Blueprint for making medicines more affordable for everyone

By Philip Soos

26 September 2011

The magnitude and severity of preventable and treatable NCDs – diabetes, stroke, cancer and heart disease – has brought the affordability of medicines to the forefront of global public health.

 For more than a decade, a worldwide campaign has been agitating for more timely and affordable access to medicines for the world’s poor. This is because hundreds of millions of people around the world don’t have access to the medicines they require to combat and alleviate suffering from a plethora of NCDs.

 Patently obvious

One of the direct causes of the lack of affordability of pharmaceuticals is the patents system.

 Patents are a monopoly granted by the government ostensibly to promote greater levels of research and development (R&D) than would exist without some form of intervention. But the problem is that monopolistic pricing makes medicines less affordable to individuals.

 While traditional forms of protectionism such as tariffs result in markups of 20% to 30%, patents can increase medicine prices by a thousand or even ten thousand percent above market competitive prices. And monopolistic pricing is not the only hurdle to making medicines more affordable and accessible.

 It is compounded by perverse incentives for pharmaceutical companies to spend R&D on creating largely non-innovative medicines for high-income markets. Add to this, the temptation for pharmaceutical companies to withhold clinical research that indicates negative side-effects of some drugs.

 Merck knew before Vioxx was released on the market, for instance, that it substantially increased the incidence of heart attack and stroke, resulting in tens of thousands of preventable deaths in the United States.

 It’s pointless to advocate policies that result in cheaper medicines if they are defective so consumers are harmed rather than treated. But under the patent system, firms are faced with such perverse incentives that are clearly not aligned with the common good.

 All over the world

It’s wrong to assume that patents are the sole cause for lack of medicines’ affordability.

 The lack of a well-functioning public health-care systems and medicine subsidy schemes; sales taxes; poverty; government corruption; and the high cost of on-going medical treatment are also reasons why many individuals and entire populations lack timely and affordable access to pharmaceuticals.

 One of the oddities of the access to medicines campaign is that many assume only developing nations are in need of help. In fact, the affordability crisis also strikes closer to home in many of the wealthier Western nations.

 The United States, for instance, lacks a comprehensive national subsidy scheme and there’s an expectation that private insurers provide coverage alongside Medicare and Medicaid. Despite this, many millions of Americans can’t afford to purchase medicines, which are often sold at grossly inflated prices.

 Australia has one of the best medicine subsidy schemes in the world: the Pharmaceutical Benefits Scheme (PBS). But the PBS cannot subsidize every medicine on the market for the simple reason of containing costs.

 The PBS will soon cost $10 billion and is expected to continue to grow. And even now there are instances of Australians who cannot afford unsubsidised medicines and are placed at an economic (and health) disadvantage.

 True cost

The US pharmaceutical market recently reached US$300 billion in size. It would actually only be worth approximately US$30 billion at competitive market prices.

 If medicines were priced at the cost of production under an alternative R&D system, not only would they become more afford but the budgets of government subsidy programs and charities would be able to provide greater coverage and treatment to those who need it. It’s critical for activists driving the access to medicines campaign to examine the assumptions and justifications that uphold the pharmaceutical patents system.

 They shouldn’t accept what the industry and the economics profession say in support of an R&D system that’s grossly inefficient in both economic and social terms. There are much better systems to promote research and development.

 And there’s no plausible rationale for relying on 15th century government monopolies to finance R&D – a creation from the time of the feudal guild system. Overturning pharmaceutical patents, rather than fiddling around the margins, should comprise a core focus of the access to medicines campaign.

 This will help bring our scientific and innovation research structures into the 21st century, and most importantly, improve the affordability of medicines at a time when the world is facing an epidemic of non-communicable diseases.

  Source: The Conversation

 http://theconversation.edu.au/blueprint-for-making-medicines-more-affordable-for-everyone-3503

Uganda sued over maternal deaths

Activists file lawsuit in court regarding cases of women who died while giving birth unattended in hospitals. A coalition of activists has taken the Ugandan government to court in a landmark lawsuit regarding the cases of two women who bled to death unattended while giving birth in hospitals.

The activists argued that the women’s rights to life and to maternal healthcare have been violated. They also said that the negligence of the authorities causes thousands of women to die in childbirth every year.

