1. "You can tell the people that if they succeed in killing me,
that I forgive and bless those who do it.
Hopefully, they will realize they are wasting their time.
A bishop will die, but the church of God,
which is the people will never perish”
"A church that suffers no persecution
but enjoys the privileges and support of
the things of the earth - beware! -
is not the true church of Jesus Christ."
From a letter to President Carter:
"You say that you are Christian.
If you are really Christian,
please stop sending military aid
to the military here,
because they use it only to kill my people."
Archbishop Oscar Romero

2. Combination therapy (HAART) revolutionzed
the fight against AIDS in the US
With deaths dropping 84% in the developed world

3. these drugs cost $10,000-15,000 per year!
However, in the late 1990’s
these drugs cost $10,000-15,000 per year!

4. Why so expensive?

5. Companies seek to recoup research costs
And make profits while medicines are
under patent

6. Companies seek to recoup research costs
And make profits while medicines are
under patent
US drug patents give 20 years of protection,
but they are applied for before clinical trials,
so the effective life of a drug patent
tends to be 7-12 years.

7. not very affordable if you are one of the 2.6 billion—
$10,000 to $15,000 per year is
not very affordable if you are
one of the 2.6 billion—
40% of the world’s population—
living on less than US$2 a day.
2007 Human Development Report (HDR) United Nations Development Program

8. Five years after HAART therapy was introduced in the West,
<8,000 people in all of sub-Saharan Africa
were receiving the life-saving drugs
Avert.org

9. A few nations (not the poorest) Took leadership roles in dealing
With this crisis

10. A few nations (not the poorest) Took leadership roles in dealing
With this crisis
In 1996 the government of Brazil pledged provide
free combination antiretroviral treatment by the end of the year.
It said it would spend up to $45 million/year
on protease inhibitors .
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28

11. This made a big difference!
By 2000 the number of people living with HIV in Brazil
was less than half that once predicted
and the number of AIDS deaths plummeted 50%
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28

12. This made a big difference!
By 2000 the number of people living with HIV in Brazil
was less than half that once predicted
and the number of AIDS deaths plummeted 50%
"It makes a lot of sense to look at what Brazil is doing...
Something they're doing is working." -
Mbulelo Rakwena, South Africa's ambassador to Brazil
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28

13. Big Pharma also made some concessions
In 1996 Glaxo Wellcome cut the price of AZT by 75%
after a trial in Thailand showed it was safe and effective
at preventing mother-to-child transmission
CNN (1998) 'Company to offer AZT at steep discount to third world', March 5

14. This was still much too expensive
For patients in the developing world!
In 1996 Glaxo Wellcome cut the price of AZT by 75%
after a trial in Thailand showed it was safe and effective
at preventing mother-to-child transmission
CNN (1998) 'Company to offer AZT at steep discount to third world', March 5

15. Big changes required two things

16. Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost

17. Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost

18. Get Cheaper drugs by avoiding patent protection Round 1, 1999
South Africa passed legislation
that enabled local companies
to manufacture or import
HIV/AIDS drugs at a fraction
of the price of patented drugs.
The US argued that this
undermined patent rights.
BBC News (1999) ' Africa AIDS drug trade dispute ends', September 18

19. The Pharma Empire strikes back
39 major pharmaceutical
companies prosecuted
the South African government
for this legislation.

20. International pressure eventually affected this
Patent litigation in 2001

21. International pressure eventually affected this
Patent litigation in 2001
Major pharmaceutical companies withdrew their
challenge of South African legislation after protests
by the European Parliament and a petition against
the action was signed by 300,000 people
from over 130 countries

22. Get Cheaper drugs by avoiding patent protection Round 2, 2001
The Indian drug company Cipla
offered to make AIDS drugs
available at sharply reduced prices
(<$1 per day!) to Doctors without Borders
(Medecins Sans Frontieres)
Kumar S. (2001) 'Indian company offers low cost AIDS drugs', the Lancet, 357:616 February 24

23. This spurred changes in pricing
By Big Pharma

24. In essence it was a price war
and patients won
wow

25. Not everyone was impressed by Pharma’s offer
''…a victory, but a small one,
much like an elephant giving birth to a mouse'’
Doctors without Borders (Medecins Sans Frontieres )

