ICEM HIV/AIDS e-bulletin - No. 76, January 2012

In this issue of the ICEM HIV/AIDS newsletter, our forst of the New Year, we report on HIV and AIDS activities of ICEM trade union affiliates in Colombia, we reflect on some of the important issues that occurred in 2011 and we report on some reactions to the cancellation of Round 11.

Colombia: HIV and AIDS Campaign in 2012

During a seminar organised for ICEM affiliates in Colombia in December 2011, participants decided to declare 2012 a year to campaign against HIV and AIDS at the workplace.

Although the virus does not yet constitute a big problem in Colombia, it does not mean that this will remain so in the future. Especially in the mining sector, workers are vulnerable to the transmission of the HIV virus. Affiliates in Colombia have therefore decided to give more importance to awareness and prevention at mining sites and in other companies organised by them.

The seminar received technical assistance from the François Xavier Bagnoud Foundation and from Carbones del Cerrejón, a Colombian coal mining company jointly owned by Anglo American, BHP Billiton and Xstrata, which operates one of the largest coal mines in the world. Carbones del Cerrejón provides HIV and AIDS services in several locations in the Department of Guajira, where the mine is located.

Affiliates in Colombia representing all ICEM sectors will participate in the work which, among other things, includes reducing stigma and eliminating discrimination through agreements with employers.

HIV and AIDS: Some Big Stories in 2011

It was a roller coaster of a year regarding HIV and AIDS in 2011. AIDS turned 30 in 2011 and with new evidence of the effectiveness of HIV treatment as prevention, experts are increasingly talking about "the end of AIDS." At the same time, however, funding for HIV has become ever more uncertain, jeopardizing efforts to put new, life-saving science into action.

The first case of HIV was reported in 1981, and 2011 was a year of reflection on the growth of the epidemic and progress made in the fight against it. In 30 years, an estimated 30 million people have died, another 34 million are living with the virus and an estimated 7,000 new infections occur every day. An estimated 6.6 million people were on treatment globally by December 2010, but some nine million people who qualified for antiretrovirals (ARVs) did not receive them.

Regarding ARVs as prevention, the little pills that turned HIV from a death sentence into a chronic condition could now help us prevent new HIV infections. In May, a large, randomized controlled trial found that earlier initiation of HIV treatment led to a 96% reduction in HIV transmission to the HIV-uninfected partner.

Regarding funding, in November, poor funding forced the Global Fund to cancel its 11th round of funding (see ICEM e-bulletin 75, December 2011). The international financing mechanism is responsible for about 70% of HIV treatment in developing countries. Earlier in the year, a report showed that funding fell from US$7.6 billion in 2009 to US$6.9 billion in 2010 - the first time funding has dropped in more than a decade of tracking HIV/AIDS spending. Between 2002 and 2008, spending rose more than six-fold before levelling off in 2009.

In April, stemming the virus experienced disappointing prevention trials when a three-country study, known as FEM-PrEP, was halted after daily doses of the ARV Truvada, used as a pre-exposure prophylaxis (PrEP), failed to prevent HIV infection in the women participating.

The year 2011 also saw threats to generic ARVs. According to activists, the European Union (EU) last year continued to push for tougher intellectual property rules in its negotiations with India over the terms of a free trade agreement. India, known as the “pharmacy of the developing world,” produces the vast majority of generic ARVs used in developing countries.

In July, Gilead Sciences became the first pharmaceutical company to sign a licensing agreement with the Medicines Patent Pool. The patent pool was established in 2010 by the international health financing mechanism, UNITAID, and aims to stimulate innovation and improve access to HIV medicines through the negotiation of voluntary licences on medicine patents that enable generic competition and facilitate the development of new formulations. The agreement allows for the production of several of Gilead's HIV medicines (see the piece below on Johnson & Johnson).

The UN also set new target levels last year. "Zero new infections, zero stigma and zero AIDS-related deaths" was the bold new goal set during the UN High-Level Meeting on AIDS in June. The meeting concluded with the adoption of a declaration that seeks, by 2015, to double the number of people on ARVs to 15 million, end mother-to-child transmission of HIV, halve tuberculosis-related deaths in people living with HIV, and increase preventive measures for the "most vulnerable populations."

(Source: Plus News, Nairobi/Johannesburg, 29 December 2011)

Reactions to the Global Fund Cancelling Round 11

The Global Fund’s decision to do away with Round 11 is “short-sighted” because it comes at a time when science had shown that the end of HIV/AIDS is “within our grasp.” This was the view expressed by the Health Global Access Project (Health GAP), Médecins Sans Frontières (MSF), the International Treatment Preparedness Coalition, and the International HIV/AIDS Alliance in the days after the Global Fund Board moved to cancel Round 11 and announce tough new rules for grant renewals.

