AIDS TREATMENT NEWS Issue #363, March 30, 2001
phone 800-TREAT-1-2, or 215-546-3776

Contents

** Africa Access: AIDS Activists Organizing Burkina Faso
Summit on Generics
AIDS activists internationally have organized a meeting in
Africa for health ministers from developing countries,
funders, and others; interview with Paul Davis and Asia
Russell, ACT UP Philadelphia.

** European Parliament Supports Treatment Access in
Developing Countries
On March 15 the European Parliament "called for the
development of a system that allows developing countries
equitable access to affordable medicines and vaccines." It
urged the pharmaceutical companies suing South Africa to
drop their lawsuit (which they did on April 19).

** Therapeutic Drug Monitoring: Medscape Web Resource Page
Medscape, a major medical Internet site, recently started a
page of links to information about the possibility of
measuring blood levels of antiretrovirals, in order to
adjust doses for individual patients if necessary, to
maintain effective levels and avoid side effects. This page
will be updated to include new information.

** AmFAR Treatment Directory: How to Obtain a Free Copy
Free copies of the AmFAR HIV/AIDS TREATMENT DIRECTORY are
available from the National Prevention Information Network
of the U.S. Centers for Disease Control -- along with other
information on HIV, sexually transmitted diseases, and
tuberculosis.

** Twinning U.S. and African AIDS Organizations: NMAC
Training in U.S. Cities
The National Minority AIDS Council has started an organized
program of pairing U.S. and African AIDS organizations. A
series of six four-day trainings will be held in U.S.
cities, starting in May.

** Barcelona 2002: International AIDS Conference Seeks
Scientific Program Coordinator
The next international AIDS conference, July 2002 in Spain,
is seeking a coordinator to help organize the scientific
program.


***** Africa Access: AIDS Activists Organizing Burkina Faso
Summit on Generics

Interview with Paul Davis and Asia Russell, by John S.
James

Earlier this year Paul Davis and Asia Russell traveled to
Paris to help plan the Summit on Generics, a meeting for
health ministers from developing countries and others,
originally scheduled for May 3-7 in Burkina Faso, West
Africa -- shortly before the important World Health
Assembly in Geneva. Activists from Paris and from Burkina
Faso had organized the generics meeting. We asked Paul
Davis and Asia Russell, both members of ACT UP Philadelphia
and of the Health GAP Coalition, to tell our readers what
was happening.

This interview took place in early March. Paul and Asia
made changes on April 5.

AIDS TREATMENT NEWS: What was the meeting in Paris, and why
was it important?

RUSSELL: Every year in May the top government health
officials from around the world meet in Geneva, at a
conference called the World Health Assembly. This year the
U.S. delegation will be headed by Tommy Thompson, the new
Secretary of Health and Human Services appointed by
President Bush. All countries that are members of the World
Health Organization can send a delegation.

Last year a few AIDS activists from the U.S. and elsewhere
went to the World Health Assembly meeting, and found that
delegates from poor countries were at a big disadvantage.
The U.S. delegation had almost 30 members, but many small
countries could only afford to send one, two, or three. So
the agendas of the rich countries -- mostly set by big
pharmaceutical companies -- were the ones the meeting
served.

DAVIS: For example, one of the important issues for poor
countries is to get the World Health Organization to give
them practical help by compiling a database of worldwide
prices for high-quality drugs. But pharmaceutical companies
are strongly opposed; they want to sell their drugs at
their prices to countries that do not have the resources to
compile this information themselves.

So last year at the World Health Assembly, people were
lured away to parties and receptions and meeting rooms, and
the United States in one unseemly maneuver convened a
meeting of mostly wealthy countries to make decisions that
included this database of drug prices around the world.
They killed this database at a closed-door meeting when
most of the delegates were absent. So we ran around to
inform the delegates from the global South [the world's
poorer countries] to attend this meeting, that it was
happening right then, and they were excluded from decision
making. They were very angry when they found out what had
happened.

AIDS TREATMENT NEWS: What is being done differently this
year?

