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[Geneva, Switzerland], UNAIDS, 2004 Nov.  p.The Global Coalition on Women and Aids brings together a wide range of partners - civil society groups, networks of women living with HIV and AIDS, governments, and UN agencies - who work together to lessen the devastating impact of AIDS on women and girls worldwide. Almost half of the adults living with HIV and AIDS today are women. Over the past two years, the number of women and girls infected with HIV has increased in every region of the world, with rates rising particularly rapidly in Eastern Europe, Asia, and Latin America. In sub-Saharan Africa, women and girls already make up almost 60% of adults living with HIV. Launched in early 2004, the Global Coalition on Women and AIDS works at global and national levels to highlight the effects of AIDS on women and girls and to stimulate concrete and effective action to prevent the spread of HIV. Coalition partners seek to address some of the fundamental gender inequalities that fuel the epidemic. Efforts are focused on preventing new HIV infections, promoting equal access to care and treatment, ensuring universal access to education, addressing legal inequities, reducing violence against women, and valuing women's care work within communities. (excerpt)
Health Policy and Development. 2004 Aug; 2(2):96-99.The World Food Programme (WFP) is the United Nations (UN) agency responding to humanitarian emergencies by delivering food aid to vulnerable populations worldwide. The protracted insurgency in northern Uganda resulted in the displacement of up to 1,619,807 people, largely women and children. The humanitarian situation among displaced persons in northern and eastern Uganda led to diminished coping abilities and increased food aid needs. Access to food through productive means varies but, on average, households can only access about 0.5 - 0.75 acres of land. Recent nutrition and health assessments conducted in Pader District, in Feb 2004 and in Gulu District, in June 2004, highlight high mortality rates of more than 1 death/10,000 people/day. While Global Acute Malnutrition (GAM) rates appear to fall within the normal range expected within African populations (<5% GAM), high mortality rates consistently highlight the severity of the health situation in the camps. The WFP Uganda Country Office currently implements a Protracted Relief and Recovery Operation (PRRO) and a Country Programme (CP). The PRRO targets Internally Displaced Persons in Northern Uganda through General Food Distribution (GFD) activities, school children, HIV/AIDS infected and affected households and other vulnerable groups. In partnership with the Government of Uganda (GOU), sister UN agencies, international and national NGOs and Community Based Organisations, WFP currently assists the 1,619,807 Internally Displaced Persons, (IDPs), including 178,741 school children in the Gulu and Kitgum, 19,900 people infected with or affected by HIV/AIDS in Gulu and Kitgum and more than 750 food insecure persons involved in asset creation. Whilst WFP and other humanitarian actors continue to provide relief support to the displaced communities of northern Uganda, it is clear that without increased security the crisis will continue. (author's)
Durban, South Africa, Health Systems Trust, 2004. 61 p.This case study presents an overview of the Stop TB Partnership operating in the South African context. It offers an analysis of the activities and impact of the Partnership in South Africa. Its overarching objective is to collect a set of baseline data on the functioning and operational aspects of the Partnership and to assess whether such initiatives contribute to the development of equitable health services in the public health sector. Tuberculosis is a priority disease in South Africa: the cure rate for new patients of 64% is still way below the World Health Organization (WHO) target of 85%. In some provinces, the cure rate is as low as 40%. The estimated incidence of TB per 100 000 population is 526, and an estimated 60% of adults with TB are also HIV positive. South Africa is ranked third in the WHO AFRO region by the number of TB cases, and ninth globally. Funded by WEMOS, this review is part of a multi-country study. It aims to augment the existing body of knowledge on Global Public Private Initiatives in Health (GPPIs) and to generate a body of country-based evidence relating to the effect of GPPIs on health policies and health systems. (excerpt)
Choices. 2004; 6.HIV/AIDS has reached the proportion of a pandemic because human rights continue to be violated on a massive scale. During my term as UN High Commissioner for Human Rights, and in the years since, I have seen first-hand how these rights violations fuel the spread of HIV/AIDS. I have met with women in rural areas across Africa who feared losing their homes and being rejected by their families due to their actual or suspected HIV status. I will never forget the elderly man I met in Delhi who was refused hospital treatment for a broken hip because he was HIV positive, or the discrimination against the gay, lesbian and transsexual community recounted to me by a group in Argentina, every one of whom had a personal story of rejection and hardship. (excerpt)