In a statement released on 23 November, Health GAP referred to “game changing” new scientific findings that HIV treatment not only saves lives, it reduces the risk of sexual transmission of HIV transmission by 96%. Further funding would have enabled scale-up of lifesaving treatment and prevention services for HIV, tuberculosis and malaria to millions of poor people in developing countries.

MSF said that on the ground in hard-hit countries where it works, the devastating effects of the overall funding crunch are becoming apparent. For example, MSF said, the Democratic Republic of Congo (DRC) is already severely capping the number of people able to start on ARVs, and other countries are facing a shortage of ARVs. MSF pointed out the shocking incongruence between both the new HIV science and political promises on one hand, and the funding reality that is now hitting the ground on the other.

ITPC said that the lack of political and financial commitment to the AIDS response is “deeply worrisome.” It said that “the millions of people living with and fighting against these deadly diseases will pay an enormous price. Rather than building on the new evidence that AIDS treatment saves lives and prevents new infections, and ramping up treatment programmes to try to end this epidemic, donor governments are now implicitly supporting a policy of triage, determining who lives and who dies. ITPC said that the shortfall in funding for the Global Fund is “an insignificant amount in comparison to the bank bailouts made by the U.S. and European governments.”

The International HIV/AIDS Alliance said news that the Global Fund Board had decided to cancel Round 11 has devastated civil society organisations across the Alliance’s global partnership.

In an article that appeared in the newswire service Reuters, a coalition of AIDS activist organisations said that southern African countries, hardest hit by the HIV/AIDS pandemic, are likely to be most affected by the situation at the Global Fund. The coalition said that countries that rely heavily on Global Fund aid, including Swaziland, Malawi, Zimbabwe and Mozambique, are expected to see increasing fatalities and infections as a result of funding shortfalls.

Organisations and individuals are being urged to sign a Call for Action demanding that the Global Fund and its Board mobilise the necessary resources to create a new funding opportunity in 2012 in the amount of US$2 billion. The Call to Action is being organised by a number of concerned civil society activists. Organisations and individuals can indicate their support for the Call by writing to Jacqueline Wittebrood of International Civil Society Support, at [email protected]. The Call to Action demands that the Global Fund hold an emergency donor conference and issue a new call for proposals before the International AIDS Conference in July 2012.

Elsewhere, Stephen Lewis, Co-Director of AIDS-Free World and former United Nations’ special envoy for HIV/AIDS in Africa, gave an excellent speech at Yale University in the US regarding the Global Fund’s cancellation. That speech, presented 28 November 2011, can be found here and it is well worth reading.

(Source: Global Fund Observer, Issue 169 of 5 December. GFO is a free service of Aidspan www.aidspan.org; to receive GFO send an email to [email protected])

Laos: Looming Threat of Increase in HIV Prevalence

Out of a total population of 6.3 million, the national prevalence in Laos of 0.2% among 15-49-year-olds puts the 8,500 reported HIV/AIDS cases there nearly a decade behind that of its neighbours. Thailand's HIV prevalence is at 1.3%, or more than half a million people living with HIV; Cambodia’s is estimated at 0.6%, translating to nearly 70,000 people living with HIV.

There are 1,600 people on ARV treatment in Laos and the number is expected to jump to 7,000 by 2015, according to the government. As the country increasingly opens its borders, health workers are bracing for a potential concentrated and catastrophic outbreak in a country where HIV prevention is not yet a priority.

The concern is an emerging epidemic among at-risk populations. Among men who have sex with men and sex workers in concentrated areas like Vientiane, the reported prevalence is above 5%. Nationwide, there are at least 11,000 high-frequency sex workers, 50,000 men who have sex with men and 40,000 amphetamine-type stimulant users, including 1,600 injecting drug users.

The global recession has left health workers wondering what will happen to the country's US$43 million Global Fund HIV/AIDS grant, $24 million of which has been disbursed since 2003 to the government. The HIV grant in Laos is up for review in June 2012. Because of its financial problems, the Global Fund will finance only essential services of ongoing programmes that end before 2014.

(Source: Plus News, Vientiane, 2 December 2011)

Swaziland: Activism over Failing Health Care System

Swaziland’s deepening financial crisis is taking a toll on service delivery and the country is experiencing an unprecedented number of protests. A new wave of activism is rising in Swaziland as people living with HIV take to the streets in protest, many of them for the first time in their lives, over continued shortages of antiretroviral treatment.

