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2004-07-15

U.S. Policies Blasted at AIDS Conference

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As the International AIDS Conference in Bangkok comes to a close the U.S. is facing sharp criticism for it’s funding policies, the small size of its delegation at the conference, and a lack of action to make generic AIDS medications available. We speak with Rep. Barbara Lee, the only member of Congress to attend the conference and we go to Bangkok and South Africa to speak with AIDS activists on the ground. [includes rush transcript]

As the International AIDS Conference in Bangkok wraps up tomorrow, the United States is facing sharp criticism for it’s funding policies, the small size of its delegation at the conference, and a lack of action to make generic AIDS medications available.

Randall Tobias, head of President Bush’s Emergency Plan for AIDS Relief and former head of pharmaceutical giant Eli Lilly, was disrupted by about 40 protesters during his speech yesterday.

Tobias" said, "Perhaps the most critical mistake we can make is to allow this pandemic to divide us."

Many conference participants criticized Bush’s 15 billion dollar plan because it prioritizes abstinence-based AIDS prevention and only a small percentage of the money will go to the multilateral Global Fund to Fight AIDS.

The global conference has included extensive discussion of the so-called ABC prevention technique, which stands for "Abstain, Be Faithful, or Use a Condom," a method advocated by the Ugandan government and supported by the US. Critics say condoms should not be a last resort because women around the world often do not have the option of abstinence.

Two reports from UNAids released at the conference reveal that AIDS prevention programs had yet to have a significant impact on the spread of the virus. Only 7% of those with HIV who need drugs to stay alive over the next two years are getting them.

Generic AIDS drugs will be vital in closing the gap between infection and treatment. Doctors Without Borders presented data from projects in 21 developing countries at the conference showing that controversial fixed-dose generic drug combinations to treat AIDS works just as well as patented medications. The treatment combines three antiretroviral drugs into one pill that patients must take twice a day. Fewer pills to take increases compliance and generic drug production pushed the cost of these medications to $389 or less, a fraction of the cost of patented drugs.

The Bush administration says it will assist in providing generic drugs after the Food and Drug Administration approves those medications. This despite the fact that the same drugs have already passed muster with the World Health Organization.

And while this conference will likely serve as a benchmark for AIDS research and treatment, it’s impact may be limited by the absence of many U.S. scientists who planned to attend but were blocked by the Administration for Health and Human Services. The U.S. sent about 230 scientists to the AIDS conference in Barcelona two years ago and this year sent only 50 AIDS researchers. Observers speculated that the move could be retribution from Secretary Tommy Thompson who was heckled by activists during his speech in Barcelona.

Transcript

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: We turn first to Barbara Lee. She has just returned from Bangkok. She was the only member of Congress to be at the International Conference on AIDS. Welcome to Democracy Now!, Congressmember Lee.

REP. BARBARA LEE: Good to be with you.

AMY GOODMAN: Can you talk about first the issue of the scientists?

REP. BARBARA LEE: You know, first let me say I participated in the Durban AIDS Conference several years ago. Also Barcelona, where Tommy Thompson was with a much larger delegation, and now at this one in Bangkok. I think that — first of all, it’s outrage, that the United States would not send its top scientists from the CDC and NIH to participate in this conference — reducing the delegation, I believe, from about 236 to 50 sends a terrible signal to the rest of the world. I mean, it says, one, that we really don’t care about the science. Two, we don’t need to talk to colleagues in the international community in terms of their insights and in terms of their scientific developments. And, three, it’s a real slap in the face, I think, to the world in terms of the largest industrialized, wealthiest country in the world that should be leading this charge. Reducing its evident in international forums. And, again, this is just another example of the go-it-alone Bush administration’s unilateral kinds of efforts and November can’t come fast enough, I tell you, in terms of every policy, every effort that we’re engaged in.

AMY GOODMAN: Congressmember Lee, we’re also joined on the phone by McGill University professor Mark Wainberg, former president of the International AIDS Society. The next International AIDS Conference will be held 2006 in Toronto where he’s from. Can you talk about the issue of retro virals and the effect of not having the scientists in Bangkok, Professor Wainberg?