Source: Al-Jazeera English

http://aje.me/qAHVLl

Questions arise over UN policy on Non-Communicable Diseases and IP Rights

United Nations members this month are setting the future course for global action against a rising public health problem well-known in developed countries and spreading to developing countries: non-communicable diseases. But whether they will – or should – address concerns that intellectual property rights issues might interfere with access to treatments for such diseases as diabetes, cancer, or heart disease remains to be seen.

The issue of non-communicable diseases – NCDs – has gained significant attention on the international stage in recent years with the acknowledgement by leading developing countries of the rise of such problems among their populations.

The World Health Organization highlights four disease areas under NCDs: cancer, cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes. Factors attributed to these diseases include tobacco use, unhealthy diet, harmful use of alcohol, and physical inactivity.

But intensive negotiations over the past few weeks leading up to the grand-scale 19-20 September UN “high-level meeting on non communicable disease prevention and control” in New York have raised concerns that access to treatments for these diseases may be hindered by IP rights.

The General Assembly meeting is only the second ever to deal with health issues (the first was HIV/AIDs), and at least 34 heads of State and government, 50 other leading government ministers and many specialists are expected to attend, according to the UN.

Ala Alwan, assistant director general at the WHO, speaking to press today at the UN, highlighted three priority areas for the UN 193 member states to take: “surveillance and monitoring; reduction of risk factors such as harmful uses of tobacco and alcohol, unhealthy diets and lack of exercise; and a health-care component to tend to the millions already suffering from NCDs,” the UN said. This indicates a clear focus on preventative measures first, treatment second.

But public health advocates see a coming crisis in treatment and want measures now to address it. For instance, Health Action International issued a briefing paper [pdf] this week showing medicine prices are often too high for those on low wages, and urging the summit to “refocus on the attainable goal of universal access to essential medicines as a core priority for the treatment of NCDs.” This includes promoting access to affordable, quality generic medicines.

In general, the issues of NCDs have motivated the public health community in Geneva and elsewhere.

Secret Negotiations

Closed-door negotiations in New York have focussed on a draft declaration for ministers at the summit. Information about the negotiations has not been public, the draft declaration was confidential even a few days before the summit gathering to approve it, and inquiries to UN press officers went unanswered. But sources say that a key element of debate has been whether to include references in the declaration related to the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

In particular, focus seems to be on inclusion of a reference to the 2001 Doha Declaration on TRIPS and Public Health, which accentuates the right of countries to use flexibilities in IP law as they see fit.

How much intellectual property rights should be a part of policy debates over NCDs is a matter of disagreement. Non-governmental groups are concerned that patents – which typically lead to higher prices by granting a monopoly – will put medicines for NCDs out of reach of poor populations. The rights-holding industry says the fear is overblown, as most existing medicines for NCDs are already off patent, and offered in cheap generic form.

But NGOs counter that this may be the case for existing drugs but would not be the case for future ones, which will presumably be patented as they are developed. An industry source replied to this by saying that while communicable diseases can develop resistance to medicines, NCDs do not, so existing medicines should remain effective. The only concern could be about better, more effective medicines that might come along in the future.

TRIPS was reportedly raised during the recent weeks’ negotiations by some of the Group of 77 developing countries who were concerned that flexibilities for developing countries embedded in those IP trade rules be applicable to this comparatively new area of public health. The tough negotiations ran over time, according to some sources, but in the end it was apparently agreed to strike the reference to the Doha Declaration on TRIPS and Public Health, as sought by developed countries.

According to sources, concerns were raised during the negotiations that the US and European Union were leading an effort to prevent TRIPS flexibilities from applying to NCDs, among other actions that would weaken the declaration on behalf of affected industries. Representatives of several agencies of the US government who are on the US delegation did not answer press requests for confirmation on this point.

One nongovernmental source said an argument was made that the Doha Declaration does not apply to NCDs. The argument may have been that flexibilities, like compulsory licences that allow the production of inexpensive versions of patented medicines without permission from the patent holder, are only allowable in cases of emergency or epidemic – which NCDs are not.

Several years ago, Thailand met with intense industry and developed country pressure when it took the step to issue a compulsory licence on a heart disease drug.  But US trade officials at the time said Thailand was apparently not in violation of TRIPS rules, and NGOs note that developed countries take compulsory licences for non-emergency matters all the time.

