV/AIDS in Africa just this year.
This constitutes a crime against humanity. Governments, multilateral
institutions, the private sector, and civil society must intervene
without delay to prevent a holocaust against the poor. We must ensure
access to antiretroviral (ARV) treatment as part of a comprehensive
continuum of care for all people with HIV who need it. In this regard,
at a minimum, we call for the immediate implementation of the World
Health Organisation goal to ensure antiretroviral (ARV) treatment
for at least three million people in the developing world by 2005.
Together with our international allies, we will hold governments,
international agencies, donors and the private sector accountable
to meet this target.
We represent
activists and organisations from 21 African countries that met in
Cape Town, South Africa, 22-24 August 2002, and launched a Pan-African
HIV/AIDS Treatment Access Movement dedicated to mobilising our communities
and our continent to ensure access to HIV/AIDS treatment for all
our people who need it.
We have heard
reports on the state of HIV/AIDS treatment and prevention interventions
throughout the continent. Remarkable achievements have been registered
in every region resulting in some countries significantly reducing
new infections and improving care for individuals, families and
communities affected by HIV and AIDS. However, there was a consensus
that current efforts are insufficient. The AIDS epidemic has exposed
many of the problems facing Africa, including poverty, socio-economic
and gender inequality, inadequate health-care infrastructures and
poor governance. We insist that access to ARV therapy is not only
an ethical imperative, but will also strengthen prevention efforts,
increase uptake of voluntary counselling and testing, reduce the
incidence of opportunistic infections, and reduce the burden of
HIV/AIDS-including the number of orphans-on families, communities,
and economies.
The recognition
of the human rights to life, dignity, equality, freedom and equal
access to public goods including health-care are the fundamental
principles of a successful response to the epidemic. In this regard,
we reaffirm the Universal Declaration of Human Rights and the African
Charter on Human and Peoples' Rights. Furthermore, we recognise
that the rights of women, children and youth are particularly vulnerable
in Africa. Treatment and prevention strategies for HIV/AIDS must
consider their particular needs. Critically, the rights of people
with HIV/AIDS (PLWAs) must be protected, including equal access
to social services and to medical insurance plans. Discrimination
and stigmatisation threaten our dignity and hamper efforts to address
the epidemic. Our experience as African PLWAs has been that of token
involvement, not meaningful participation, in decision-making processes.
It is only through active involvement of PLWAs in all policy and
implementation decisions related to HIV/AIDS that we will achieve
our goals.
Alleviating
the effects of the AIDS epidemic will require political leadership
and greater accountability from national governments, international
organisations, the private sector, especially the pharmaceutical
industry, and wealthy countries, particularly the United States
and the European Union. We are faced with enormous barriers: national
governments do not prioritise HIV/AIDS treatment; donor countries
refuse to fulfill commitments to mobilise necessary resources; pharmaceutical
companies deny access to essential medicines and diagnostics by
charging exorbitant prices; structural adjustment programmes, driven
by the World Bank and International Monetary Fund, destroy public
health-care systems; and debt to rich countries hampers financing
of vital social services, including health-care. Community mobilisation
and civil society action are essential for forcing action and ensuring
greater accountability from all these institutions.
Health is a
prerequisite for sustainable development. The AIDS epidemic presents
an immense challenge to health-care systems in Africa. Sustainable
economic development can only be possible through the implementation
of sound social security policies that target the poor and include
HIV/AIDS treatment and prevention programmes.
A humanitarian
crisis due to lack of food security presents an immediate threat
to many Africans and the gravity of this situation is exacerbated
by the HIV epidemic. We therefore call for emergency food aid to
address this crisis. The delivery of this food aid should not be
hampered by unreasonable conditions imposed by donor or recipient
governments. Food security requires active intervention and planning
from the state to ensure sustainable production and equitable distribution
in a manner that benefits society. Farmers and other agricultural
workers and nutritional experts must be consulted.