DAVIS: This year ACT UP Paris and African and other AIDS
NGOs [non-government organizations, usually called
nonprofits in the U.S.] have organized a pre-meeting for
health ministers, people with AIDS, activists, health care
providers and others in Burkina Faso, in early May, shortly
before the World Health Assembly meeting in Geneva. The
Burkina Faso meeting builds on the experience last summer
at the World AIDS Conference in Durban, South Africa, where
ACT UP Paris called a very successful meeting of health
ministers and generic drug manufacturers to talk about drug
availability and procurement. At Burkina Faso the
participants will have a chance to talk and strategize
among themselves, and then bring their own agendas,
including access to high-quality affordable medicines, to
the World Health Assembly in Geneva. The World Health
Assembly meeting, in turn, will set the mandate for the
World Health Organization for the next year.

The meeting in Paris that Asia Russell and I just attended
was a planning session for the Burkina Faso meeting, which
will be called the Summit on Generics.

AIDS TREATMENT NEWS: Who else is helping organize the
Summit on Generics?

DAVIS: ReMeD (Réseau Médicaments et Développement / Drugs
and Development Network) a rational drugs use agency which
is doing a lot on the ground in Africa, has been partners
with ACT UP Paris in organizing this meeting. RAP+ (African
Network of People with AIDS), Health Action International,
which has many local groups in Africa, Women Fighting AIDS
in Kenya (WOFAK) and many other groups were also helping in
Paris. MSF (Doctors Without Borders), and Oxfam GB, are
also sponsors of the Summit on Generics.

DAVIS: This meeting has several purposes:

* This will be a very crowded calendar year for treatment
access campaign issues. The Summit on Generics in Burkina
Faso will be a place to share information among those
seeking wider access to AIDS medicine.

* It will also help share information and build solidarity
among national campaigns. Already at the Paris meeting
there were people from Burkina Faso, South Africa,
Zimbabwe, Kenya, Cote d'Ivoire, Burundi, Cameroon, and
several other countries.

If we are successful in creating a bulk procurement and
distribution program at the U.N. level, it still will
require local support within nations. So there are many
threads coming together in this Summit. The planning
meeting was put together very well.

* The Summit on Generics will serve as a pre-meeting or
orientation to other meetings coming up during the year in
addition to the World Health Assembly. This includes the
United Nations Special Session on HIV and AIDS (UNGASS) and
the G-8 meeting in July in Genoa, Italy.

* And after the health ministers and treatment access
campaigners have talked among themselves, they will meet
with funders -- corporate sponsors, foundations, rich-
country donors and others, and with decision makers, to
talk about practical solutions. Now that we have made
progress in getting the United States to be somewhat less
of an obstruction to access to medicine, it is time for
rich countries, especially the U.S., and foundations to be
involved in solutions. This is the agenda we will bring to
the World Health Assembly, where we will be focusing on the
essential drugs list; this is among the proposals we are
bringing to UNGASS, where we will focus on bulk drug
procurement; and we will also be focusing on debt
cancellation later in the year. So we will be trying to tie
up many strings in the Burkina Faso Summit on Generics.

We hope this summit can serve as a pre-meeting to
strategize, and prepare an agenda, because in the past the
people who came with an agenda were mainly pharmaceutical-
company representatives.

RUSSELL: In the fight for treatment access, generic drugs
for HIV treatment need to be talked about as a key tool
that poor countries can use to translate the desire for
sustained access to affordable medication into reality.

Especially in Africa, some key medications are patent
protected, while others are not currently patented--so
there is a lot of information about intellectual property
law and the recourses countries have, such as compulsory
licensing, that will be shared and discussed at this
important Summit on Generics. Even countries where there is
little patent protection currently, and where generics
could provide low cost, quality access, are facing dramatic
new restrictions to their domestic patent laws, thanks to
the rules of the World Trade Organization. Now is a
critical time to be strategizing with an array of activist
and health care organizations about coordinated efforts to
fight for access to affordable medication.

To listen to the brand-name pharmaceutical companies,
generics amount to no more than "piracy." Much of this
summit will be cutting through some of the myths with
facts, and talking in a hands-on way about the resources
people need and next steps people can take in order to make
access to affordable medicine a reality.

Note: The Web site for the Summit on Generics is
http://www.genericsnow.org

Note: We have received word that the Summit on Generics may
be postponed due to scheduling difficulties. For more
information, check the Web site or contact ACT UP Paris:
Sylvain Coudret, Planet Africa, Commission Nord/Sud, Act
Up-Paris, BP287 - 75525 Paris Cedex 11; fax: (011) 33-1-48-
06-16-74, email: planetafrica@...