Choices. 2004; 7.I left the 1998 International AIDS Conference in Geneva frustrated and angry. The slogan of the conference--'Bridging the Gap'--was right on target, but none of the major players in the conference (the international agencies, governments, the big pharmaceutical companies) offered a vision, let alone a strategy, for making life-saving treatments available to the millions of HIV-positive people in poor and developing countries. As has been true since the beginning of the AIDS epidemic, it was left to HIV-positive people themselves and to advocacy groups to formulate demands, mobilize the political support to challenge the status quo and lead in the development of new policies. Dramatic changes have occurred between 1998's 'Bridging the Gap' and 2004's 'Access for All' conferences. In the intervening six years, an alliance of NGOs from around the world with a bloc of progressive poor and developing countries has won significant victories: It is no longer morally acceptable to do nothing about the death and suffering of millions; The broader global AIDS community has accepted that any effective approach to stopping the epidemic must include treatment as well as prevention and mitigation. (excerpt)
[Chapel Hill, North Carolina], Ipas, 2004. (8)  p.This document compiles facts and recommendations for action to prevent maternal mortality due to unsafe abortion, ensure that legal abortion is safe and accessible for all women, guarantee that legal abortion and postabortion care services are within reach of all women throughout health systems, and review laws and policies that place women's lives in danger. These essential steps to protect women's health and guarantee their human rights--endorsed by the world community over the past decade--require concerted action from health systems, professional associations, parliamentarians, women's organizations and all relevant stakeholders. Implementing safe, legal abortion services, removing barriers to existing services, and informing the public about where they can obtain abortion care are key measures to ensure safety and access to abortion. (excerpt)
Ethical and programmatic challenges in antiretroviral scaling-up in Malawi: challenges in meeting the World Health Organization's "Treating 3 Million by 2005" Initiative goals.
Croatian Medical Journal. 2004; 45(4):415-421.The Fifty-seventh World Health Assembly's (WHA's) resolution on the "scaling up of treatment and care within a coordinated and comprehensive response to HIV/AIDS" is welcomed globally, and even more so in Sub-Saharan Africa, where the majority of the people currently in need of antiretroviral therapy do not have access to it. The WHA identified, among others, the following areas which should be pursued by member states and the World Health Organization (WHO): trained human resources, equity in access to treatment, development of health systems, and the integration of nutrition into the comprehensive response to HIV/AIDS. The WHO Director-General was requested to "provide a progress report on the implementation of this resolution to the Fifty-eighth World Health Assembly." Much of what happens between now and that time depends on the actions of the WHO and the member states and also on the contribution of the international community to the fight against HIV/AIDS. Much of what is to be done will be based on what is available now in terms of practice, human resources, and programs. This paper explores the WHA's resolution, especially regarding the scaling up of antiretroviral therapy, taking Malawi as the case study, to identify the challenges that a Southern African country may be facing which will eventually influence whether the initiative to "Treat 3 Million by 2005" ("3 by 5") will be achieved or not. The challenges southern countries may be facing are presented in this paper not in order to undermine the initiative but to create an awareness of these factors and initiate the appropriate action which would surmount the challenges and achieve the goals set. (author's)
UN Chronicle. 2004 Sep-Nov; 41(3): p..For many in the developed world, the HIV/AIDS crisis has receded as an active concern. The spotlight of international attention has shifted away from the devastating effects of the epidemic on Africa to other crises. There is also a sense that the situation is somehow under control, given the increasing availability of funds to combat HIV/AIDS and wider access to antiretroviral drugs. That is certainly not the case. HIV/AIDS remains a huge problem in Africa. The crisis persists, deepens and resists easy solutions. The disease is not only a serious obstacle to development efforts but is shifting the horizons of development. The epidemic has decimated an entire generation of young adults; born after independence, they represented the hopes, savings and investments of their peoples. It leaves communities and societies struggling to survive. If they are left without support, the Millennium Development Goals will only be idle talk, and strategies to reduce poverty will be equally empty frameworks. (excerpt)
