amfAR, The Foundation for AIDS Research

Advocating for Treatment Access

Workshop in Bangkok inspires and equips activists


July 2004–While international foundations and organizations survey Asia and make plans to expand treatment access, people working on the ground in Southeast Asia came together in March to decide how they can play a role in putting antiretroviral therapy in the hands of every AIDS patient who needs it.

“The Community Sector Workshop on HIV Treatment Access: Building Policy and Advocacy Capacity in Southeast Asia,” organized by the Australian Federation of AIDS Organisations (AFAO), took place in Bangkok, March 16–19. The workshop was attended by 40 participants, speakers, and organizers from Indonesia, Viet Nam, Cambodia, Laos, and Thailand.

Expansion of access to treatment is experiencing its first real momentum in Asia. With the launch of the World Health Organization’s “3 by 5” plan, new developments concerning the Trade-Related Aspects of Intellectual Property Rights agreement, and increased production of antiretroviral (ARV) drugs in the region, Asia seems poised for a surge of ARV availability. But very real obstacles, not the least of which is money, mean that around five percent of the estimated one million who need treatment in Asia are accessing it.

Those living and working in the communities affected by AIDS feel they have the deepest understanding of the challenges faced by people living with AIDS, how few are being treated, and how treatment could best reach those in need. What community organizations often lack are the resources and clout to solve the problems they see every day.

The goal of the workshop was to improve policy and advocacy skills, share experiences and knowledge about which strategies work, and achieve a greater voice in the battle to improve treatment access.

To prepare participants for the three-day workshop, Kevin Frost, amfAR’s Vice President for Clinical Research and Prevention Programs and Director of TREAT Asia, conducted an introductory session on treating HIV/AIDS—from understanding basic virology to coping with treatment failure, touching upon topics such as highly active antiretroviral therapy, fixed-dose combinations, and first- and second-line regimens.

Don Baxter and Andy Quan, Executive Director and International Policy Officer of AFAO respectively, welcomed participants on the first day and were followed by country reports on the progress being made and the challenges ahead.

Country Reports
Though Thailand has the greatest number of people receiving treatment in Southeast Asia, Sangsiri Teemankan of AIDS Access Foundation identified the continuing need for developing partnerships, reducing ARV prices, increasing generic production, and implementing compulsory licensing. She also said that not all hospitals in the country are ready to distribute ARVs.

By contrast, Nguyen Thi Minh Ngoc, a representative from POLICY Project Viet Nam, reported that only 300 people in Viet Nam have access to treatment and that the regimens available are less effective mono and dual therapy courses. For Viet Nam, critical goals are approving a national HIV/AIDS strategy, improving health care infrastructure, and expanding training for health care workers.

In Indonesia, where HIV infections are rising sharply, Kurniawan Rachmadi of the Working Group (Pokdisus) on AIDS of the Faculty of Medicine, University of Indonesia, reported that access to ARVs is increasing and prices are falling as a result of local production. However, Samuel Nugraha of PITA added that a lack of treatment knowledge is contributing to low adherence and inconsistent advice on when to start therapy.

Laos faces a very different challenge. According to Anouxay Bounthaluexay of the Lao Red Cross, the country’s low prevalence and extremely limited resources mean that very little attention is paid to treating HIV/AIDS.

In Cambodia, said Dr. Thith Khimuy of KHANA, the greatest barriers to treatment are stigma, lack of resources, and lack of nationwide ARV availability.

Rallying Against Patents
Though local challenges vary from one country to another, one universal obstacle to treatment access around which participants found common ground and against which they were ready to take action was patent law. On the second day of the conference, Dr. Kamjorn, a representative from Thailand’s Government Pharmaceutical Organization (GPO), Alycia Draper, representing Merck Sharp & Dohme, and Don Baxter gave presentations on the World Trade Organization, patent issues, and the role of the pharmaceutical industry. Afterwards, participants held a spirited discussion and proposed a plan to initiate a media and action campaign to pressure pharmaceutical companies to voluntarily suspend their patents.

How to Advocate
The final day of the conference was devoted to discussing advocacy and how to implement a strategy for national HIV treatment access. Among the components outlined by Don Baxter were deciding clear goals and accompanying messages, analyzing how decisions are made in individual countries, identifying allies and opponents, mobilizing constituents, and creating media, public demonstration, and lobbying strategies.

Closing the conference, Don Baxter charged the group with a collective responsibility, “Whether you realize it or not, you are now the HIV treatment access activists network for Southeast Asia.”

The Future
That network is already at work. The Indonesian Red Cross and community organizations are jointly planning a treatment workshop in Indonesia. A community-sector treatment preparedness workshop for East and Southeast Asia, sponsored by the Tides Foundation, is scheduled for September. And Viet Nam is expecting to host the third regional roundtable meeting on treatment access in late 2004. Regional treatment access discussions will also be continued at the XV International AIDS Conference in Bangkok in July 2004.

The March workshop was organized by AFAO in conjunction with the Asia Pacific Network of People Living with HIV/AIDS (APN+), AIDS ACCESS Foundation, the Asia Pacific Council of AIDS Service Organizations, and the Australian Red Cross Asia Regional Office. The workshop was sponsored by the Australian Red Cross, the POLICY Project, TREAT Asia, and a private donor to AFAO.