***** European Parliament Supports Treatment Access in
Developing Countries

Introduction by John S. James

On March 15 the European Parliament adopted the following
resolution on access to HIV and other treatment in poor
countries. It is not widely known in the U.S., so we are
reprinting it here.

Paragraph number 6 (see below), on the TRIPS agreement, was
particularly fought for by international AIDS activists.
TRIPS (the agreement on Trade-Related Aspects of
Intellectual Property Rights) is the part of the WTO (World
Trade Organization) treaty dealing with intellectual
property.

Note: The European Parliament, also not well known in the
U.S., is in fact a model for democratic governance in an
age of growing globalization. For over 20 years it has been
directly elected by citizens of different countries,
bypassing national governments (one person one vote, but
with some weighting to help small countries). Today it has
significant power, with veto authority over about 80% of
European Union legislation. For more information (in your
choice of 11 languages) see http://www.europarl.eu.int/

For a look at the development of international civil
society today, and a call for a popularly elected world
assembly, see "Toward a Global Parliament" by Richard Falk
and Andrew Strauss, FOREIGN AFFAIRS January/February 2001,
volume 80 number 1. Both authors are professors of
international law, but the article is written for
nonspecialists.

Note: As this issue went to press, the April 19 withdrawal
of the pharmaceutical industry lawsuit against South Africa
made headlines around the world -- marking a milestone in
the development of international civil society. We will
have more information in AIDS TREATMENT NEWS #364.

* * * * *

Statement approved by European Parliament, March 15, 2001:

Access to Medicines for AIDS Patients in the Third World

The European Parliament,

-- having regard to its previous resolutions on AIDS and
sexually transmitted diseases,

A. whereas 95% of people infected with HIV live in the
developing world, including more than 25 million in sub-
Saharan Africa, one of the world's most infected regions,

B. whereas over half of all new cases are amongst young
people under the age of 25, who make up the most
economically active part of the population, and each 15-
year-old in South Africa has a 50% risk of becoming
infected and dying from AIDS,

C. whereas it is predicted that in South Africa, where 1 in
10 South Africans are HIV positive, HIV/AIDS will reduce
life expectancy by 20 years by 2010, and whereas hundreds
of thousands of South Africans die every year from AIDS,
tuberculosis and malaria,

D. whereas anti-retroviral drugs have already reduced the
number of AIDS deaths in Europe and the USA by 75%, but the
price of these drugs keeps these medicines out of reach of
millions of infected people, notably in Africa,

E. whereas the Commission's February 2001 Communication on
a Programme of Actions to combat HIV/AIDS, malaria and
tuberculosis includes a commitment to tiered pricing where
developing countries pay the lowest possible price for
medicines, an acknowledgement of the possibility of
exploring the best use of compulsory licensing systems and
a commitment to launch a debate in the WTO on reconciling
the TRIPS agreements with the objectives of health
protection in developing countries,

F. whereas Article 31 of the WTO/TRIPS Agreement permits a
country to enact national laws permitting the use of a
patented product without the authorization of the patent-
holder (compulsory licensing) under certain specified
circumstances,

G. whereas many drugs are unaffordable because of patents
which allow the companies a monopoly for 20 years from the
date when the patent is filed,

H. whereas the court case between 39 pharmaceutical
companies and the South African Government over the terms
of its 1997 Medicines Act has now been adjourned in order
that the Pharmaceutical Manufacturers Association of South
Africa can provide the information requested by Judge
Ngoepe,

I. whereas the Kenyan Government has announced its
intention to implement a law that would allow it to obtain
cheap life-saving medicines, under the provisions of the
current TRIPS Agreement,

J. whereas the US has taken legal action in the framework
of the TRIPS Agreement at the WTO against Brazil, which has
shown that through improvements in its health care system,
combined with the provision of generic medicines, it is
possible to halve the mortality rate of people with AIDS,
for allowing the national production of generic medicines,

K. whereas the EU has asked the new US Administration to
work with it on an initiative to get anti-AIDS drugs to the
developing world at prices it can afford and this issue
will be dealt with at the EU-US June Summit in Stockholm,

L. whereas tropical diseases such as malaria, tuberculosis
and sleeping sickness kill millions of people each year,
particularly because of the increase in resistance or the
non-existence of treatments due to research having been
abandoned simply on grounds of commercial profitability,