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2004.  p.This document is one important step in a process for improving access to quality of care in family planning by reviewing the medical eligibility criteria for selecting methods of contraception. It updates the second edition of Improving access to quality care in family planning: medical eligibility criteria for contraceptive use, published in 2000, and summarizes the main recommendations of an expert Working Group meeting held at the World Health Organization, Geneva, 21-24 October 2003. (Please see Annex 2 for the list of participants.) The Working Group brought together 36 participants from 18 countries, including representatives of many agencies and organizations. The document provides recommendations for appropriate medical eligibility criteria based on the latest clinical and epidemiological data and is intended to be used by policy-makers, family planning programme managers and the scientific community. It aims to provide guidance to national family planning/reproductive health programmes in the preparation of guidelines for service delivery of contraceptives. It should not be seen or used as the actual guidelines but rather as a reference. The document covers the following family planning methods: low-dose combined oral contraceptives (COCs), combined injectable contraceptives (CICs), combined patch (P), combined vaginal ring (R), progestogen-only pills (POPs), depot medroxyprogesterone acetate (DMPA), norethisterone enantate (NET-EN), levonorgestrel (LNG) and etonogestrel (ETG) implants, emergency contraceptive pills (ECPs), copper intrauterine devices (Cu- IUDs), levonorgestrel-releasing IUDs (LNG-IUDs), copper-IUD for emergency contraception (E-IUD), barrier methods (BARR), fertility awareness-based methods (FAB), lactational amenorrhoea method (LAM), coitus interruptus (CI), and female and male sterilization (STER). (excerpt)
Making it real. Universal access to reproductive health care is difficult to measure and even more difficult to achieve.
Countdown 2015: Sexual and Reproductive Health and Rights for All. 2004; (Spec No):92-95.The International Conference on Population and Development was, fundamentally, about making sure that everyone could get the reproductive health services they wanted or needed—“universal access”. This goal seems straightforward, if by no means easy to achieve—especially for the poor and those in isolated rural areas. But ensuring access is not only about mobilising the political will and financial resources to make services available. It is also about making sure people know what and where the services are; that they can physically get to them; and that they can afford to pay for them. Finally, it is about ensuring that people want to use the services—because their families and communities support their choices, and because they feel welcome and accepted at service sites. (excerpt)
Geneva, Switzerland, WHO, 2004 Jun.  p. (WHO/EDM/PAR/2004.4; Development Experience Clearinghouse DocID / Order No. PN-ADB-693)Antiretroviral therapy, prevention and treatment of opportunistic infections and cancers, as well as palliative care are important elements of HIV/AIDS care and support. HIV/AIDS care hence requires a wide range of essential medicines. If available, these effective and often relatively inexpensive medicines can prevent, treat, or help manage HIV/AIDS and most of the common HIV-related diseases. Less than 8% of people who require antiretroviral (ARV) treatment can access these medicines in developing countries. The high price of many of the HIV-related medicines and diagnostics offered by common suppliers – especially antiretroviral and anti-cancer medicines – is one of the main barriers to their availability in developing countries. There are several other important barriers, including a lack of the basic components required for care, treatment, and support of people living with HIV/AIDS (PLWA) such as: trained staff in health facilities, constant availability of laboratory equipment and supplies, sufficient funding, efficient pharmaceutical services, strong political will and government commitment. Wider availability of information on prices and reliable sources of medicines can help those responsible for procurement make better decisions. Since 2000, prices of important first-line ARVs have fallen considerably. This trend is attributable to a cumulation of factors including advocacy, corporate responsiveness, competition from generic manufacturers, sustained public pressure, and the growing political attention paid to the AIDS epidemic. In addition, originator companies began announcing discount offers for the benefit of the poorest countries or those where HIV/AIDS prevalence is highest. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, Stop TB, 2004.  p.Globally, over 98% of the deaths caused by tuberculosis (TB) annually are in developing countries. Within the Western Pacific Region, the seven countries that account for 94% of the TB prevalence are low or lower middle-income economies. Within countries, as well, poor and marginalized communities suffer disproportionately from TB. Importantly, TB affects the most economically and socially productive age group, as 77% of TB deaths occur within the ages of 15 – 54. This evidence points to the important relationship between poverty and TB. The deprivation associated with poverty, such as overcrowding, poor ventilation and malnutrition, increases the rate of transmission and progression from infection to disease. In turn, the costs of TB can further impoverish poor households. This is because poor households must dedicate a larger proportion of their income to meet the direct and indirect costs of seeking TB care than the non-poor. The opportunity costs are likewise higher for the poor than non-poor. For the poor, a decrease in productivity or an increase in time away from work because of illness leads to a reduction in income. Moreover, coping mechanisms employed by poor households during periods of illness may reduce household productivity in the long-term. TB has important social costs as well, which are more likely to affect women with TB than men. For example, stigma and isolation resulting from TB can reduce an individual's social position. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2004 Dec.  p.There is an urgent need to define at country level an essential package of interventions that can be delivered through health services to meet the needs of young people. This document summarizes the evidence for effective action, and encourages policy makers and programmers to turn concern and commitment into effective and sustainable action. It is based on an understanding that HIV infects people when they are young, but AIDS affects and kills people at an age when they would be parents and workers who sustain society and domestic and family life. Helping young people to protect themselves against HIV and AIDS protects people now and in the future. It protects the future of family life and the economic prospects of countries in development. (excerpt)
New York, New York, UNFPA, .  p.As a lead UN agency for reproductive health commodity security, UNFPA tracks and forecasts supply and demand. A combination of factors are creating severe shortages: MORE PEOPLE OF REPRODUCTIVE AGE: More than one billion people are between 15 and 24 years of age. They are entering their reproductive lives as the largest-ever generation of young people. INCREASED DEMAND FOR CONTRACEPTIVES: The number of contraceptive users is projected to increase more than 40 per cent between 2000 and 2015, due to population growth and the success of family planning programmes. Over this same period the cost of quality contraceptives is projected to increase from US $ 810 million to US $ 1.8 billion. INCREASES IN TRANSMISSION OF HIV/AIDS: HIV transmission rates are still on the rise. In a few countries, as many as 40 per cent of all pregnant women are estimated to be infected with HIV. The fact that 75 per cent of infections are acquired through sexual transmission makes condoms essential for HIV prevention. In addition, each year there are some 340 million new cases of other sexually transmitted infections. (excerpt)
London, England, Christian Aid, 2004 Jul. 17 p.The World Health Organisation (WHO) hopes to treat three million people with antiretroviral drugs by 2005. If ‘3 by 5’, as it is known, is achieved it would represent a ten-fold increase in the number of people in poor countries receiving antiretroviral treatment (ART). This would be a hugely important step – prolonging the lives of the most productive generation and allowing parents to survive long enough to put their children through school. Christian Aid applauds this commitment but warns that this is a highly complex situation. HIV/AIDS is the biggest threat to the developing world. Today’s productive generation is dying and the workforce of tomorrow is being left without parents; the economic future of the developing world is bleak. But, as Drugs alone are not enough shows, without the appropriate infrastructure the drugs themselves may actually become counter-productive. Community organisations and networks must provide recipients of drug treatment with backup. Home-based care and other community-support programmes, the backbone of much of Christian Aid’s HIV work, are ideally placed to provide these services. (excerpt)
Geneva, Switzerland, WHO, 2004. 6 p.WHO and UNAIDS are actively promoting the scale-up of programmes to deliver antiretroviral therapy (ART), with the aim of reaching three million people by the end of 2005 ('3 by 5 Initiative'). Equity in access to HIV treatment is a critical element of the '3 by 5' and will contribute to the broader 'right to health' for all. Attention must therefore be given to ensuring access to ART and other treatment, care and prevention, for people who risk exclusion including on the basis of their sex. Currently there is limited information available on the sex and age distribution of those receiving ART, however, we know that gender-based inequalities often affect women's ability to access services. Attention is therefore required to ensure that women and girls have equitable access to ART as it becomes available. Gender-based inequalities put women and girls at increased risk of acquiring HIV. Women's limited ability to negotiate safer sex practices with their partners, including condom use, can place even women who are faithful to one partner at risk of HIV infection. Married adolescent girls may be particularly vulnerable. Sexual violence, including rape, likewise increases the risk of HIV for women and girls. In addition, they typically have less access to education, income-generating opportunities, property ownership and legal protection than men. This means many women are not able to leave relationships even when they know that they may be at risk of HIV. (excerpt)
Report of the fifteenth meeting of the UNAIDS Programme Coordinating Board, Geneva, 23 and 24 June 2004.