TRIPS In and Out of Draft Text

The latest draft of the declaration contains compromise text for paragraphs 34h and 48bis of the draft declaration which references TRIPS flexibilities, but dropped any mention of the Doha Declaration. The relevant portions of these paragraphs currently read:

“34h: Promote access to comprehensive and cost-effective prevention, treatment and care for the integrated management of NCDs, including, inter alia, increased access to affordable, safe, effective and quality medicines and diagnostics and other technologies, including through the full use of TRIPS flexibilities.

48bis: Urge relevant international organizations to continue to provide technical assistance and capacity building to developing countries, especially to the least developed countries, in the areas of NCD prevention and control and promotion of access to medicines for all, including through the full use of TRIPS flexibilities and provisions.”

These paragraphs previously included references to TRIPS flexibilities and the Doha Declaration, according to sources. Opponents of inclusion of the Doha Declaration may have viewed it as expanding the agreement to new areas, which they wanted to prevent because it could lead to lower prices for treatments produced by their private sectors. The Doha Declaration contains a reference to “other epidemics”, so theoretically removing reference to epidemics or the Doha Declaration would remove its applicability.

Knowledge Ecology International and others NGOs and academics interpret the omission of specific reference to the TRIPS and Public Health declaration as an attempt to make it possibly not applicable to NCDs. In this way, they argue, northern economies, and the Obama administration in particular, are undermining an agreement made by the predecessor Bush administration. KEI has a website section dedicated to the NCD negotiations.

Brook Baker, a Northeastern University (US) law professor, said the concern by the US and EU is that the UN efforts will lead to NCDs being considered an emergency. And developed countries interpret TRIPS as allowing use of compulsory licences and other flexibilities in cases of emergency. The northern countries housing most of the brand-name drug producers are opposed in order “to reduce the risk that countries might consider NCDs ‘emergencies or matters of extreme urgency’ that do not require prior negotiations for voluntary licenses on reasonable terms before issuance of compulsory licenses under Art. 31 of the TRIPS Agreement,” Baker said today on the KEI ip-health listserv. Instead, they have their eyes on those markets as NCDs continue to rise, he charged.

The draft declaration still refers to NCDs as “epidemic.”

Also in the text, another non-agreed paragraph discusses the importance of access to diagnostics and medicines, including help with financing of affordable products including generics, sources said.

And another paragraph in the draft declaration on access to medicines also appears to be not agreed: “33.d. Contribute to efforts to improve access and affordability for medicines and technologies in the prevention and control of non-communicable diseases. [Chair’s Text]”

Other references in the declaration include the impact on NCDs of food security problems, climate change and increasing loss of biodiversity, and a call for increased access to “cost-effective” vaccinations. There is also a reference to the importance of respecting, preserving and promoting traditional knowledge and medicines – but with the usual legal catchword: “as appropriate.” The next paragraph emphasises that efforts related to traditional knowledge be governed at the national level. Developed countries have resisted binding legal language at the international level in regards to this, while local communities in developing countries complain about a lack of international protection against theft of their traditional practices and resources.

Industry: Focus on Prevention, Not IP

Andrew Jenner, director of innovation, intellectual property and trade at the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) in Geneva, called the TRIPS reference issue “a red herring,” and said that “TRIPS flexibilities apply regardless” of whether there is mention or not.

Industry is concerned that policy debates will become overly focussed on the IP issues as they have done in recent years with infectious diseases (such as HIV/AIDS), which could undermine effective policymaking against NCDs, he said. “We don’t want the TRIPS discussion to hijack the discussion,” Jenner told Intellectual Property Watch.

IP issues are not the same with NCDs, he said, because of the availability of generics. “There are many generic alternatives available but many patients are not getting access in developing countries,” he said. What’s more important at this stage is to ensure effective diagnosis and delivery.

In general, flexibilities were not intended to be the first step, Jenner said, calling flexibilities “a blunt tool in the box.” There are other steps that can be tried first, he said, such as discussing needs with rights holders, tiered pricing for different markets, or going through international agencies.

Pharmaceutical industry representatives say the upcoming summit in New York will be a high-level opportunity to begin focussing on the challenge as it faces developing countries, with the first priority being on prevention. The first focus of policymakers should be on prevention of NCDs, said Mario Ottiglio, associate director for public affairs & global health policy at IFPMA. Healthy diet and exercise can have a drastic impact on NCDs, he said. IFPMA launched a “framework” for prevention in June, and in August launched a consultation on the framework.

