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Arlington, Virginia, JSI, DELIVER, 2013 Jan.  p.This brief describes the evolution of contraceptive procurement in the Latin America and Caribbean (LAC) region, highlighting how LAC countries monitored and evaluated key data when making performance improvements. By introducing and monitoring key indicators, they were able to smooth the procurement process and improve procurement performance.
The state of food and agriculture, 2010-11. Women in agriculture: Closing the gender gap for development.
Rome, Italy, FAO, 2011.  p.This edition of The State of Food and Agriculture addresses Women in agriculture: closing the gender gap for development. The agriculture sector is underperforming in many developing countries, and one of the key reasons is that women do not have equal access to the resources and opportunities they need to be more productive. This report clearly confirms that the Millennium Development Goals on gender equality (MDG 3) and poverty and food security (MDG 1) are mutually reinforcing. We must promote gender equality and empower women in agriculture to win, sustainably, the fight against hunger and extreme poverty. I firmly believe that achieving MDG 3 can help us achieve MDG 1. (Excerpt)
Current Opinion In HIV and AIDS. 2010 Jan; 5(1):38-47.PURPOSE OF REVIEW: Access to first-line antiretroviral therapy in resource-limited settings has increased rapidly in the last 5 years. Newer medicines with greater potency and better safety profiles open the possibility for improving first-line antiretroviral therapy for developing countries. RECENT FINDINGS: Several medicines offer the potential to improve the simplicity, safety and efficacy of first-line antiretroviral therapy in resource-limited settings. These include tenofovir, raltegravir, elvitegravir, rilpivirine and protease inhibitors. A number of clinical questions are outstanding, particularly regarding safety in pregnancy and compatibility with drugs to treat common coinfections including tuberculosis. SUMMARY: Simple, affordable regimens were key to the initial emergency response, but the long-term response to HIV calls for a reconsideration of current treatment options. Preconditions for widespread use in developing countries include affordability, simplicity and answers to relevant research questions. In the absence of strong pharmacovigilance systems, cohort monitoring will be critical to assessing the safety profile of new drugs in such settings.
[Geneva, Switzerland], Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Jan 12. 17 p.The AMFm is an innovative financing mechanism to expand access to affordable artemisinin-based combination therapies (ACTs) for malaria, thereby saving lives and reducing the use of inappropriate treatments. The AMFm aims to enable countries to increase the provision of affordable ACTs through the public, private not-for-profit (e.g. NGO) and private for-profit sectors. By increasing access to ACTs and displacing artemisinin monotherapies from the market, the AMFm also seeks to delay resistance to the active pharmaceutical ingredient, artemisinin.
Washington, D.C., Constella Futures, Health Policy Initiative, 2008 Nov.  p. (USAID Contract No. GPO-I-01-05-00040-00)This report describes how the Government of Peru was successful in diversifying its procurement options and mechanisms for contraceptive commodities. It shows the progress made between 1999, when Peru began purchasing contraceptive supplies with public funds, and mid-2007, when important changes were made in procurement channels. Today, the Peruvian government procures contraceptives from multiple national and international suppliers and is able to negotiate for favorable prices and other terms. (Author's abstract)
New York, New York, UNFPA, . 48 p.This advocacy booklet provides real-life examples to illustrate how HIV prevention can save lives in diverse cultural and geographical settings. It includes chapters on youth and HIV, promoting and distributing male and female condoms, protecting women and girls, linking HIV prevention with other sexual and reproductive health care, and empowering populations who are at particular risk. The booklet features stories from Belize, China, Egypt, Ethiopia, Nigeria, the Russian Federation, and Tajikistan.
HIV and AIDS treatment education: a critical component of efforts to ensure universal access to prevention, treatment and care. UNAIDS Inter-Agency Task Team (IATT) on Education.
Paris, France, UNESCO, 2006 Jun. 50 p. (ED.2006/WS/11309713)This paper explores some of the issues contained within the definition of treatment education, signalling ways that the education sector can play a role along with others engaged in treatment access and education. It considers some key strategies, including how to effectively engage and prepare communities and how to involve key constituencies, particularly people with HIV and those on treatment. Moreover, the paper reexamines the harmful effects of stigma and discrimination and how these impede progress in prevention as well as expanded treatment access. The paper also suggests some possible future directions, underscoring areas of particular priority. These include the need for: Identification, documentation and wide dissemination of effective approaches to treatment education that are feasible, sustainable and that can be scaled up; Development of practical guidelines and materials that can be used by programme implementers to support the integration of treatment education within ongoing HIV and AIDS education efforts; Ongoing and close communication with authorities and organizations responsible for expanding treatment access to ensure coherent and well-coordinated programming. (excerpt)
The dilemma of intellectual property rights for pharmaceuticals: the tension between ensuring access of the poor to medicines and committing to international agreements.