Geneva, Switzerland, UNAIDS, 2004 Jul 30. 62 p. (UNAIDS/PCB(15)/04.15)The fifteenth meeting of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Programme Coordinating Board (PCB) took place at the Ramada Park Hotel, Geneva, Switzerland, on 23 and 24 June 2004. The participants are listed in Annex 3. On behalf of Zambia, the outgoing Chair of the PCB, H.E. Dr Brian Chituwo, Minister of Health, opened the fifteenth meeting of the PCB and welcomed all those attending. Dr Chituwo stated that it had been an honour and a privilege on behalf of Zambia to chair the PCB. In light of various international proclamations, including the United Nations Millennium Development Goals, the Copenhagen Consensus and the World Health Organization (WHO) Commission on Macroeconomics and Health, he felt that the global community had given a broad mandate to UNAIDS to take the fight against the pandemic to higher levels, and he noted that UNAIDS had responded by scaling up activities significantly. He warned against complacency, however, and cited the particular challenges posed by the “3 by 5” Initiative, including his country’s own efforts to scale up treatment. He paid tribute to Dr Peter Piot (Executive Director of UNAIDS) and his team and thanked them for their close support during his tenure in office. In closing, he urged all to remain united in the fight against HIV/AIDS. (excerpt)
Nature. 2004 Jul 8; 430:133.Next week, some 15,000 delegates will converge on Bangkok, Thailand, for the XV International AIDS Conference. It is appropriate, given the meeting's location in a fast-developing country that has done much to protect its citizens from HIV, that its theme is 'access for all'. For the poor countries hit hardest by AIDS, this is the crucial issue -- they need access to lifesaving drugs, to interventions that can limit the spread of HIV, and to the money to pay for it all. At the last international conference, in Barcelona in 2002, hopes were high that the rich world would begin to provide the cash to allow developing nations, particularly those in sub-Saharan Africa, to fight back against HIV. "Bangkok will be a time of accountability," observed Peter Piot, executive director of UNAIDS, the Joint United Nations Programme on HIV/AIDS (see Nature 418, 115;2002). Now it is time to take stock. Today's balance sheet reveals a mixed picture. On the plus side, more people than ever before are being treated with cocktails of antiretroviral drugs. According to UNAIDS, 230,000 AIDS patients in developing countries were getting these drugs at the end of 2001; two years later, this figure had risen to 400,000. Price reductions have driven this progress -- negotiations by philanthropic organizations have helped to lower costs from a minimum of US $300 per person, per year in 2002 to today's figure of $140. (excerpt)
Central European Journal of Public Health. 2004 Mar; 12(1):52.Health workers' experience shows that HAART can be delivered and is effective in poor settings. The World Health Organization (WHO) welcomes the research published in the issue of The Lancet highlighting the substantial increased survival for people with HIV/AIDS who have access to highly active antiretroviral therapy (HAART). The new report focuses on findings in rich countries, but the experience of WHO and public health workers in clinics around the world shows that antiretroviral therapy (ART) can be delivered effectively and with equally dramatic results in poor countries. This research and the new evidence that antiretroviral therapy is extremely effective gives added backing to WHO in its push to deliver antiretrovirals to three million people in developing countries by the end of 2005 (the "3 by 5" target). WHO expects survival gains to be as good or even better in resource-poor settings over a similar period of time. "Treatment with antiretrovirals works for everyone - rich and poor. Now the poor urgently need access to these drug," said Dr Charlie Gilks, head of WHO's "3 by 5" team. "We are determined too simplify treatments and to ensure that affordable, quality drugs reach those in need as quickly as possible." (excerpt)
BMJ. British Medical Journal. 2004 Nov 27; 329:1281-1283.WHO’s “3 by 5” initiative to increase access to antiretroviral drugs to people with AIDS in developing countries is highly ambitious. Some of the biggest obstacles relate to delivering care. Access to good quality antiretroviral treatment has transformed the prognosis for people with AIDS in the developed world. Although it is feasible and desirable to deliver antiretroviral drugs in resource poor settings, few of the 95% of people with HIV and AIDS who live in developing countries receive them. The World Health Organization has launched a programme to deliver antiretroviral drugs to three million people with AIDS in the developing world by 2005, the “3 by 5” initiative. We identify some of the challenges faced by the initiative, focusing on delivery of care. (excerpt)
How was the UNAIDS drug access initiative implemented in Chile? [¿En qué consistió la iniciativa de acceso a las drogas ONUSIDA implementada en Chile?]
