6 min

Some final World AIDS Day thoughts

As a final sign-off on yesterday’s (largely non-) events, I have a couple of additional things to add.

First up is an op-ed by MP Keith Martin, a doctor who spends a great deal of time in Africa delivering aid.

At this year’s International AIDS Conference in Vienna, many excellent solutions were discussed about how to combat the pandemic, from treating people with antiretroviral (ARV) drugs once they are diagnosed (Vancouver's Seek and Treat Program) to ways we can better stop the transmission of the virus from mother to fetus.

We already possess the knowledge to effectively prevent, treat and manage this disease; however, there is still a massive gap between the treatments we have and their availability for those who need them.

What good are ARVs if there isn't a healthcare worker to test the patient, dispense the medications and follow up with them? What good are ARVs if adequate diagnostics are not available? What if you don't have access to adequate nutrition? (An HIV-positive person needs 1,500 calories per day, minimum, versus 1,200 calories if you are HIV-negative. Proper nutrition is the most important "drug" for a person who is HIV-positive.) What if the medications needed to treat the many other diseases that can kill people, whether they have HIV or not, are not available? What are the effects on a population's health if the people do not have access to clean water with which to take their drugs?

How do you dispense information on prevention, along with the condoms people need to protect themselves, without a skilled primary healthcare worker? The number of new infections still vastly exceeds the number of new patients receiving treatment, so prevention is crucial to containing the disease.

There is only one proven way to collectively confront the AIDS pandemic and the other common preventable or treatable diseases that kill tens of millions of people per year: invest in primary healthcare.

This is the best way to implement an integrated program that enables us to manage a patient's overall health needs — from prevention to treatment. As Michel Sidibe, executive director of UNAIDS said, "AIDS isolation must end."

There is also a natural convergence between addressing the AIDS pandemic and improving maternal and child health (a commitment to the latter was just made at the G8 Summit in Ontario).

Quite simply, if you can provide good obstetrical care for a pregnant woman, it means there is access to basic surgical capabilities, trained healthcare workers, basic medications, electrical power, access to proper nutrition and clean water.

These are the same assets that are needed to prevent HIV infections and treat those who are HIV-positive. An enormous added benefit is that with these capabilities, 80 percent of the problems in an emergency room can also be treated.

Annually, 50,000 women around the world die during pregnancy from complications associated with AIDS. Most of these deaths are entirely preventable.

In order to save these women's lives, along with the 380,000 pregnant women and 8.8 million children who die every year from entirely preventable or treatable causes, the international community must redouble their efforts to invest in primary healthcare.

This is not glamorous, but it works. If we strengthen this often-neglected area in healthcare, then we can provide maternal care, infant care, HIV programs, tuberculosis programs and much more.

Access to primary care is truly the common path that will dramatically reduce the annual death toll of so many people who die needlessly in the developing world. The international community must stop focusing on specific diseases and instead take a broader, public-health view.

This week's World AIDS Day is a time for the international community to redouble efforts to help low-resource countries build up their primary care system, the common pathway to prevent and treat the world's biggest killers.

The second is an open letter from leading NGOs to the House of Commons to pass C-393, with the one-licence solution intact.

On World AIDS Day, we are writing to ask you to place people before politics and support an initiative that will make a tangible difference in the lives of people in developing countries.

Last week, the United Nations released its annual report on the state of the global AIDS epidemic. It highlights both that significant progress can be and has been made in confronting the epidemic. Yet the disease continues to have devastating consequences for tens of millions of people around the world. Consider that in 2009 there were:  

  • 33.3 million people living with HIV – almost equivalent to the population of Canada;
  • 2.6 million people newly infected with HIV – 7,000 a day;
  • 1.8 million people who died of AIDS, including 260,000 children;
  • and 97% of people who died from AIDS were in low- and middle-income countries.

They die not because life-saving medicines do not exist. They die because these medicines aren’t available to them and to their countries, at prices they can afford, because of limited budgets and overwhelming needs. They die because they are too poor to buy the medicines that those of us in wealthy countries such as Canada so often take for granted. Those medicines have meant deaths from AIDS have dropped dramatically in the last decade. With effective treatment, people with HIV are living, working, studying and being active members of their communities. But in the developing world, 14.6 million people with HIV need treatment under international guidelines from the World Health Organization, and only 5.2 million – or 36% of those in need – are receiving it. For children with HIV, access to treatment is even worse. In sub-Saharan Africa, roughly half of all children born with HIV will die before reaching their second birthday because they don’t have access to medicines.

The fact is these deaths are preventable and Canada can help prevent them – if there is the political will to help make medicines available to those in need, including by fixing Canada’s broken Access to Medicines Regime (CAMR) to supply generic medicines at more affordable prices.

Competition by generic manufacturers in the global marketplace has been the single most important factor driving down the prices of medicines to bring them within reach. Indeed, without access to low-cost generic medicines, the tremendous success in recent years of quickly and dramatically scaling up the number of people receiving life-saving AIDS drugs would not have been possible. Yet even as we are seeing the results of globally scaling up access to affordable generics, this progress is now being jeopardized. Global funding to prevent and treat AIDS, and to strengthen health systems, is being flat-lined. Meanwhile, there are growing challenges to the future supply of affordable generic medicines for developing countries. These make it all the more important that all countries with the capacity to produce such medicines, including Canada, act to make this simple and straightforward.

The question is whether the political will exists in Parliament to make affordable generics available to those in need in the developing world. In 2004, Parliament unanimously passed legislation creating Canada’s Access to Medicines Regime (CAMR), with this laudable goal. But it has failed: in more than six years, it has resulted in only one licence being issued to authorize the export of one order of only one AIDS drug to one country (Rwanda).

Bill C-393, as supported by members of all parties at second reading, is intended to reform CAMR by creating the “one-licence solution”, reducing red tape and making it easier for developing countries and generic manufacturers to utilize it. Detailed arguments in favour of this approach by international legal and health experts can be reviewed at www.aidslaw.ca/camr.

The goal of CAMR reform, and specifically the proposed “one license solution” approach, has been endorsed by dozens of Canadian civil society organizations with direct experience working with people with AIDS in developing countries. It also has the support of more than 80% of Canadians according to a national poll, as well as a growing list of prominent individuals including former Prime Minister Paul Martin, former Lieutenant Governor of Ontario James Bartleman, former UN Special Envoy for HIV/AIDS in Africa Stephen Lewis, past International President of Médecins Sans Frontières Dr. James Orbinski, former Members of Parliament, leading researchers, faith leaders, artists and numerous members of the Order of Canada.

Bill C-393 – in its original form, before significant changes weakening the bill were passed at the committee stage – has the power to make a significant contribution in the fight against AIDS and other public problems. It meets all of Canada’s international legal obligations, including under WTO rules. It is fair to both generic and brand-name pharmaceutical companies. And it won’t cost Canadian taxpayers a penny.

There are three ways you can make a difference to people living with AIDS right now: 

  1. Commit to voting to restore the “one-licence” solution to Bill C-393 when it comes up for debate at report stage.
  2. Consent to transferring sponsorship of Bill C-393 from former MP Judy Wasylycia-Leis to MP Brian Masse.
  3. Vote for a Bill C-393 that includes the one-licence solution when it comes up for a final vote at third reading.

Now is the time to act. By supporting CAMR reform you will be keeping Canada’s promise to the developing world. You will be directly responsible for saving lives. People in the developing world, including hundreds of thousands of children with HIV and other illnesses, have waited long enough for Canada to fulfill its promise. They don’t have time to wait any longer.

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