Developing World Bioethics. 2003 May; 3(1):27-48.In this paper, we provide an overview of how the outcomes of the Uruguay Round affected the application of pharmaceutical intellectual property rights globally. Second, we explain how specific pharmaceutical policy tools can help developing states mitigate the worst effects of the TRIPS Agreement. Third, we put forward solutions that could be implemented by the World Bank to help overcome the divide between creating private incentives for research and development of innovative medicines and ensuring access of the poor to medicine. Fourth, we evaluate these solutions on the basis of utilitarian considerations and urge that equitable pricing is morally preferable to the other solutions. (author's)
Bulletin of the World Health Organization. 2006 May; 84(5):337-424.Developing countries are failing to make full use of flexibilities built into the World Trade Organization's (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to overcome patent barriers and, in turn, allow them to acquire the medicines they need for high priority diseases, in particular, HIV/AIDS. First-line antiretroviral (ARV) drugs for HIV/AIDS have become more affordable and available in recent years, but for patients facing drug resistance and side-effects, second-line ARV drugs and other newer formulations are likely to remain prohibitively expensive and inaccessible in many countries. The problem is that many of these countries are not using all the tools at their disposal to overcome these barriers. Medicines protected by patents tend to be expensive, as pharmaceutical companies try to recoup their research and development (R&D) costs. When there is generic competition prices can be driven down dramatically. The TRIPS Agreement came into effect on 1 January 1995 setting out minimum standards for the protection of intellectual property, including patents on pharmaceuticals. Under that agreement, since 2005 new drugs may be subject to at least 20 years of patent protection in all, apart from in the least-developed countries and a few non-WTO Members, such as Somalia. Successful AIDS programmes, such as those in Brazil and Thailand, have only been possible because key pharmaceuticals were not patent protected and could be produced locally at much lower cost. For example, when the Brazilian Government began producing generic AIDS drugs in 2000, prices dropped. AIDS triple-combination therapy, which costs US$ 10 000 per patient per year in industrialized countries, can now be obtained from Indian generic drugs company, Cipla, for less than US$ 200 per year. This puts ARV treatment within reach of many more people. (excerpt)
BMJ. British Medical Journal. 2005 Nov 12; 331(7525):1104.By 2010, poor developing countries will continue to suffer from a shortfall in supplies of low cost antiretroviral drugs (ARVs) for patients with HIV/AIDS unless rational measures are taken quickly, a top World Health Organization official has warned. “We’re going to reach a crisis in terms of supply very very soon . . . of [antiretrovirals] throughout the developing world because the scale-up is happening very very quickly,” Dr Jim Yong Kim, WHO’s outgoing director for HIV/AIDS, told the BMJ. The issue now for the public health world, he said, in the aftermath of the recent summit of the G8 (the world’s most industrialised countries) in Scotland, was that a potential eight to 10 million people will need treatment. In July, the leaders of the G8 agreed at the Gleneagles summit “to provide as close as possible to universal treatment for AIDS by 2010.” (excerpt)
Geneva, Switzerland, WHO, 2005.  p.AIDS Medicines and Diagnostics Service is a network that aims to increase access to good quality and effective treatments for HIV/AIDS by improving supply of antiretroviral medicines and diagnostics in developing countries. Goals: To ensure that the supply of quality commodities is never an obstacle to expanding treatment, care and support; To use improved commodity supply to catalyze rapid expansion of treatment, to promote equity, and to support prevention. (excerpt)
Lancet. 2005 Mar 26; 365:1198-1200.In the early 1990s, a subset of the health sector— patented drugs—burst quite unexpectedly into the international trade debate. The ongoing trade negotiations of the Uruguay Round were in disarray, and support from sectors that relied on the protection of intellectual property rights became essential to move them forward. Indeed, the Uruguay Round Agreement was signed in 1994 only because it included a then much praised Trade-Related Intellectual Property Rights (TRIPs) agreement. Between 1994 and the 2001 Doha Ministerial of the World Trade Organization (WTO), the spread of AIDS reached pandemic proportions. Research had yielded a cocktail therapeutic of drugs, but in 2001 a typical treatment cost US$12 000 a year per person—a sum far out of reach for most people with AIDS in developing countries. This imbalance fuelled a debate about access to essential medicines so acrimonious that it came close to derailing the Doha Ministerial. A solution was reached only 2 years later, and only 2 weeks before the 2003 Cancún WTO Ministerial. (excerpt)