26. Generics mean the price of antiretroviral medication in
resource-poor countries
continues to plummet
A year’s first-line drugs
can now be bought
for as little as $92.2
An estimated 33 million people were living with HIV at the end of Someone who is infected with HIV is likely to become sick with AIDS within a few years, but if treated with antiretroviral (ARV) medication their life can be prolonged, often for a long time. ARV treatment has already dramatically cut the rate of AIDS diagnoses and deaths in Western countries where it has been provided since the mid 1990s.As of December 2007, an estimated 9.7 million of the people living with HIV in low- and middle-income countries urgently needed this life-saving ARV medication. Of these only 2.99 million – just under a third – were accessing the drugs.Though shockingly small, this figure represents a great advance since 2003, when only 400,000 were receiving treatment. At the UN General Assembly Meeting on HIV/AIDS on 22nd September 2003, WHO, UNAIDS and the Global Fund declared the lack of access to HIV treatment a global health emergency2.
Towards Universal Access: Scaling up priority
HIV/AIDS interventions in the health sector",
WHO, 2008

27. Generics mean the price of antiretroviral medication in
resource-poor countries
continues to plummet
A year’s first-line drugs
can now be bought
for as little as $92.2
In 2007, generics accounted for 57% of the
$131 million PEPFAR spent on anti-AIDS drugs.
An estimated 33 million people were living with HIV at the end of Someone who is infected with HIV is likely to become sick with AIDS within a few years, but if treated with antiretroviral (ARV) medication their life can be prolonged, often for a long time. ARV treatment has already dramatically cut the rate of AIDS diagnoses and deaths in Western countries where it has been provided since the mid 1990s.As of December 2007, an estimated 9.7 million of the people living with HIV in low- and middle-income countries urgently needed this life-saving ARV medication. Of these only 2.99 million – just under a third – were accessing the drugs.Though shockingly small, this figure represents a great advance since 2003, when only 400,000 were receiving treatment. At the UN General Assembly Meeting on HIV/AIDS on 22nd September 2003, WHO, UNAIDS and the Global Fund declared the lack of access to HIV treatment a global health emergency2.
Towards Universal Access: Scaling up priority
HIV/AIDS interventions in the health sector",
WHO, 2008

28. WHO

29. Prices of antiretroviral medication in
the developed world remain high due to
“Tiered pricing”
Drug prices are calculated using formulas
based on average income per head

30. Prices of antiretroviral medication in
the developed world remain high due to
“Tiered pricing”
Drug prices are calculated using formulas
based on average income per head
"Preferential pricing is the only way we can
meet both conflicting needs in the fight against AIDS.
We can refinance our high research and development costs
for innovative, new treatments by the established
price system in industrialised countries and can
offer affordable medicines to patients in poor countries
who otherwise cannot afford antiretroviral medication"
- Alessandro Banchi, chairman of Boehringer

31. “Tiered pricing” In reality Updated March 2008
aids.about.com/b/2006/03/08/how-much-do-hiv-drugs-cost.htm
Updated March 2008

32. Patent issues continue to linger over the process
In 1995 TRIPS - The Agreement on Trade Related
Aspects of Intellectual Property Rights
was accepted by all members of the
World Trade Organization
Because its implementation will have a huge impact on
generic drug production, most developing countries
(e.g. India) were given a 10-year transition period.
Least developed countries have until 2016.
Avert.org

33. Patent issues continue to linger over the process
Since 2003 TRIPS has contained a waiver that
allows ''compulsory licenses'' to be issued to
override specific patent restrictions.
With these, countries that suffer a serious health crisis
but are unable to produce drugs at home
can import generics from other nations

34. In 2002 WHO created a list of preferred AIDS drugs
As part of its list of ESSENTIAL medicines

35. WHO also issued guidelines for when to start treatment:
Stage 1 asymptomatic
Stage II moderate weight loss and mild infections
Stage III severe weight loss, chromic diarrhea or fever, TB, etc
Stage IV wasting syndrome or severe opportunistic infections

36. Would you be happy with this if you were the patient?
Stage 1 asymptomatic
Stage II moderate weight loss and mild infections
Stage III severe weight loss, chromic diarrhea or fever, TB, etc
Stage IV wasting syndrome or severe opportunistic infections

37. Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost

38. Public pressure grew to find Funds to help poor patients

39. Many players came together
To push for more money

40. The World Health Organisation
created the first global target for
ARV treatment access in 2003.
It called for 3 million people in developing countries
to have access to treatment by the end of 2005,
meeting 50% of estimated need.

