AIDS activism, globalization, and the struggle for global treatment access
Asia Russell • Health GAP Coalition • www.healthgap.org
Iowa City, Iowa April 1, 2003
The AIDS crisis is a political crisis that requires political action.
1987: CIA research on the AIDS pandemic anticipates 52 million people infected by 2000.
1992: World Bank on mass death in Africa: ―If the only effect of the AIDS epidemic were to reduce the population growth rate, it would increase per capita income growth rate in any plausible economic model.‖
2001: Andrew Natsios, US AID Director, insists that ―Africans can’t tell time‖ and therefore the US is justified in refusing to use foreign aid to fund AIDS treatment.
2001: UN Secretary General Kofi Annan declares: ―There has been a world-wide revolt of public opinion. People no longer accept that the sick and dying, simply because they are poor, should be denied drugs which have transformed the lives of
ACT UP in the United States
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ACT UP New York founded in 1987 ACT UP Philadelphia founded in 1988 Right to exist/visibility Desperate people disrupt business as usual Draw experience, politics, tactics from:
– – – Civil rights movements Gay liberation struggle Women’s movements
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Also fueled/aided/hampered by notions of class entitlement and professional skills
ACT UP tactics:
mass protest sneaky zaps sophisticated mainstream press work alternative press/community education political funerals civil disobedience independent research and
The U.S. AIDS activist movement
Why We Fight by Vito Russo, ACT UP New York
excerpted from a speech delivered in front of the Department of Health and Human Services during a demonstration on Monday, October 10, 1988
―I'm here to speak out today as a PWA who is not dying from --but for the last three years quite successfully living with --AIDS. If I'm dying from anything it's homophobia. If I'm dying from anything it's racism. If I'm dying from anything it's indifference and red tape. If I'm dying from anything it's Jesse Helms and Ronald Reagan. If I'm dying from anything it's the sensationalism of newspapers and magazines and television shows that are interested in me as a human interest story only as long as I'm willing to be a helpless victim, but not if I'm fighting for my life. If I'm dying from anything it's the fact that not enough rich, white, heterosexual men have gotten AIDS for anyone to give a shit. Living with AIDS in this country is like living through a war that's happening only for those people in the trenches. Every time a shell explodes you look around to discover that you've lost more of your friends. But nobody else notices--it isn't happening to them.”
In 2003, ACT UP Philadelphia is stronger then ever.
• We are the largest grassroots AIDS activist group in the U.S., and our members are primarily African American activists living with HIV or who have loved ones who are HIV positive • We work with our community allies on local, state, national and international issues that affect the lives of people with HIV
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Realities: AIDS death rates drop in the U.S. and other rich countries
Treatment Breakthroughs
• more effective combination therapy started to become widely available in the United States in 1996 • for the first time in the epidemic, the death rate starts to drop -- first in white men, eventually in everyone • while the treatments are highly problematic—hard to comply with complicated regimens; side effects or permanent toxicities are common—they are life-extending for many people.
But life expectancy plummets in Africa.
The problem: essential medicines are not luxury goods, to be reserved for the wealthiest of the world…
…but are too often priced like them, causing preventable suffering and death.
“The people with HIV are where the drugs are not.”
U.S. NGO founded by AIDS, human rights and fair trade activists
• Campaigns for changes to U.S. Administration and corporate policies obstructing access in poor countries to affordable medicines to treat HIV;
• Campaigns for resources (money, technology transfer, other investments from governments and private sector) from donor countries to sustain medicines and treatment access in poor countries; and
• Educates and mobilizes the grassroots: networks include thousands of people living with HIV and other health care consumers in the United States
Pressuring decision makers: 1999
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Case study: the Fight for Drug Access in South Africa
• a leaked State Department memo showed that the Clinton White House was directing a ―full court press‖ against South Africa, pressuring them to withdraw legislation to allow the manufacture or importation of low-cost medication
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• South Africa’s actions were legal under WTO rules regarding intellectual property. But US drug companies directed the Administration to punish South Africa with trade sanctions
• VP Gore, about to announce his candidacy for president, was a leading force in pressuring the South African government
What have we won?