Geneva, Switzerland, WHO, 2003 Jun.  p.This report sets out to provide market information that can be used to help procurement agencies make informed decisions on the source of medicines and serve as the basis for negotiating affordable prices. The aim is to help increase access to medicines for people living with HIV/ AIDS in developing countries. The data provided by the manufacturers serves to highlight the multiplicity of suppliers and the variation in price of some essential HIV/AIDS-related medicines on the international market. Without this information, there is a risk that low-income countries may be paying more than needed to obtain essential medicines. Price variations are highlighted through the tables and graphs included. Provision of price information addresses only one barrier to access to medicines in countries with limited resources and, it is appreciated that many other factors will affect the availability of medicines. Some of the other issues that must be considered in relation to the purchase of medicines for HIV/AIDS and related conditions are health infrastructure, human resources, and supply and distribution systems. (excerpt)
Antiretroviral therapy in primary health care: experience of the Khayelitsha programme in South Africa. Case study.
Geneva, Switzerland, WHO, 2003. 10 p. (Perspectives and Practices in Antiretroviral Treatment)With 42 million people now living with HIV/AIDS, expanding access to antiretroviral treatment for those who urgently need it is one of the most pressing challenges in international health. Providing treatment is essential to alleviate suffering and to mitigate the devastating impact of the epidemic. It also presents unprecedented opportunities for a more effective response by involving people living with HIV/AIDS, their families and communities in care and will strengthen HIV prevention by increasing awareness, creating a demand for testing and counselling and reducing stigma and discrimination. The challenges are great. Sustainable financing is essential. Drug procurement and regulatory mechanisms must be established. Health care workers must be trained, infrastructure improved, communities educated and diverse stakeholders mobilized to play their part. This series, Perspectives and Practice in Antiretroviral Treatment, provides examples of how such challenges are being overcome in the growing number of developing countries in which antiretroviral treatment programmes are underway. The case studies and analyses in this series show how governments, civil society organizations, private corporations and others are successfully providing antiretroviral treatment and care to people with HIV/AIDS, even in the most resource-constrained settings. In documenting these pioneering programmes, WHO hopes that their experiences will both inform and inspire everyone who is working to make access to treatment a reality. (excerpt)
Accelerating Access Initiative. Widening access to care and support for people living with HIV / AIDS. Progress report, June 2002.
Geneva, Switzerland, World Health Organization [WHO], 2002.  p.The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) estimate that in 2001 about 3 million people died from AIDS, with the vast majority of these deaths occurring in developing countries. While the availability of antiretroviral (ARV) therapy has significantly reduced AIDS morbidity and mortality in the industrialized world, in developing countries, where 95% of HIVpositive people live, the overwhelming majority of HIV-positive people do not have access to these life-sustaining medications. WHO conservatively estimates that in 2002, around 6 million people in developing countries are in need of ARV therapy. Yet only about 230,000 people living with HIV in those countries have such access today. Half of these live in one country, Brazil. Access to medicines is dependent on their rational selection and use, the availability of financial resources, the strength of the health infrastructure and their affordability. As the high cost of medicines is a major factor limiting access to ARVs in developing countries, in May 2000 five UN organizations (the United Nations Population Fund [UNFPA], United Nations Children’s Fund [UNICEF], World Health Organization [WHO], World Bank and UNAIDS Secretariat) entered into a partnership offered by five pharmaceutical companies (Boehringer Ingelheim GmbH; Bristol-Myers Squibb; GlaxoSmithKline; Merck & Co., Inc.; and F. Hoffmann-La Roche Ltd. – later joined by Abbott Laboratories) to address the lack of affordability of HIV medicines and to work together to increase access to HIV/AIDS care and treatment in developing countries. (excerpt)
[Marginalized urban and rural areas in Latin America] reas rurales y urbanas marginadas de América Latina.