“Developing countries are under a double burden,” Ottiglio told Intellectual Property Watch. They already face problems with infectious diseases, and now have the problems that the rise in NCDs in many developing countries is bringing to the healthcare system. Better use of resources for health literacy could lead to a more efficient use of funds.

In addition, the summit is a “great opportunity for new partnerships between stakeholders that may otherwise never have met,” he said. For instance, IFPMA is working with the World Health Professionals Alliance, carrying out a program to help patients measure their health status. IFPMA also is working with the Red Cross Red Crescent Society.

Separately, in the rules for the summit, member states were encouraged to consider including in their national delegations elected officials, and civil society – including NGOs, academia and “networks working on the control and prevention of non-communicable diseases.” It is unclear the extent to which governments have heeded this suggestion.

Seeking a Strong Declaration for the Public

Universities Allied for Essential Medicines and other nongovernmental organisations issued a release on 1 September, the day before negotiations ended, raising concern about the watering down of the declaration by the richer countries seeking trade and economic advantages, such as for tobacco and snack food industries. They singled out the United States, European Union, Canada, and Japan.

“Alarmed by explicit efforts led by developed countries to weaken the Declaration’s language in a way that will undermine effective prevention and treatment of NCDs, over 70 public health NGOs and groups representing hundreds, if not thousands, of people living with HIV/AIDS from across the globe are now sounding the alarm,” it said. AIDS activists say they had a tough fight to achieve better access for poor populations to high-priced patented drugs, and do not want to see the same difficult path to access to NCD-related drugs.

WHO Report

Separately, the WHO this week launched its WHO Non communicable Diseases Country Profiles 2011, a report with new information about the situation in 193 countries. According to WHO, the report details the proportion of each country’s deaths due to diseases such as cancer, heart and lung diseases, and diabetes. It also looks at trends in metabolic risk factors (cholesterol, blood pressure, body mass index and blood sugar) and countries’ capacities to address the challenges of NCDs. The report was to be presented at a 12 September press conference by Douglas Bettcher, director for Tobacco Free Initiative, and Leanne Riley, team leader surveillance in the WHO Department of Chronic Diseases and Health Promotion.

Source: Intellectual Property Watch 

http://www.ip-watch.org/weblog/2011/09/16/questions-arise-over-un-policy-on-non-communicable-diseases-and-ip-rights/

Will the UN backtrack on accessible medicine?

By James Love

A plan to create ‘cancer prizes’ would eliminate patent monopolies for cancer drugs, and instead grant prizes to innovators who create new medicines.

On September 19, the United Nations will convene a high-level meeting to consider the “international aspect of public health” for non-communicable diseases (NCDs), with a particular focus on the social and economic impacts for developing countries.

The UN has been widely praised for undertaking this initiative, and there is considerable support for giving attention to the growing burden of cancer, diabetes, heart disease and other non-communicable diseases, not only in high-income countries, but everywhere. However, some of the issues are controversial, including those relating to intellectual property rights for new medicines, diagnostics and medical devices.

Last week, details of the negotiations were leaked that reveal the UN declaration on NCDs will be used to attack a ten-year-old agreement on intellectual property rights and public health. The controversy involves the November 14, 2001, World Trade Organisation (WTO) Doha Declaration on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and public health. This landmark agreement was agreed upon in Doha, Qatar, during an emotionally charged and tense ministerial meeting of the WTO.

Among other things, the Doha Declaration effectively gave WTO members more flexibility in designing patent and other intellectual property rules, and said that WTO members “should” implement their laws “in a manner supportive of WTO members’ right to protect public health and, in particular, to promote access to medicines for all”.

This agreement was also the basis for subsequent changes in WTO rules on patents that allowed medicines to be exported to countries that lack local manufacturing capacity, and that deferred obligations to enforce pharmaceutical patents in the world’s least developed countries.

In 2001, big drug companies bitterly fought the Doha Declaration, but the Bush Administration, reeling from 9/11 and a subsequent scare over access to medicines to treat anthrax, wanted to build bridges with the international community, and so accepted strong language on public health.