We make the
following key demands of national governments in Africa, donor countries,
multilateral institutions, pharmaceutical companies, and the broader
private sector:
We demand that
National Governments in Africa:
- Create and
implement clear, legally binding HIV/AIDS policies and plans including
antiretroviral treatment as part of a comprehensive continuum
of care, which should be brought to scale and include:
- Prevention:
Expand distribution of male and female condoms, and invest in
research for microbicides and vaccines.
- Voluntary
Counselling and Testing (VCT): Ensure accessibility to VCT centres
in rural and urban areas. This will promote openness and assist
prevention and treatment efforts.
- Prevention
of Mother-to-Child-Transmission (MTCT)/Parent-to-Child-Transmission
(PTCT): Immediately implement programmes that integrate MTCT/PTCT
into all antenatal care facilities, as they serve as an important
entry point for care. Successfully implemented MTCT/PTCT prevention
programmes should be linked to existing and future ARV treatment
programmes, and must provide women with all information necessary
to make informed choices about feeding options.
- Post-Exposure
Prophylaxis (PEP) for sexual assault survivors and occupational
exposure:
- Treatment
of opportunistic infections (OIs): Treat aggressively all OIs,
including tuberculosis (TB), Kaposi's Sacoma, thrush, and meningitis;
expand access to key drugs such as fluconazole, acyclovir, and
cotrimoxazole; and monitor resistance and side-effects (especially
with cotrimoxazole).
- Treatment
of TB: Revise diagnostic protocols; improve diagnosis; devote
resources to research for new, easier to use drugs; and utilise
existing TB clinics to scale-up ARV programmes.
- Treatment
of sexually transmitted infections (STIs): Ensure access to appropriate,
vigourous treatment of STIs and education.
- Nutritional
support: Ensure adequate nutritional information, education, and
support to affected individuals and families.
- Palliative
care: Ensure clinic-linked home-based end of life care.
- Clinical
trials: Ensure that all clinical trials abide with universal ethical
guidelines and that pharmaceutical companies guarantee treatment
for life for all trial participants. This standard must be developed
by the WHO
- Fulfil commitments
made at the Abuja Summit to dedicate at least 15% of annual national
budgets to improve health, particularly HIV/AIDS, TB, and malaria
because of the overwhelming burden of death and disease on our
families, communities and economies. This should include ensuring
retention of skilled health-care workers through sufficient remuneration.
- Implement
the Doha Declaration on the TRIPS Agreement and Public Health,
and take steps to increase local production of generics through
south-south collaboration (including technology transfer with
Brazil, Thailand, India and other countries manufacturing generic
medicines)
- Ensure inclusion
of ARVs on national essential drug lists at primary care level
- Intensify
treatment education and promote treatment literacy for PLWAs,
communities, and health-care workers
- Apply to
the GFATM with comprehensive proposals that expand or launch ARV
treatment programmes using the lowest cost, quality drugs available
to ensure equitable and sustainable access
- Promote equity,
transparency and accountability in the allocation of national
health and HIV/AIDS budgets. Non-partisan resource allocation
is indispensable for effective health care interventions
- Eliminate
taxes on all essential medicines and diagnostics
We demand that
Donor Countries (members of the Organisation of Economic Development
and Cooperation or OECD and middle-income countries):
- Fulfil existing
commitments to adequately fund the Global Fund to Fight AIDS,
Tuberculosis and Malaria and other HIV/AIDS financing mechanisms
with at least $10 billion of new funding annually as a proportion
of GDP
- Implement
the Doha Declaration in good faith and resolve the problems of
production for export in a way that ensures that countries with
insufficient manufacturing capacity have the right to import quality
generics in the most efficient manner
- Immediately
stop pressuring developing countries to: focus primarily on prevention
interventions, procure drugs from proprietary companies only,
and scale back proposals to the GFATM
- Cancel debt
and ensure reinvestment into social services, particularly health-care
- Increase
investments into research and development for better drugs, diagnostics,
vaccines and microbicides
- We demand
that Multilateral Institutions (including WHO, WTO, UNAIDS, UNICEF,
the Global Fund, etc.):
- Immediately
develop a strategic plan including specific targets and timelines
to achieve the goal of providing ARV treatment for at least 3
million people by 2005
- Provide technical
assistance to African countries to develop and implement sound
treatment programmes and proposals
- Demand independence
from member states to fulfil mandates without political interference
- Define a
research & development agenda that will meet the needs of
resource-limited settings including simplified treatment regimens
(ARV therapy, TB); simplified diagnostic and monitoring tools
(for ARV therapy, TB, management of OIs); microbicides; and vaccines
- Develop international
ethical guidelines for clinical trials that guarantee life-time
treatment free of charge for all trial participants
Pharmaceutical
industry profiteering and patent abuse has already caused and continues
to cause death and suffering across our continent and elsewhere.