41. Congress and the President Put US dollars behind the effort
President George W. Bush signs the United States
Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act of 2003 =up to $15 billion over 5 years

42. As of September 2007,
PEPFAR estimates that it helped provide
ART to approximately 1,445,500 people

43. Public health experts and nonprofit organizations
have questioned some aspects of
PEPFAR programs, including requirements
mandating that one-third of prevention spending
be directed towards abstinence-only programs.

44. Progress began well,
but failed to accelerate.
At the end of 2005
only 1.3 million people
in low- and middle-income
countries
were receiving drugs,
40% of the target.

45. Not surprisingly, progress
was uneven in different
parts of the world. Only
three African nations -
Botswana, Namibia and Uganda -
met their 50% targets.

46. If at first you don’t succeed….

47. July 2005
The Group of Eight (G8)
(Canada, France, Germany, Italy, Japan, Russia,
the UK and the US) pledged to work toward
universal access to antiretroviral (ARV)
treatment worldwide by 2010.

48. July 2005
The Group of Eight (G8)
(Canada, France, Germany, Italy, Japan, Russia,
the UK and the US) pledged to work toward
universal access to antiretroviral (ARV)
treatment worldwide by 2010.
Two months later,
all United Nations Member States endorsed this goal
by committing themselves to:
"Developing and implementing a package for HIV prevention,
treatment and care with the aim of coming as close
as possible to the goal of universal access
to treatment by 2010 for all those who need it"

49. In 2006, UNITAID
an international drug purchase facility
was established to ensure a stable source
of funding for drugs to fight HIV/AIDS,
malaria and tuberculosis.

50. This IS making a difference
"3 by 5 has helped to mobilize political and financial
commitment to achieving much broader access to treatment.
This fundamental change in expectations is transforming
our hopes of tackling not just HIV/AIDS,
but other diseases as well." -
Dr Lee Jong-wook, WHO Director-General

51. This IS making
a difference

52. The trend is good but there is a long way to go
An estimated 33 million people were living with HIV at the end of Someone who is infected with HIV is likely to become sick with AIDS within a few years, but if treated with antiretroviral (ARV) medication their life can be prolonged, often for a long time. ARV treatment has already dramatically cut the rate of AIDS diagnoses and deaths in Western countries where it has been provided since the mid 1990s.As of December 2007, an estimated 9.7 million of the people living with HIV in low- and middle-income countries urgently needed this life-saving ARV medication. Of these only 2.99 million – just under a third – were accessing the drugs.Though shockingly small, this figure represents a great advance since 2003, when only 400,000 were receiving treatment. At the UN General Assembly Meeting on HIV/AIDS on 22nd September 2003, WHO, UNAIDS and the Global Fund declared the lack of access to HIV treatment a global health emergency2.
Avert.org

53. The trend is good but there is a long way to go
An estimated 33 million people were living with HIV at the end of Someone who is infected with HIV is likely to become sick with AIDS within a few years, but if treated with antiretroviral (ARV) medication their life can be prolonged, often for a long time. ARV treatment has already dramatically cut the rate of AIDS diagnoses and deaths in Western countries where it has been provided since the mid 1990s.As of December 2007, an estimated 9.7 million of the people living with HIV in low- and middle-income countries urgently needed this life-saving ARV medication. Of these only 2.99 million – just under a third – were accessing the drugs.Though shockingly small, this figure represents a great advance since 2003, when only 400,000 were receiving treatment. At the UN General Assembly Meeting on HIV/AIDS on 22nd September 2003, WHO, UNAIDS and the Global Fund declared the lack of access to HIV treatment a global health emergency2.
Avert.org

54. The trend is good but there is a long way to go
WHO

55. The trend is good but there is a long way to go
WHO

56. 97% of those treated are receiving 1st line drugs
WHO

57. What about those resistant to this combination?
WHO

58. Second line drugs are much more expensive
WHO

59. The US must continue to lead in this effort

60. The US must continue to lead in this effort
On July 30, 2008, President Bush signed into law
H.R. 5501, the Tom Lantos and Henry J. Hyde
United States Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act.=
up to $48 billion to combat the three diseases,
including:$39 billion for: •
PEPFAR bilateral HIV/AIDS programs