Evaluation and Program Planning. 2004 Aug; 27(3):295-308.In 1997, UNAIDS decided to implement Drug Access Initiatives (DAI) in four different pilot-countries. We studied the implementation of the DAI in Chile as part of the evaluation program conducted by the ‘Agence Nationale de Recherche sur le SIDA’ (ANRS/France). The objective was to understand how the politico-organizational dynamic influenced the implementation process of the DAI. Approximately 50 semi-directed interviews and observation activities were conducted with the actors who participated in the implementation of the DAI or who played a role in the HIV/AIDS context. The program theory models were established and their evolution analyzed. This article offers an original analysis of an international HIV/AIDS drug access program that was put in place at a time when such programs were seen as a priority by international and governmental institutions. It also offers some insights for the creation of international projects that will be locally implemented. (author's)
Forced Migration Review. 2004 Jan; (19):16-18.Every year more than half a million women die from complications of pregnancy and childbirth. Many more suffer severe disabilities. WHO estimates that 15% of all pregnant women will develop direct obstetric complications such as haemorrhage, obstructed or prolonged labour, pre-eclampsia or eclampsia, sepsis, ruptured uterus, ectopic pregnancy and complications of abortion. If left untreated, they will lead to death or severe disability. Maternal mortality and morbidity can only be reduced by ensuring women with obstetric complications receive good-quality medical treatment without delay. The desperate circumstances of refugee and IDP women fleeing conflict place them at exceptional risk of pregnancy-related death, illness and disability. The target of reducing maternal mortality by 75% by 2015 is a key UN Millennium Development Goal. Because obstetric complications cannot be predicted or prevented, all pregnant women need access to good quality EmOC. (excerpt)
Geneva, Switzerland, UNAIDS, 2004. vii, 64 p.This report grows out of our shared belief that the world must respond to the HIV crisis confronting women. It highlights the work of the Global Coalition on Women and AIDS—a UNAIDS initiative that supports and energizes programmes that mitigate the impact of AIDS on girls and women worldwide. Through its advocacy and networking, the Coalition is drawing greater attention to the effects of HIV on women and stimulating concrete, effective action by an ever-increasing range of partners. We believe this report, with its straightforward analysis and practical responses, can be a valuable advocacy and policy tool for addressing this complex challenge. The call to empower women has never been more urgent. We must act now to strengthen their capacity, resilience and leadership. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], HIV / AIDS Branch, UNAIDS Inter-Agency Task Team on Young People, 2004. 8 p.Young people remain at the centre of the epidemic in terms of transmission, vulnerability, impact, and potential for change. Today’s young generation, the largest in history, has not known a world without AIDS. Of the over 1 billion young people worldwide, 10 million are currently living with HIV. If we are to reach the global targets set forth in international agreements, urgent action and increased investment must be made in HIV prevention, treatment and care programmes specifically for young people. (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)