MARK WAINBERG: Well, first, I think we should point out that this conference in Bangkok has been a success. People have responded favorably as they did in Durban four years ago to the ideas that these meetings should be held on alternating occasions in a developing country venue where the disease is so endemic. I think that there has also been significant acceptance of the idea as the congresswoman pointed out that we need to deliver drugs to people who need them so desperately and the fact that the form lie that we now have to treat people seem to be working so well diminishes any rationale to not provide these drugs on an expeditious basis to people around the world who will die without them. In regard to the lack of a significant American presence here, it’s true that we wish that there had been more top-flight American scientists, but I think it’s fair to point out as well that there are many Americans who are participating in this conference. And, you know, there’s an old saying, people vote with their feet. There are significant numbers of American scientists who have come here at their own expense. There are significant numbers of American scientists who have benefited from travel funds other than those provided by the United States government to come here and have made coming here a priority. I think it would be a mistake to give the impression that Americans are not here, although certainly the numbers would have been much increased had the Bush Administration made it possible for scientists from the NIH to come here, using travel funds that would normally be available to such individuals through monies that are normally made available for this purpose through the research funding mechanisms.

AMY GOODMAN: We’re also joined on the phone by Rachel Cohen, a U.S. liaison for Doctors Without Borders, Campaign for Access to Essential Medicines, is in Bangkok for the week for the International Aids Conference. Now a number of reports were put out. Doctors Without Borders presented data from projects in 21 developing countries at the conference, showing that the controversial fixed dose generic drug combinations to treat AIDS works just as well as patented medicines. Can you explain that and its implications, Rachel?

RACHEL COHEN: Sure. First, thanks for having me. In fact, Doctors Without Borders today has over 13,000 people living with HIV on anti-retro viral therapy in our various programs throughout the world and are working in 25 countries to deliver anti-retro viral treatment. One small retrospective study that we did basically show that of those 13,000 patients that we have on treatment, roughly half or over 6,000 are on the first line six dose base combination of D4T, 3TC and Nevirapine. That drug is only available from generic manufacturers. Why? Because the single ingredients, that is to say D4T produced by Bristol-Meyers-Squibb and 3TC produced by Glaxo-Smith-Kline, Nevirapine with is produced by Boerhinger and hold the patents and they have not managed to collaborate or have not overcome the various patent barriers to keep them from combining the medicines into one. So, in fact, the innovation that has enabled us, in large part, to expand our treatment programs in resource limited settings and scale up the number of people on treatment in our programs is an innovation that is really only happened in the generic industry. The data is — are significant not because we didn’t expect these outcomes, frankly we didn’t feel such approximate study was necessary. What’s important is the political context in which this is meeting is happening in which treatment scale up is taking place and that is to say the sort of misinformation that’s being spread by the U.S. government, by the Bush administration, and by some others, including in the pharmaceutical industry about the quality, safety, and efficacy of generic medicines and, in particular, fixed-dose combinations that I mentioned. I want to really emphasize why fixed-dose combinations are important. First, if a person has to take the brand name pills on their own, the single drugs, they have to take six pills a day. With fixed-dose combination, our patients are taking one pill in the morning, one pill in the evening. Simple science treatment regiments reduces the risk of resistance because you can’t take partial doses of these drugs. It promotes adherence because these pills simply speaking easier to take. It eases supply chain management, which makes procurement and drug supply management easier because they’re simply stored pills and importantly, this combination is available for as little as $140 per person, per year. The brand name equivalent is, best available price, worldwide, is $562. So, it is quite an increase if you have to shift into brand name drugs. That’s why these drugs are so important. But the clinical evidence that was presented at this conference is only important in so far as it demonstrates what the rest of the world has been saying for a long time, which is these generic medicines are safe, effective, and they’re saving lives today. There is no reason to justify not promoting their wide scale use in developing countries.