In: Simposio Latinoamericano de Planificación Familiar, Noviembre - Diciembre, 1992, México D.F., México, edited by Guillermina Herrera. Mexico City, Mexico, Population Council, 1993 Nov. 22-25.Latin America, with its almost 460 million inhabitants, constitutes a heterogeneous reality made up of diverse and contrasting levels of development and sociopolitical situations. It consists of 20 countries-the Spanish-speaking countries of the continent and the Caribbean, plus Brazil-that in one way or another saw their economies seriously affected beginning in the early 1980s. Multiple factors contributed to that situation, most significant among them the drop in prices of their raw materials on the international market and the increase in their onerous external debts. It was no surprise that the Economic Commission for Latin America and the Caribbean (ECLAC) characterized the 1980s as the economically "lost decade." (excerpt)
Southern Africa HIV / AIDS Action. 2003 Jun; (56):10.Because Antiretroviral drugs are very expensive and unaffordable most people think that it is not feasible to use antiretrovirals in resource poor settings. However, use of antiretrovirals is feasible in developing countries. This is an important lesson that has been learnt from the pilot phase of the UNAIDS HIV Drug Access Initiative. The Drug Access Initiative (DAI) was launched in November 1997, designed to develop innovative, effective models to improve access to needed drugs to treat HIV and its opportunistic infections. The initial phase of the Initiative has been designed to set up the necessary infrastructure and systems to increase access to HIV related drugs on a small but sustainable scale. (excerpt)
Africa Recovery. 2004 Apr; 18(1): p..Almost a decade ago, the development of an effective treatment for the human immunodeficiency virus (HIV) that causes AIDS opened an ugly new gap in the global divide between rich and poor. People in wealthy countries could get the expensive new drugs, known as anti-retrovirals (ARVs), and live. For people in poor countries, there would be no drugs, only the certainty of a slow and agonizing death. And die they did, in the millions. Declaring the inability of the poor to obtain HIV/ AIDS medications "a global health emergency," the director-general of the UN's World Health Organization (WHO), Dr. Lee Jong-wook, launched a global drive to provide life-extending ARVs to 3 million people, including 2 million in Africa, by the end of 2005. It is known as the "3x5" campaign. About 6 million people worldwide currently require ARVs, which are prescribed only to those in the last stages of the disease. It is also a long-term commitment, since the drugs do not cure the disease and must continue for life. "To deliver anti-retroviral treatment to the millions who need it we must change the way we think and change the way we act," noted Dr. Lee. "Business as usual will not work. Business as usual means watching thousands of people die every single day." (excerpt)
Lancet. 2004 Dec 4; 364:2007-2008.Mikhail Rukavishnikov sits in his modern apartment in central Moscow sipping tea. To the casual visitor he has all the trappings of Russia’s emerging middle class who have overcome the chaos of the 1990s and made a comfortable life. He has an office job with a big Russian firm, a decent apartment, a big TV, and money to travel abroad on holiday. But Rukavishnikov and his girlfriend are among the million Russians living with HIV. “I toyed with drugs when I was younger and got infected. We had no idea then of the dangers. We had never heard about HIV/AIDS and Russian awareness is still catching up with the rest of the world”, says Rukavishnikov. Drug abuse in Russia is rampant and is still the main route of HIV transmission, but the spread of the disease has reached a critical point: public-health officials warn that the virus has begun to move from the high-risk groups such as drug users, sex workers, and prisoners, to a bridge population. A recent report by UNAIDS says the Russian epidemic is growing out of control, as infection spreads faster than in any European country. (excerpt)
BMJ. British Medical Journal. 2004 Jul 17; 329:129.A huge international effort is under way to get lifesaving antiretroviral treatment to three million people with AIDS in poor countries by the end of 2005, said the World Health Organization, but added that its six month campaign had fallen short of interim targets. In all, 400 000 AIDS patients in developing countries were receiving antiretrovirals when WHO launched its "3 by 5 strategy." That figure has edged up to 440 000, said WHO's progress report, presented at the international AIDS conference this week. "Although this was disappointing, the absolute increase of 40,000 people in a few months dose indicate that country and international efforts to scale up HIV- AIDS treatment are resulting in progress report. The progress report is likely to fuel critics of WHO's 3 by 5 campaign, who contend that it is overambitious, poorly managed, and too focused on lowering drug prices. (excerpt)
Canadian HIV / AIDS Policy and Law Review. 2002 Dec; 7(2-3):57-58.In mid-2002, the World Health Organization (WHO) estimated that some six million people with HIV/AIDS in developing countries are currently in need of life-sustaining antiretroviral (ARV) therapy, but that only 230,000 have access to these medicines, half of whom live in one country, Brazil. The WHO believes that, with a concerted international effort to expand access to HIV treatment and care, three million people could have access to ARVs by the end of 2005. A number of recent initiatives provide some useful tools toward reaching this goal. (author's)