1. Calls for the development of a system allowing
developing countries equitable access to medicines and
vaccines at affordable prices, while expressing its
solidarity and support for the Governments of South Africa
and Kenya in their struggle to use WTO-compliant
legislation to gain access to the cheapest possible life-
saving medicines;

2. In this context welcomes the statement by Commissioner
Lamy that the Commission supports the right of developing
countries to use the safeguards in the WTO/TRIPS Agreement,
including compulsory licensing, and the commitment by the
Commission to launch a debate in the WTO on reconciling the
TRIPS Agreement with objectives regarding health protection
in developing countries;

3. Calls on the pharmaceutical companies that issued a
legal challenge to the South African 1997 Medicines Act to
withdraw from the case;

4. While respecting the intellectual property rights of the
pharmaceutical industry, calls on the Commission to
strengthen the ability of developing countries to resist
the pressure to introduce more stringent patent laws than
those currently required under the WTO TRIPS Agreement;

5. Calls on the Commission to work with the Member States
to show international leadership in the struggle for life-
saving medicines by encouraging technology transfer and
support for the strengthening and/or development of local
production capacity;

6. Calls for the current review of the TRIPS Agreement to
ensure that the rights of developing countries to obtain
the cheapest possible life-saving medicines, whether
patented or generic, are guaranteed, and further calls on
all the interested parties to actively engage in this
process;

7. Instructs its President to forward this resolution to
the Commission, the Council, the WTO, the ACP-EU Joint
Parliamentary Assembly and the OAU.


***** Therapeutic Drug Monitoring: Medscape Web Resource
Page

by John S. James

Therapeutic drug monitoring (TDM) means measuring the level
of a drug actually found in the blood (or inside certain
blood cells), in order to adjust the drug dose up or down,
either to make sure there is enough to inhibit HIV or to
avoid side effects. The reason for measuring drug levels is
that people are different, both in how well they absorb
drugs from the stomach or intestines, and in how rapidly
the body destroys or eliminates the drugs. For various
reasons, there is most interest today in measuring blood
levels of protease inhibitors.

For years there has been reluctance to measure HIV drug
levels in routine patient care, because the current one-
size-fits-all dosing is more convenient. Companies are
racing to make their medicines easier to take (preferably a
single pill once a day), and adjustable dosing would
probably require more pills and/or increase the chances of
error. Companies have incentive to sell their existing
products -- not to bring attention to their variable blood
levels or other complications.

TDM is not yet part of standard HIV care, but increasingly
new information suggests that it may become important for
helping antiretrovirals work better. In the future, it is
likely that shortly after one has started taking a protease
inhibitor (and perhaps other antiretrovirals as well), the
blood level will be tested in order to adjust the dose if
necessary.

Recently the Medscape HIV/AIDS Web site
(http://hiv.medscape.com) added a page of links to recent
articles, conference summaries, news reports, and other
information about therapeutic drug monitoring in HIV
treatment. This page will be updated as new information
becomes available. Currently the link is under "Resource
Centers" on the home page.

Note: You need to register in order to read the articles on
the Medscape site, but registration is a one-time process
and is free. You will need to make up a user name and a
password, and write them down for when you use the site
again; you will also be asked to complete a short survey.
This site has much useful information and is worth the
trouble of registering.


***** AmFAR Treatment Directory: How to Obtain a Free Copy

In our last issue we reviewed the new AmFAR HIV/AIDS
TREATMENT DIRECTORY, and suggested contacting the AmFAR
(the American Foundation for AIDS Research) New York office
for a copy. That office cannot handle the volume of
requests, and asked us to let readers know that they can
obtain a free copy from the National Prevention Information
Network (NPIN), 1-800-458-5231, Monday through Friday 9
a.m. to 6 p.m. Eastern Time, or by email at
info@..., or by mail at NPIN, P.O. Box 6003,
Rockville, MD 20849. NPIN can send a copy to U.S. or
international addresses. Be sure to include your mailing
address including ZIP code, and the name of the book, the
AmFAR HIV/AIDS TREATMENT DIRECTORY.