The Doha Declaration came about during a period of great concern over access to patented AIDS drugs. During both the 2001 negotiation and a follow-up WTO negotiation in 2002-2003, Pfizer, Merck, Abbott, and other big drug companies and their lobby groups – such as the Pharmaceutical Research and Manufacturers of America (PhRMA), the International Federation of Pharmaceutical Manufacturers & Associations, and the European Federation of Pharmaceutical Industries and Associations – tried to narrow the Doha Declaration to AIDS and a handful of other infectious diseases, or to exceptional public health emergencies.

The PhRMA position was decisively rejected in the WTO negotiations. Legally, the 2001 Doha Declaration, and subsequent amendments to TRIPS, applies to any disease. But in practice, the perceptions are as important as the legal reality. By continuing to assert that the Doha Declaration is in fact limited in various ways, US and European trade negotiators have tried to discourage the granting of compulsory licenses on patents for high-priced drugs for cancer and other non-communicable diseases.

The term “compulsory license” is used to describe cases in which governments or courts set aside the exclusive rights of a patent, and allow others to use inventions, normally in return for a royalty payment to the patent owner. In such cases, the patent is no longer an absolute monopoly to use the invention, but does ensure that patent owners are paid when the inventions are used by third parties.

The use of compulsory licenses are as old as the patent system itself (a 1474 Venetian statute and an English law passed in 1623 both sanctioned compulsory licenses), and are used in a wide range of cases. While maintaining an active trade policy to prevent developing countries from using compulsory licenses for patents on medicines, at home the United States has used compulsory licenses to expand access to patented inventions to treat cancer, diagnose the Hepatitis C virus, manufacture contact lenses, and treat aortic valve heart disease.

The US has also recently twice granted compulsory licenses to Microsoft for patents on features used in Microsoft Office, and granted compulsory patent licenses to DirectTV, Toyota and other technology firms. The European Union has used compulsory licenses on Microsoft Windows technologies, and Italy has issued several compulsory licenses for pharmaceutical inventions, including one product used to restore hair loss.

When the UN convenes on September 19, it will complete its work on an outcomes resolution. Currently, the European Commission and the White House Office for the United States Trade Representative (USTR) have blocked any mention of the 2001 Doha Declaration, although a “compromise” text makes references to “the full use of TRIPS flexibilities”. The EU trade negotiator believes that the lack of reference to the Doha Declaration will allow them to assert that the 2001 agreement does not apply to non-communicable diseases. Many public health groups have urged delegates to fix this, by restoring the references to the Doha Declaration that the European Commission’s Directorate-General for Trade and the USTR have opposed.

However things play out at the UN high-level meeting on non-communicable diseases, battles over access to new cancer drugs will heat up. In India, an August 30, 2011, request for a compulsory license was filed for patents on the cancer drug Sorafenib (developed and marketed by Bayer and Onyx Pharmaceuticals as Nexavar). The India generics firm CIPLA is expected to soon launch less-expensive generic versions of several drugs, including Trastuzumab (sold by Roche under the trade name Herceptin), a super-expensive but effective treatment for women with a certain type of breast cancer.

Developing countries cannot improve access to cancer drugs unless they grant more compulsory licenses on patents, or undertake more fundamental and radical changes in the way research and development (R&D) for cancer drugs is financed.

Prize funds

In 2009, Bangladesh, Bolivia and Suriname asked the World Health Organisation to hold a meeting to consider an entirely new way to address paying for R&D for cancer drugs. Rather than depend upon 20-year patent monopolies, they proposed de-linking drug prices from R&D incentives. All monopolies for cancer drugs would be eliminated, so that drugs could be purchased at generic prices. To reward R&D, countries would put a percentage of their cancer treatment budgets into new innovation prize funds.

This proposal was entitled, “Prizes as a Reward Mechanism for New Cancer Treatments and Vaccines in Developing Countries. It was based upon ideas first put forth by Thai public health officials, who were struggling to expand access to newer cancer drugs, but were under intensive pressure from the US government to leave the patent monopoly intact.

Under the cancer prize approach, access to expensive drugs would give health authorities greater incentives to invest in the diagnosis and treatments for cancer. As outlays on cancer health care rise, countries would allocate more money for innovation prize rewards. Countries with higher incomes and greater investments in care would contribute more.

The cancer prize fund approach is also being considered in Europe. There are huge income differences between Eastern Europe and Northern Europe, and it is much easier to de-link incentives from drug prices than to manage a system of negotiating affordable prices country by country.

