amfAR, The Foundation for AIDS Research

Funding Crisis and Trade Agreements Threaten Asia's AIDS Response

The TREAT Asia Report Interview: Shiba Phurailatpam

Mr. Phurailatpam protesting the E.U. free trade agreement provisions that would limit access to medicines, Thailand 2010
Shiba Phurailatpam is the director of the Asia Pacific Network of People Living with HIV/AIDS (APN+). Founded in 1994 by HIV-positive individuals from eight countries, APN+ was established to serve as a collective voice for people living with HIV (PLHIV) in the region. Before joining APN+, Mr. Phurailatpam worked with the UN Development Program and ActionAid International and spent many years fighting for the rights of PLHIV in India.

TREAT Asia Report: What progress has been made in addressing the HIV/ AIDS epidemic in Asia and what major challenges are expected for PLHIV in Asia in the future?

Shiba Phurailatpam:  Since the 2001 UNGASS Declaration on HIV and AIDS, governments in Asia have built their HIV programs, often at the urging of vocal, empowered communities of PLHIV demanding their rights and accountability from their governments. The Global Fund and the availability of affordable generic medicines have played the most important role in treatment scale-up across the region.

The record for our region has been patchy though. Rates of treatment are still low with only about 36 percent of those requiring treatment getting it. Marginalized communities are still fighting criminalization in many countries. And the funding crisis and uncertain future of access to generic medicines are creating significant barriers as our countries work to build on past successes and finally get ahead of the epidemic.

TA Report: In November, the Global Fund announced the cancellation of funding Round 11, delaying new grants until at least 2014. What are the consequences of this decision in the region?

Phurailatpam:  The November announcement came as a shock for many groups in the region and around the world. The consequences are serious for the region. PLHIV in several countries are at the point of requiring second-line treatment, and governments must scale-up their programs. Marginalized groups like drug users, sex workers, and men who have sex with men (MSM) are particularly vulnerable, as governments are still reluctant to fund programs supporting these groups.

For China, the situation is especially grim as the decision also states that high-middle-income countries will not be eligible even for their second phase grant renewals. China was expecting nearly $880 million in these renewals. It is encouraging that the Chinese government has announced that it will fill the gap itself, but there is concern that funding priorities in the country may change without the influence of an independent, neutral funding source like the Global Fund to enforce a strong anti-corruption mechanism and focus support on evidence-based practices that place community groups at the heart of programs.

The donors who backed out of their pledges to the Global Fund, forcing the cancellation of the round, have much to answer for. To quote Stephen Lewis, "It's not a matter of the financial crisis; it's a matter of human priorities. We have a right to ask the G8: what do you sanctify as governments—profits and greed or global public health?" We ask the same question on behalf of PLHIV across Asia and demand that people be placed before profits.

TA Report:  As governments face growing budget constraints, global health funding is becoming scarcer. How will this shifting donor landscape affect Asia specifically?

Phurailatpam: For some time now, donors have been cutting or restructuring aid to several developing countries. Even so-called streamlining of aid can have a negative impact, particularly on community-based programs.

In August 2011, a community-based organization in Nepal was forced to reduce the number of beds in its care centers from 250 to 50 as a result of DFID's [the U.K.'s Department for International Development] decision to harmonize its bilateral aid with that of other donors who decided to support the Nepal Health Sector Plan II, which did not incorporate community-based service providers.

With the shifting donor landscape already threatening the continuation of community-led programs, the lack of funds will only make matters worse. 

Mr. Phurailatpam at work at the APN+ offices in Bangkok, Thailand  

TA Report:  President Obama recently announced that his administration will deliver ARVs to six million people around the world by the end of 2013. What do you hope these new commitments will mean for Asia? 

Phurailatpam: While the announcement that the Obama administration would be ambitious in its plans to deliver treatment comes at a crucial period when donors are retreating, it also must be seen in the context of the U.S. government's trade policies.

The Trans Pacific Partnership Agreement (TPPA) is a free trade agreement (FTA) being pushed by the U.S. on several countries in the region, including Malaysia and Vietnam. It includes several aggressive provisions on intellectual property that will undermine access to generic medicines. Previous U.S. FTAs have led to significant increases in prices of medicines in developing countries, and for Malaysia and Vietnam, the TPPA would create a serious barrier to their ability to import generic ARVs or manufacture these medicines themselves.

Additionally, Europe is pushing an FTA with India that threatens its production and supply of generic ARVs. PEPFAR, the primary program through which the U.S. delivers treatment in Africa, is heavily reliant on generic ARVs produced in India. Therefore, for President Obama's promise to become reality, India must continue producing generic ARVs.

TA Report:  How might recent scientific advances in HIV prevention be translated into policy, and ultimately practice, in Asia?

Phurailatpam: The evidence is growing that PLHIV on treatment, particularly on early treatment, are less likely to transmit the virus. This means that our governments must abandon the false dichotomy in their policies of treatment versus prevention. 

Faced with tight budgets, governments invariably adopt more extensive prevention programs, even though it is clear that treatment, care, and support are critical in HIV prevention. Now science has given us the evidence for this. Governments in Asia must determine how many more people need treatment and devise all possible mechanisms to ensure sustained access to affordable treatment. 

Currently, however, the funding crisis and pressure to sign trade agreements are pushing governments to make poor treatment decisions like sticking to older, more toxic forms of HIV treatment and hesitating to examine earlier and better treatment options. In all this, the dramatic progress of the past decade is at risk, not just in Asia but across the globe.

TA Report:  Are there other obstacles that stand in the way of improving drug access in the region and what strategies exist to overcome them?

Phurailatpam:  Several governments in the region have had HIV treatment programs for several years and now have significant numbers of PLHIV requiring improved first-line or second-line treatment. The provisions in the FTAs proposed by both the E.U. and the U.S. will seriously undermine access to medicines for PLHIV and other diseases across the region. 

Governments that have attempted to use health safeguards in their application of international trade rules are being sued by multinational pharmaceutical companies. From Pfizer in the Philippines to Novartis in India, companies are using legal and financial muscle to prevent countries from ensuring access to generic medicines for their people. And even institutions set up with health objectives, like the Medicines Patent Pool, have issued licenses that exclude Malaysia, Indonesia, and China from access to generic tenofovir. 

A strong people's movement has built up across the region to counteract these actions. From protests in Nepal to the brave actions of South Korean activists who faced unwarranted police brutality at the ICAAP [International Congress on AIDS in Asia and the Pacific] in Busan, PLHIV are demonstrating loudly against the actions of developed countries and multinational companies. 

From the UN to the Global Fund, the advice to governments is clear—do not sign any trade agreements that undermine access to medicines and use all legal measures to ensure generic production and supply.

TA Report:   Finally, what do you see as the major policy priorities for the HIV/AIDS community in Asia?

Phurailatpam:  Discrimination is still a critical concern, and few governments in the region have provided legal protections for PLHIV. Laws in several countries continue to criminalize drug users, sex workers, transgender people, and MSM. Women living with HIV continue their struggle for equal rights, including sexual and reproductive rights. 

As discussed above, the treatment scenario remains grim with governments being pressured to trade away the lives of their people. Our policy priorities are to address these challenges at local, national, regional, and international levels. We need policies that prevent drugs from just lying on the pharmacies' shelves and instead get them to the people who need them.