Driving a decade of change: HIV/AIDS, patents and access to medicines for all

Abstract

Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilization that cleared the way for competitive production of generic versions of widely patented medicines.Global trade rules agreed upon in 1994 required many developing countries to begin offering patents on medicines for the first time. Government and civil society reaction to expected increases in drug prices precipitated a series of events challenging these rules, culminating in the 2001 World Trade Organization's Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health. The Declaration affirmed that patent rules should be interpreted and implemented to protect public health and to promote access to medicines for all. Since Doha, more than 60 low- and middle-income countries have procured generic versions of patented medicines on a large scale.Despite these changes, however, a "treatment timebomb" awaits. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required.One promising new mechanism is the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health.

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

“…Reasons include adolescents' risk taking behavior, the stage of development when thought and reasoning is not fully developed, and regimen fatigue [18,38]. As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38]. Some studies have reported adherence rates for long term prescription medications to be between 50-75% [18,19].…”

“…As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38]. Some studies have reported adherence rates for long term prescription medications to be between 50-75% [18,19]. In the present study, adolescents between 9-18 years (90.4%) were switched to 2 nd line medications, thus bringing into focus the issue of adherence to medications among adolescent, and the need to find a lasting solution to this reoccurring decimal.…”

“…Growing number patients in the developing countries have switched to 2 nd line therapy, and some requiring 3 rd line medications [18][19][20]. Failure to 1 st line ART has been documented in 13% of HIV-infected Uganda children [9], 16% in South Africa [21], 16% in Thailand [22], 33% in Kenya [23], 44% in Mali [24], 9.1% in another South African study [25], and 0.8% from a multi-center study in Africa and Asia [26].…”

Access to essential medicines for sexual and reproductive health care: the role of the pharmaceutical industry and international regulation

“…Governments and inter-governmental agencies must be called upon to live up to their obligations to protect access to medicines as a fundamental component of the human right to health. 65 At this point in time it is hard to imagine how such mechanisms can be put in place in a sustainable manner, given the extraordinary wealth and power of "big pharma". Nonetheless, there was a time not so long ago when it was also hard to imagine the growth in generic medicines, the incredible increase in access to treatment that has been achieved for people living with HIV and AIDS in developing countries, or the successful appearance of medical abortion pills in places where all the forces on earth ranged against women's right to a safe abortion have not been able to stop women getting access to them.…”

Antiretroviral purchasing and prescription practices in Mexico: constraints, challenges and opportunities

“…28 The TRIPS provides limited flexibilities to bend intellectual property rules in specific public health cases, but Mexico's compliance with the North American Free Trade Agreement (NAFTA) limits its ability to use them. In particular, this means that Mexico can't use the sole argument of excessive prices to make use of obligatory licenses to override patent monopoly and allow generic manufacturers to produce and market affordable versions of patented drugs.…”