• • Within months of the Gore zaps, the White House announced that it was ending all trade pressures against South Africa. Within only 6 months, by the Seattle WTO meeting December 1999, Clinton signed an executive order mandating that health concerns must be taken into account in trade negotiations with sub-Saharan Africa, and that exceptions to patent monopolies are permitted to increase access to AIDS medication. This Executive Order has been upheld by Bush. April 2001: International protest against 39 drug companies that were suing South Africa for its drug pricing policies forced an end to the case--and showed the world the David could beat Goliath. July 2001: The US dropped its WTO case against Brazil, in which they had accused them of violating WTO laws with their generic drugs policies 2000—present: In response to public pressure and generic competition, every major AIDS drug company has announced drug discounts for poor nations. However, these ―discounts‖ often come with strings attached, and the price allow some rich and middle class people to get the drugs but they still remain absolutely out of reach of most people
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What forces down the cost of medicines?
from MSF: ―Accessing ARVs: Untangling the web of price reductions for developing countries‖Oct 2001
What have we won? (cont’d)
• Treatment access campaigns are being established all over the world, from India to China to Nigeria to Chile…people with AIDS are dramatically increasing pressure on their governments, demanding the right to affordable, life-extending medicines. • April 2001: The creation of a Global Fund to fight AIDS, Tuberculosis, and Malaria designed to pool billions in new money from governments and the private sector, funding treatment, care, and prevention—prioritizing ARV treatment • Nov 2001: Developing countries and AIDS activists win a declaration from the WTO stating that nothing in WTO rules should stand in the way of public health and access to medicines. The US delegation—and Big Pharma—are crushed. • Coca Cola caves in—mostly—on treatment access for bottlers and distributors in Africa • 2002: Launch of Pan African AIDS Treatment Access Campaign; Africans living with HIV demand access to medicines
Declaration on the TRIPS Agreement and Public Health
―We agree that the TRIPS Agreement does not and should not prevent Members from taking measures to protect public health. Accordingly, while reiterating our commitment to the TRIPS Agreement, we affirm that the Agreement can and should be interpreted and implemented in a manner supportive of WTO Members' right to protect public health and, in particular, to promote access to medicines for all.‖
Pressuring decision makers: 2003 and beyond
Administration promises on Global AIDS
• Jan. 28, 2003, two months after massive protest and civil disobedience, Bush announces ―Emergency Plan for AIDS Relief‖
– $10 billion over five years; treatment goal of 2 million people by 2008 – Low-cost generics will be used—while U.S. thwarts broader access at the WTO
• Bush gives vote of ―no confidence‖ to Global AIDS Fund—cutting U.S. funding to $200 million per year
– Bush obstructs Congressional efforts to increase U.S. funding for Global Fund – Global Fund has no funds for upcoming grant cycle – Other G7 countries happy to follow U.S. lead
Compare and contrast
0.018 0.016 0.014 0.012 0.01 0.008 0.006 0.004 0.002 0 1 2
• Rwanda gives $1 million to Global Fund • US gives $200 million to Global Fund • Making Rwanda more ten times more generous, proportionately
2003: a turning point?
• Activists must hold the Administration accountable to its promises—and must demand more • The Administration’s unprecedented war on Iraq, focus on militarization, and deep cuts to essential programs in the U.S. make our job tougher—but not impossible
2003: a Global AIDS Presidential Project
• Candidates must be pressured to commit to implementing bold, clear plans to fund the fight against global AIDS, including full funding of the Global Fund • Candidates must be pressured to pursue trade policy that puts access to medicines first, regardless of the demands of the U.S. pharmaceutical industry--at the WTO, FTAA, and other fora • Iowa and New Hampshire—key states for sustained activism in spring and summer 2003!
What strategies are needed?
• Education • Mobilization • Pressure decision makers
• Multiple strategies have helped activists extract limited, but meaningful reform from two U.S. Administrations and from the most powerful and profitable industry in the industrialized world
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Lessons learned: what went right?
Activating Congressional allies Focus on Administration power brokers Massive street-based protest Sneaky ―zaps‖ Aggressive media work Lobbying UN multilaterals to take sides (WHO, UNAIDS, UN HRC) – Solidarity with allies in developing countries – Organizing broad, powerful coalitions—domestically and internationally
Thank you!
www.healthgap.org • asia@healthgap.org
"If there is no struggle there is no progress…power concedes nothing without demand. It never has and it never will.” Frederick Douglass