DRCAFTA and Key Challenges in HIVAIDS Treatment Access in Central America

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DR-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

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Winners 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.
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-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
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Test 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
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• 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.

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• 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.
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March Against CAFTA in Costa Rica
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(No Transcript)
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HIV/AIDS Treatment Access in Central America
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Belize
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
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Belize

• 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).

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Nicaragua

• 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

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Nicaragua

• 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

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El 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)

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Honduras

• 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

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Honduras

• 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
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Dominican 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

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Guatemala

• 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
  

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Costa 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

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Key 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

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THANK YOU!!
Eugene Schiff Agua Buena Human Rights
Association www.aguabuena.org Eugene.schiff_at_gmail.
com