At first, the cancer prize fund proposal was so controversial that the World Health Organisation at first refused to publish it on its website. And in 2010, the proposal was ignored by a WHO expert group on R&D financing. But after the first WHO expert group was criticised for its pro-industry report, a second group of experts was appointed, and the cancer prize fund approach is now being re-evaluated.

The UN is being asked to backtrack from an important agreement to put “access to medicine for all” at the centre of trade policy. This comes at the same time that the United States and Europe are involved in all sorts of regional and bilateral trade negotiations that ratchet up intellectual property protections, making it harder to obtain affordable generic medicines. Inequalities of access to medicine and healthcare are already shocking, and these trade pressures just make things worse. Negotiators at the UN meetings, public health groups, politicians, and the public need to push back and demand changes in global trade negotiations.

We need to move away from lobbyist-driven policies that pit innovation against access, to a new trade policy that reconciles both objectives. Eyes will turn next to the recommendations of the World Health Organsation’s Consultative Expert Working Group on R&D, to see if this can jump-start a new direction in global negotiations – one that puts people and human rights at the center of patent policy.

Source: Al jazeera

http://english.aljazeera.net/indepth/opinion/2011/09/201191492714279493.html

Thousands on HIV treatment in Uganda risk imminent HIV drugs ban

By Henry Zakumumpa

August 17, 2011

Thousands of people enrolled on antiretroviral treatment in Uganda risk early death unless a grace period placed on the manufacture of generic drugs imposed under Trade Related Intellectual Property Rights (TRIPS), an international trade law, is extended.

The critically important Industrial Properties Bill, which makes provision for exercising the flexibilities of the TRIPS agreement, including extending the grace period of manufacturing generic drugs, has been shelved by the Ugandan national parliament, putting the lives of thousands of Uganda at grave risk come 2016.

Generic drugs refer to medicines manufactured by pharmaceutical companies who are not the original manufacturers. Under the World Trade Organization (WTO)’s TRIPS agreement, to which Uganda is a signatory, poor countries were given a transitional period to manufacture HIV drugs using the original formulas of mainly Western pharmaceutical companies such as Pfizer and Smith Kline Beecham.

For developing countries such as India, the ban on the manufacture of generic HIV drugs came into force in 2005 under the TRIPS agreement of the WTO, whereas a similar ban on poorer developing countries such as Uganda will take effect in 2016 unless Uganda passes a national law that allows for extension of this deadline. This includes drugs to treat HIV, malaria and tuberculosis.

Denis Kibira of HEPS-Uganda,a health-rights advocacy NGO, says all HIV drugs used in Uganda are manufactured in-country or in India, under an international intellectual property law that permits drug manufacturers in developing countries to manufacture pharmaceutical products that imitate those originally made by Western pharmaceutical companies on account of public health emergencies.

In 2006, CIPLA, a prominent Indian pharmaceutical company, entered into a joint venture with Quality Chemicals of Uganda to manufacture generic drugs previously produced in India whose grace period under TRIPS regulations expired in 2005.

‘’Unless the Ugandan parliament passes the Industrial Properties Bill, which it has currently shelved, the permission to manufacture cheap generic ARV drugs will cease in 2016 with thousands affected since Quality Chemicals manufactures generic AIDS drugs’’ said Moses Mulumba, Executive Director of the Centre for Health Human Rights and Development (CEHURD), a healthcare access and advocacy NGO.

With the expiry of the TRIPS grace period, the alternative for Uganda will be to buy antiretrovirals (ARVs) from Western manufacturers at prices beyond the reach of the average Ugandan ARV user.

The process of reforming Ugandan laws to bring them in line with the TRIPS agreement started back in 2000 with the Copyright and Neighboring Rights Acts being enacted in 2006 and 2010 respectively.

According to the Uganda AIDS Commission, there are 135,000 new HIV infections in Uganda. This adds to the already rising number of those in need of ARV treatment. Currently, only half of those in need of ARV treatment in Ugandan have it.

The TRIPS agreement threatens to dramatically reverse the gains achieved in access to ARVs to pre-2004 levels where only a few paying patients could afford HIV treatment.

Source: KC team

http://www.keycorrespondents.org/2011/08/17/thousands-on-hiv-treatment-in-uganda-risk-imminent-hiv-drugs-ban/