Title: DRCAFTA and Key Challenges in HIVAIDS Treatment Access in Central America
1DR-CAFTA and Key Challenges in HIV/AIDS Treatment
Access in Central America
Prepared for Conference on Access to Medicines
and Intellectual Property April 19-21 Ottawa,
Canada
- Eugene Schiff
- Agua Buena Human Rights Association
2Winners and Losers
- Trade agreements inevitably have winners and
losersThose who stand to lose in the DRCAFTA
are the ones who are already disadvantaged in
these highly unequal societies, where the
majority of poor people live in rural areas, rely
on income from agriculture and must pay for
medicines out-of-pocket.
-Written Testimony before the US House Ways and
Means Committee, Stephanie Weinberger, Policy
Advisor to Oxfam. April 21, 2005.
3-Image from Wikipedia, Taken at White House.
Courtesy of US Federal Government
- Francisco Flores Pérez El Salvador (former
President) Dec. 2004 - Ricardo Maduro Honduras (former President)
March 2005 - President George W. Bush USA - July 2005
- Abel Pacheco Costa Rica (former President),
- Enrique Bolaños Nicaragua (former President)
September 2005 - Alfonso Portillo Guatemala (former President)
March 2005
CAFTA came into effect March 1, 2006 in El
Salvador USA, then Honduras, Nicaragua,
Guatemala
4Test Data Exclusivity
- Test data exclusivity refers to protection of
clinical test data required to be submitted to a
regulatory agency to prove safety and efficacy of
a new drug, and prevention of generic drug
manufacturers from relying on this data in their
own applications. - Pharmaceutical companies argue that since test
data is so expensive to produce, it is an unfair
advantage to let other companies rely on that
data without cost. - Critics charge that it can act as a restriction
to producing a generic copy that although it
would not raise prices of drugs, it would prevent
prices from falling due to generic competition
and make it more costly for the poor to gain
access to life-saving drugs (e.g. anti-HIV
anti-malarial medications.) -
- Developed countries with innovative
pharmaceutical industries (including the United
States) have sought data exclusivity provisions
in Free Trade Agreements with their trading
partners, e.g. DR-CAFTA which includes such a
provision
-Wikipedia
5- In controversial areas, such as the impact of
more stringent standards (TRIPs plus) for
protecting pharmaceutical patents, no
methodologies have yet been developed to evaluate
the welfare impacts of these types of commitments
especially if we consider gains from other
aspects of the FTA. While greater IPR protection
usually means restrictions on the use of generic
drugs, the treaty seems to provide flexibility
for governments to bypass the usual protections
in order to protect public health, through
compulsory licensing and the option of parallel
imports. -
- -World Bank Report on DR-CAFTA Challenges and
Opportunities in Central America (p. 51)
Released June 28, 2005.
6- Guatemalan Anti-Free Trade Protester Shot Dead
- Reuters
- March 16, 2005
- By Frank Jack Daniel
- GUATEMALA CITY, Mar 15 (Reuters) - At least one
person was killed and several - injured in Guatemala on Tuesday when police tried
to disperse a protest against a - controversial free trade agreement.
- Protesting teachers and farmers say the police
fired live rounds as they tried to clear a - demonstration from a road 180 miles (290 km)
north of Guatemala City close to the - border with Mexico in the highland region of
Huehuetenango. - "(The protesters) say the dead man was shot at
point blank range ... but this will have to - be established by appropriate authorities," said
Huehuetenango Governor Mauro - Guzman.
- Staff at a local hospital said four people were
receiving emergency care for bullet wounds
Dec. 2003 ACT-UP NYC Protest in Washington D.C.
7March Against CAFTA in Costa Rica
8(No Transcript)
9HIV/AIDS Treatment Access in Central America
10Belize
440 People on Treatment, all with generic,
first line medicines provided for free along
with 4 CD4 tests per year No access to
second line medicines (March 2007) Children
and adults dying because they cannot access
Kaletra No Viral Load or Resistance Testing
available in Belize
11Belize
- Belize is technically ineligible for future
Global Fund projects due to its GDP and HDI. - High levels of Stigma and discrimination very
few people living with HIV/AIDS willing to come
forward publicly - Belize has the highest rate of HIV in Central
America and the third highest in the Americas
after Haiti and Guyana with an estimated 2.4 of
the adult population HIV positive (UNAIDS).