For more information on educational materials about AIDS,
sexually transmitted diseases, or tuberculosis, see
http://www.cdcnpin.org

The AmFAR office does offer a paid subscription to the
directory, allowing you to receive the new issues
automatically when they come out. For more information on
subscribing, call 1- 800-38-AMFAR.

Anyone can read the online version of the directory at
http://www.amfar.org/td


***** Twinning U.S. and African AIDS Organizations: NMAC
Training in U.S. Cities

The National Minority AIDS Council (NMAC), working with the
U.S. Office of AIDS Research (OAR), will be holding a
series of 4-day workshops on partnerships between U.S. and
African AIDS organizations. Two African organizers --
selected by a coalition of African organizations -- will
attend each of these workshops.

The following dates and locations were announced April 20,
2001:

* May 15-18 in Seattle (with Martha Nthenge who works at
KANCO, Nairobi, Kenya and Amina Ridwani, who works with
MAWA, in Mombasa, Kenya); for more information about the
Seattle meeting, see:
http://www.nmac.org/conference/regionals/seattle/letter.htm

* June, to be announced;

* July 10-13, in New York City;

* July 31 - August 3, in San Juan, Puerto Rico;

* October, in San Antonio, Texas; and

* October 30 - November 2, New Orleans.

From the Announcement:

What Is Twinning?

Twinning is a formal, substantive collaboration between two
organizations. The word formal implies that there is an
agreement or contract that is either written or verbal
which substantively indicates that the interaction is
significant and that it lasts for a period of time.
Twinning should be two-way in order for both organizations
to benefit from the collaboration and learn from each
other.

Twinning is a type of collaboration that is critical to the
success of the work that HIV/AIDS organizations do.
Collaboration implies that two organizations are working
with each other on a specific project to exchange
information or skills. If twinning is carried out
successfully, vital information is exchanged between the
organizations. This exchange of significant information
allows them to create opportunities to work together.

Benefits Of Twinning

Strengthening Capacity
Identification & Sharing Of Best Practices
Increased Program Effectiveness
Decreased Cultural Barriers
Relationship Building
Networking
Solidarity
Building Of A Global Movement

Follow Up

It is our hope that in February of 2002 [NMAC] will bring
the 12 NGOs from Africa who participated in this program
back to the US to once again meet with their twinned NMAC
constituents. This meeting will be a follow-up to evaluate
the process, make recommendations for future activities and
to continue the process and benefits of twinning.

It is also NMAC's hope that should the process work well
with these African NGOs, that we will broaden our reach
during our 2002 regionals to include NGOs from Central and
South America as well as South East Asia and India.

How To Get Involved

Attend one of the NMAC Regional Trainings 2001. Two African
NGOs will attend each of our regional trainings starting in
Seattle (see schedule below), different African NGOs will
attend the remaining 6 trainings. Please review the
twinning document and learn more about the regional
training by going to:
http://www.nmac.org/conference/regionals/seattle/letter.htm
(after the Seattle meeting, you may need to start at:
http://www.nmac.org).

If you want to be considered as a potential "twin", please
contact Jay Blackwell, Email: jblackwell@..., phone 1-
202-234-5120.


***** Barcelona 2002:

International AIDS Conference Seeks Scientific Program
Coordinator

The major international AIDS conference takes place every
two years, and the next one will be in Barcelona, Spain,
July 7-12, 2002. The organizer of this conference, Fundacio
Barcelona AIDS 2002, is seeking a scientific program
coordinator. From the April 12 announcement:

Scientific Programme Coordinator

Programme organizers seek highly qualified candidate to
coordinate and implement planning for scientific programme
of the Conference. Responsibilities include technical and
logistical issues, liaison between organizers,
international scientific community and international
agencies. The applicant should have: research knowledge and
international experience with public health issues, basic,
clinical and/or social sciences in the HIV/AIDS field,
including developing countries; excellent interpersonal and
organizational skills; ability to take initiative and work
independently. English speaking and writing proficiency
(working knowledge of Spanish useful but not required).
Policy development and advocacy experience are desirable.

Position will be based in Barcelona from time of hire
through September 2002. Salary based on candidate's skills
and experience.

To apply, send your CV and 3 references with a cover letter
by email to: aids2002@... or by mail to: Fundacio
Barcelona SIDA 2002. c/ Pomaret, 21. Barcelona 08017. Spain

Application Deadline: Open until position is filled.


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AIDS Treatment News
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