Johannesburg, South Africa, ActionAid International, 2004 Jun. 11 p. (3 by 5 Discussion Paper)This paper addresses these concerns. Prevention, care and support: in the push to provide antiretrovirals, prevention, care and support programmes must not slip down the priority list of the world’s governments. ActionAid International calls on developing countries to demonstrate clearly in their 3 by 5 plans how ARV treatment delivery will interface with, and be balanced by, other prevention, care and support initiatives, including the promotion of good nutrition. Equity: initially, the limited supply of ARVs under 3 by 5 will be the focus of a struggle between different interest groups trying to ensure access for their client populations. ActionAid International’s past experience would suggest that men, and those that are better off or living in urban areas, will win out over women, children, marginalised groups and those living in rural areas. We call on all involved in developing 3 x 5 plans to ensure equity in access by focusing on the special needs of women, marginalised groups, poor and rural communities. Ideally, such groups should be involved in the design and implementation of care services that will be appropriate to their needs and be located close to where they live. Health systems: ActionAid International welcomes the recent emphasis given by the WHO World Health Assembly to health system strengthening as an essential component in delivery of 3 by 5. In many of the countries most affected by HIV/AIDS health systems are not working, having been undermined by World Bank/IMF structural adjustment programmes as well as attrition caused by HIV/AIDS. The rapid rebuilding of health systems is a basic requirement if 3 by 5 is to succeed. ActionAid International calls on donors to provide increased funding and support and to ensure that large-scale capacity building programmes for health service personnel are instituted without delay. (excerpt)
Lancet. 2004 Feb 21; 363(9409):659.The article by the new Director General of the WHO will lift the hearts of many in the developing world because of its thrust “to take the organization back to its core values”. I write from India where the WHO, in the recent past, had developed an unsavoury reputation. I am looking here only at the issues surrounding vaccinations. The WHO and the Global Alliance for Vaccines and Immunization (GAVI) have been bullying the government to include newer (and expensive) vaccines such as hepatitis B vaccine and the Haemophilus influenzae type b (Hib) vaccine into the routine programme of immunisation in the country. Reliable data from India suggest only a very small number die of hepatocellular carcinoma. Similarly, for Hib, the incidence of invasive disease in India is remarkably low. (excerpt)
The role of civil society in protecting public health over commercial interests: lessons from Thailand.
Lancet. 2004 Feb 14; 363(9408):560-563.In October, 2002, two Thai people with HIV-1 won an important legal case to increase access to medicines. In its judgment in the didanosine patent case against Bristol-Myers Squibb, the Thai Central Intellectual Property and International Trade Court ruled that, because pharmaceutical patents can lead to high prices and limit access to medicines, patients are injured by them and can challenge their legality. This ruling had great international implications for health and human rights, confirming that patients—whose health and lives can depend on being able to afford a medicine—can be considered as damaged parties and therefore have legal standing to sue. The complexities of pharmaceutical intellectual property law are most poorly understood by those most affected by their consequences—the patients who need the drugs. The Thai court case was the outcome of a learning process and years of networking between different civil society actors who joined forces to protect and promote the right of access to treatment. Our Viewpoint, based on key interviews and published reviews, summarises the efforts of civil society in Thailand to achieve a fair balance between international trade and public health. These efforts have focused on didanosine, an essential antiretroviral drug that in Thailand has become symbolic of how multinational companies and governments of industrialised countries protect their own interests at the expense of access to essential medicines for the poor. (author's)
New York Times. 2004 Feb 11;  p..After a long, clumsy war against AIDS, Romania has finally declared itself the winner. "Yes — at this moment, we have a victory," said Dr. Adrian Streinu-Cercel, president of the National AIDS Committee. "Everyone who needs triple therapy is getting triple therapy." The country, which became infamous in 1990 for the squalid orphanages and babies dying of AIDS that marked the final years of Nicolae Ceausescu's dictatorship, is now being cited as a model of how governments, drug companies and international agencies can bring AIDS under control by ensuring that the necessary three-drug anti-retroviral cocktails are available and paid for. (excerpt)