Marwaan Macan Markar interviews MICHEL SIDIBE, chief of UNAIDS
BANGKOK, Mar 24 2009 (IPS) – The global financial crisis has created a space for a vigorous debate on the life-prolonging drugs needed for people living with HIV, says Michel Sidibe, the new head of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
Michel Sidibe Credit: UNAIDS
The global financial crisis has created a space for a vigorous debate on the life-prolonging drugs needed for people living with HIV, says Michel Sidibe, the new head of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
Against such a prospect, however, is the inevitable gloomy forecast that the financial contagion can impact the programmes to prevent the spread of the killer disease and to care for those infected by the epidemic in regions like Asia, according to Sidibe.
Asia is home to some five million people of the 33 million people living with HIV globally. There were 380,00 new infections recorded and the same number of people died from AIDS-related illnesses across the continent last year.
Nearly three million people were receiving anti-retroviral treatment (ARV) in low- and middle-income countries, the Geneva-based U.N. body stated in its 2008 global report on the killer disease.
That number accounted for only a third of the people in the developing world who need ARV coverage. In East, South and South-east Asia the ARV coverage is slightly lower, with only a fourth of those who need the treatment having access.
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Central to the debate for the life-prolonging anti-AIDS drugs is the push by some developing country governments and public health activists to use international trade rules that grant poorer nations the right to break patents of expensive brand-name drugs produced by pharmaceutical giants to deal with public health emergencies.
This option is recognised by the World Trade Organisation (WTO) under the flexible provisions of the trade related intellectual property rights (TRIPS). Through TRIPS, developing countries can issue compulsory licenses (CLs) to seek alternative and cheaper generic versions of brand-name drugs.
Yet, though the TRIPS flexibilities were approved at a WTO ministerial meeting in Doha, in 2001, developing countries avoided testing the provision fearing a backlash from the world s powerful economies, such as the United States, which has sided the drug multinationals.
Thailand has emerged as a front-line state in this battle. In late 2006, it issued CLs for two anti-AIDS drugs, adding to a list of cheaper generic drugs it has been locally producing for its citizens living with HIV.
Such efforts have enabled the South-east Asian country to ensure 200,000 people with HIV receive ARV treatment of the 600,000 people living with the HIV in the country, consequently placing Thailand, along with its poorer neighbour Cambodia, among the worlds 20 nations where ARV coverage is between 50-70 percent.
Sidibe, a Mali national, sat down with IPS correspondent Marwaan Macan-Markar for an interview while on a recent visit to Bangkok.
IPS: You are starting your job as the new head of UNAIDS at a time when there is so much bad news stemming from the global financial crisis. Do you worry that the crisis will impact HIV/AIDS programmes in Asia? Michel Sidibe: Yes, because even before the crisis Asia was facing an annual financial gap of two billion US dollars to scale up its programmes for universal access for HIV prevention, treatment, care and support. The minimum annual investment Asia needs is about 3.1 billion dollars; what it currently attracts is 1.2 billion dollars.
IPS: Are there particular areas of concern in Asia? MS: The roots from where the infection is spreading are underfunded. There is a need for more investment to help the most vulnerable groups such as injecting drug users, men who have sex with men and sex workers. This is because of the lack of prioritisation in responding to the epidemic.
The financial crisis can also lead to a collapse of a caring society in the region. It will create a major burden for people with HIV, since caring for them requires money and time. It is this safety net that has been important to take care of children who have become orphans after their parents died and to care for people with HIV in countries like Cambodia and Laos.
IPS: There are already reports in South-east Asia of growing unemployment because of a dramatic drop in exports. If there are people with HIV among this newly unemployed, it will not be easy for them to buy ARVs. Do you think the crisis will strengthen the case for countries to use the TRIPS flexibilities and issue compulsory licences to secure cheaper drugs for their people? MS: It is a good time to use the crisis for a debate around the issue of access to treatment. There will soon be a need for second- and third-line treatment, because the majority of people are still receiving the first-line treatment. There should be a possibility to reduce the price of second- and third-line drugs like we did with the first line-drugs. But we must make sure we have a mechanism to help to maintain innovation, research and development of new drugs.
We can use this time to make countries know what opportunities they have under the TRIPS agreement. Few of them are using it today in Asia. Most of the countries don t have the knowledge to explore the opportunities under TRIPS.
IPS: But you admit that the crisis will result in tough choices for people living with HIV, especially those who need ARV treatment MS: Two things: we don t want a mother to make a choice between treatment and breastfeeding a child. The financial crisis should not lead a mother to make such a choice- to abandon treatment or to abandon breastfeeding. Because AIDS is not only about health; it is about human rights.
IPS: Finally, Burma, or Myanmar, doesn t seem to view the epidemic the way you do, from a rights perspective. Its HIV prevalence rate is 1.3 percent, which places it third after Cambodia and Thailand in South-east Asia. Yet the junta has placed restrictions on programmes to help people living with HIV. Have such policies curtailed your organisation s work there? MS: We have an office there and are developing a national strategy with the government to build a monitoring system to collect data. We have begun to reopen the discussion with the Global Fund (the humanitarian agency to finance AIDS, tuberculosis and malaria that pulled out of Burma in 2005). To deal with them in isolation will not help. An integrated, cross-border, sub-regional approach will help.