Excessive prices have ensured that this continent with the greatest
disease burden has the lowest access to essential medicines.
Therefore, we
demand that the Pharmaceutical Industry:
- Unconditionally
reduce prices of drugs, diagnostics, and monitoring tools
- Immediately
stop blocking the production and importation of generic drugs
by developing countries
- Issue non-exclusive
voluntary licenses upon request
- Provide free
treatment for life for all participants in clinical trials and
abide by international ethical standards to be developed by the
WHO
- We demand
that the Private Sector (including multinational corporations,
parastatals, large corporations, and other private sector entities):
- Contribute
to the social good through social investments to address HIV/AIDS
- Implement
comprehensive HIV/AIDS workplace policies, including provision
of HIV/AIDS education, VCT, psycho-social support, and provide
treatment, including ARV therapy, for all workers
- Adopt non-discriminatory
hiring and promotion policies and practices
- Ensure that
private medical insurance provides appropriate care and treatment
for PLWAs
AND we commit
ourselves to:
- Develop a
community-based response to the AIDS pandemic in Africa that places
PLWAs at the centre and ensures the involvement of PLWAs in key
decision-making processes that will affect our lives
- Mobilise
our communities, our political leaders, and all sectors of society
throughout the continent to ensure access to ARV treatment for
all who need it, starting with the immediate implementation of
the WHO goal to ensure ARV treatment for at least three million
people in the developing world by 2005
- Work with
our governments, wherever possible, to develop national treatment
plans that include ARV treatment as part of a comprehensive continuum
of care, with the concrete goal of providing ARV treatment for
at least 10% of the predicted number of PLWAs by 2005
- Advocate
for local production and importation of generics, regional procurement
of medicines, and other strategies to ensure equitable and sustainable
access to the lowest cost quality drugs, diagnostics, and monitoring
tools
- Hold our
governments, donors, international agencies, and the private sector,
particularly the pharmaceutical industry, accountable to implement
sound policies and programmes and meet identified targets by carefully
monitoring progress and raising our voices in protest when necessary,
together with our international allies
- Promote treatment
literacy for PLWAs, communities, and health-care workers by developing
and disseminating simple, accessible treatment education information
on all aspects of HIV/AIDS care and treatment
- Share information
and expertise with each other to support capacity-building for
increasing access to treatment at the local, national, and regional
level
- Mobilise
for a Global Day of Action on the Global Fund to Fight AIDS, Tuberculosis
and Malaria on 9 October 2002 to demand more money from donor
countries, prioritisation of treatment in national proposals and
funding decisions, increased transparency and monitoring of fund
disbursements, and active involvement of PLWAs in Country Coordinating
Mechanisms
- Mobilise
for a Global Day of Action Against Coca-Cola, the largest private
employer in Africa, and other multinationals on 17 October 2002
to demand ARV treatment for all HIV-positive workers and their
families
- Mobilise
for a Global Day for Access to HIV/AIDS Treatment on 1 December,
World AIDS Day, 2002
We know this
is an immense challenge. Millions of lives are at stake. We must
succeed."
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