AMY GOODMAN: Rachel Cohen from Doctors Without Borders. Congressmember Barbara Lee, the whole issue of the Bush administration’s emphasis on abstinence, can you talk about that?

REP. BARBARA LEE: Sure. The bill which we actually participated in writing, that set up this abstinence-only, 33% satisfied, is a bill that portion that we add — adamantly fought when the bill was being drafted, of course we didn’t win that fight because of the composition of the house. This is — it doesn’t make any sense, first of all, to have a 33% designation of funding for abstinence only. If you talk about a comprehensive strategy to address this pandemic, you’re talking about abstinence, being faithful, and condom use all three equal weighted. You can’t take one out and designate 33% to the exclusion of others. Women — the new face of AIDS, of course, is with women and often times women do not have a choices in terms of abstaining, given the power relationships and given the issues of violence that women are dealing with. So, minimally we should provide for adequate distribution and promotion of education as it relates to condoms. I am trying to repeal this provision. I introduced a bill last week with 54 co-sponsors that would say this 33% should not be government policy, we should allow for a full comprehensive strategy if we are really going to attack this pandemic. Abstinence-only is not a scientifically proven method. Condom use is scientifically proven and we need a comprehensive strategy that involves abstinence, be faithful, and condoms. Certainly we teach our young people to delay their sexual debuts. That’s a given. That has nothing to do with the fact that millions of people around the world are sexually active and to stop the spread of the disease, we do not need an abstinence-only policy, but we need a comprehensive effort. So, we’re going to try to repeal this policy and, again, hopefully with the new administration with the president Kerry, we will be able to eliminate and get rid of that policy. Let me finally say that, you know, abstinence-only is the policy of our own country as it relates to our domestic education policy. Federal funds are not allowed for school districts that teach comprehensive sex education. California actually denied, said we don’t want to take the federal funding. We’ve lost close to $50 million because we teach comprehensive sex education in classes. For the most part, the rest of the country has to teach abstinence-only. And so, of course, I’ve introduced the family life education act with close to 100 co-sponsors that would say that states are eligible for federal funding if they choose to teach comprehensive sex education. It is up to them to decide what to do. This abstinence-only policy is a very backwards policy. It doesn’t make sense and it is not scientifically proven.

AMY GOODMAN: Congressmember Lee speaking to us, just getting back from the 15th International Conference on AIDS in Bangkok. We go there now to a member of the Treatment Action Campaign South Africa, Nathan Geffen. Can you talk about the U.S policies on your country in South Africa?

NATHAN GEFFEN: Sorry, just a small correction. I’m not in Bangkok; I’m in Cape Town. Unfortunately, our Bangkok representative wasn’t available. Yeah, there are very serious effects of the Bush administration’s policy with regards to HIV. I think the congresswoman just pointed some of them out very eloquently. For what one of the problems is that by giving most of the money that the U.S. Government has put aside for fighting the international HIV Epidemic efficient the global fund to fight AIDS, TB and malaria, that is really a problem for us because the global fund to fight AIDS, TB, and malaria is a multilateral independent institution, which doesn’t make decisions based on politics. It makes decisions based on what are the best proposals available for alleviating HIV, for alleviating TB, and alleviating malaria. All the baggage that comes with the — whether we should be promoting condom use or not or promoting abstinence or whether promoting reproductive rights is acceptable or not to the Bush administration —all that baggage falls away if the money is given to you, primarily to the global fund to fight AIDS, TB, and malaria. The moral -— or the pseudo moral agenda of the Bush administration in trying to dictate to other countries about whether they should be promoting the use of condoms or whether they should be promoting reproductive rights education, really has no place in the funding of AIDS.

AMY GOODMAN: Well, I want to thank you all very much for being with us. Nathan Geffen of the Treatment Action Campaign in South Africa, Rachel Cohen of Doctors Without Borders, campaign for access to essential medicines, Barbara Lee, the only member of the U.S. Congress, who attended the International Conference on AIDS in Bangkok and Professor Mark Wainberg, director of the McGill AIDS center and chairman of the next International AIDS Conference to be held in 2006 in Toronto.

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