More than a quarter of adult Swazis are living with HIV and about 47,000 people nationwide were on ARVs at the end of 2009, according to UNAIDS, while an estimated 90,000 are in need of treatment.

In 2010, the Swazi government announced that it would take over funding for all ARVs from the Global Fund but lack of money, partly due to reduced revenues from the Southern Africa Customs Union and also attributable to the extravagant spending of the royal household, led to the 2011 shortages. The country is calling on donors to come to its aid. In August 2011, the US President’s Emergency Plan for AIDS Relief (PEPFAR) gave the country US$7 million in emergency funding, but this was only for first-line ARVs.

(Source: IRIN/Plus News, Mbabane, 13 December)

Johnson & Johnson Refuses to Licence Drug Patents

Despite continuing to earn record profits and a company credo that calls for putting patients first, on 19 December, the American pharmaceutical and health products giant Johnson & Johnson continued to turn its back on people living with HIV/AIDS in many developing countries by telling the Medicines Patent Pool it refuses to license its patents on the three lifesaving HIV/AIDS drugs – rilpivirine, darunavir and etravirine.

Over the past two years, Doctors Without Borders/Médecins Sans Frontières (MSF) has been urging Johnson & Johnson, and other companies holding HIV drug patents, to take this critical step of joining the Pool. The Pool would license patents on HIV drugs to other manufacturers and the resulting competition would dramatically reduce prices, making them much more affordable in the developing world and allow new combination medicines.

In refusing to join the Medicines Patent Pool, Johnson & Johnson says there is no urgency for making these drugs widely available in developing countries. That is simply not true. MSF now provides treatment to more than 180,000 people living with HIV worldwide, and is beginning to witness the inevitable, natural phenomenon of treatment failure, whereby people develop resistance to the drugs they are taking and need to graduate to newer medicines.

Furthermore, rilpivirine, darunavir and etravirine were identified among the key drug formulations needed for HIV treatment by the Medicines Patent Pool, UNITAID and the World Health Organization’s HIV/AIDS Department. Although Johnson & Johnson is already engaging in voluntary licensing with some generic companies, the company decided against taking the extra step of joining the Pool to improve access for people living with HIV. In saying no to the Medicines Patent Pool, Johnson & Johnson has made a conscious, wilful decision to turn its back on people living with HIV in the developing world.

There are now more than six million people receiving lifesaving HIV treatment worldwide. This did not happen because individual companies lowered their prices for specific countries or worked out exclusive deals with certain generic companies, which is what Johnson & Johnson is doing with their newest HIV medicines. Antiretroviral treatment was made more accessible because of competition among many generic companies which helped bring prices down by 99%, from US$10,000 per patient per year to roughly US$150 per patient per year.

(Source: Website of the U.S. section of Doctors Without Borders/Médecins Sans Frontières (MSF)

News from Global Unions

The International Transport Workers’ Federation (ITF – www.itfglobal.org), dedicates the entire issue its latest HIV/AIDS update 117 of 15 December to the feedback they received from affiliates of activities on World AIDS Day.

Five Years Ago: From the January 2007 Issue (No. 16)

The first issue of the ICEM HIV/AIDS e-bulletin was published in October 2005. In current issues, we refer to an article from the same month five years ago and reflect on developments.

In the January 2007 issue of the ICEM e-bulletin, we reported on the Regional Workshop in Johannesburg in December 2006. The workshop was the fourth in a series of workshops held in the framework of the HIV/AIDS projects for the African region during the 2005-2006 project cycle. It followed two workshops for national coordinators in 2005 (on initiation and strategies and developing the collective bargaining manual) and one earlier in 2006 on peer education.

The objectives of the workshop were: to identify immediate targets for fundraising, to build arguments on co-investment, to develop own workplace programmes and to write HIV/AIDS projects. The workshop was based on website research and project identification and project writing in small groups.

On fundraising for HIV/AIDS activities, it was stressed that funding sources are decentralised. Partnerships have to be built at national and international level and “friendly technicians” have to be found to help in the development of proposals as unions lack the capacity to work with non-traditional methods and arguments (public/private partnerships, co-investment). The working of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was explained. The need to have unions on the Country Coordinating Mechanism (CCM) was emphasised.

We also informed on a report, Strengthening Resistance: Confronting Violence Against Women and HIV/AIDS. Women in both the global South and North face not only staggering rates of HIV infection, but also unabated levels of violence, whether at the hands of male partners, police, or community members. When women are, or are even perceived to be HIV positive, they are at risk of violence, discrimination and other human rights violations. And when women are sexually assaulted, whether in conflict situations or in their homes, they are at risk of contracting HIV. UNAIDS estimated at the time that there were 17.7 million women living with HIV.

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