12Nicaragua
- Poorest Country in Central America, yet reports
the smallest HIV/AIDS epidemic - Only 348 People with Access to ARV Medicines
(Feb. 2007) - Large Donations of ARV medicines from Venezuela,
Brazil, and the Global Fund Project, smaller
number with medicines from government resources - Cuban Doctors working in rural communities along
the Caribbean Coast
13Nicaragua
- Recent stock outs of second line drugs including
Nelfinavir (Roche) and Ritonavir (Abbott) - Previous Government Signed DR-CAFTA but current
government led by Sandinista Daniel Ortega more
closely allied with Cuba and Venezuela promises
to eliminate all user fees in schools and
hospitals - Todo Generico Generic Medicines Only Policy
Promoted by New Government - Site of CONCASIDA Conference in November 2007
14El Salvador
- Highest Prices for Antiretroviral Drugs in the
Region - First Country to Sign CAFTA
- National HIV Prevalence in Adults 0.9 (UNAIDS)
- Number of People living with HIV/AIDS 36,000
(UNAIDS) - Estimated Number of Deaths due to HIV/AIDS 2500
(2005, UNAIDS) - Cost of 2nd line treatment - tenofovirabacavirl
opinavir/ritonavir) is 7613 per year (WHO,
UNAIDS, Unicef Report April 2007)
15Honduras
- Logistical problems and long interruptions in
supply of lab tests including CD4, Viral Load,
and Resistance Testing, which are required in
order to receive second line medicines - Despite price reductions and small donations
there are still waiting lists and high prices for
second line medicines such as Kaletra, which is
also not available in heat stable formulation in
Central America - User Fees charged at point of care for
antireotriviral medicines and lab tests serve as
a barrier to access, adherence, and form of
further impoverishment of people living with
HIV/AIDS
16Honduras
- Lack of access to antiretroviral medicines in
several regions of the country, including the
large area of Olancho, La Mosquitia, and Western
Honduras - Garifuna Communities along Caribbean Coast report
high rates of HIV/AIDS (8) - Uncertainty about sustainability of treatment
access and Global Fund Project, as the proposal
for round six was rejected and the current Round
1 Grant ends in approximately one year (May
2008).
Punta Piedra
17Dominican Republic
- Haiti and the Dominican Republic mark the
epicenter of the HIV/AIDS epidemic in the
Caribbean - Haitians in the Dominican Republic face
discrimination and difficulties accessing health
care which extends to Haitians with HIV/AIDS
trying to access ARV medicines - Prisoners, Pregnant Women, Injection Drug Users
with HIV/AIDS face extraordinary challenges in
getting access to medicines, lab tests, and basic
care - People living with HIV/AIDS excluded from new
Social Security System as result of regressive
policy and weak government commitment - Constant and increasing evidence of political
patronage, misguided priorities and waste of
resources in management of Global Fund Project by
COPRESIDA reflects high level disinterest and
disregard for HIV/AIDS epidemic and people living
with AIDS on the island
18Guatemala
- Serious lack of access to HIV Testing and
treatment in rural areas and among indigenous
communities - Chronic lack of government investment in health
care and acute budget shortages for National
HIV/AIDS Program (3 Million Short in 2007, and
Guatemala may need to invest 107 Million to
provide universal access to ARVs by 2015) - 40 Million HIV/AIDS Global Fund Project managed
by World Vision Guatemala -
- New guidelines for first line antiretroviral drug
therapy switch to tenofovir/emtricibine
efavairenz from triomune and similar combinations
19Costa Rica
- Only country that has yet to ratify CAFTA, major
protests and opposition to the trade agreement
primarily in relation to state owned
telecommunication sector - Estimated 3000 PLWA with ARVs - highest
percentage of coverage of any country in Central
America - Due to elevated prices from ongoing differential
drug pricing set by multinationals, Government
and Caja de Seguridad Social have used
non-prequalified generic antiretroviral medicines
for many years - Estimated 95 PLWA needing medicines with access
20Key Issues
- CAFTA only potentially affects newest ARV
medicines, scary IP provisions but little if any
impact so far - Coordinated local and international advocacy
oriented towards national governments and
specific drug companies can be more important and
effective - Moving from theory to practice, requires paradigm
shift and constant advocacy until the poorest
people in Latin America receive preferential, not
just charity or even equitable access to
essential medicines and health care
21THANK YOU!!
Eugene Schiff Agua Buena Human Rights
Association www.aguabuena.org Eugene.schiff_at_gmail.
com