The title of the Universal
Declaration of Human Rights
makes it clear. Our rights are
universal. When it comes to
these rights, no one is excluded.
Yet, when it comes to access to
medicines and other essential
health tools, the world has yet to
recognize the universality of our
rights. People are denied access
to affordable, lifesaving health
technologies based on where
they live. This is a violation of
human rights, and it holds back
progress in ending AIDS as a
public health threat.
I first became involved in the
response to HIV in my home
country of Morocco, motivated
by a commitment to supporting
the gay community and
promoting principles of equality
and nondiscrimination. Our work
was an affirmation of the equal value of every life. There was
no treatment then, and so we
worked to raise awareness of HIV
prevention among gay men and
other men who have sex with
men.
Then came an amazing
medical breakthrough. At the
International AIDS Conference in
Vancouver in 1996, we learned
that HIV need not be invariably
fatal, and there were effective
treatments that could prevent
the progression of AIDS.
But now the people I worked
with faced another violation of
rights, another exclusion. This
time, it was because of where
they lived: HIV treatment was
almost exclusively available in
North America and western
Europe.
Activists united to demand
that the HIV response chart
a new way forward on access
to lifesaving medicines.
The emergence of generic
manufacturers for antiretroviral
medicines meant there was a
path to ensure worldwide access
to affordable medicines.
The 2001 Doha Declaration on
the World Trade Organization
Agreement on Trade-related
Aspects of Intellectual Property
Rights (TRIPS) and public
health emphatically stated
that patents should not tie the
hands of countries seeking to
address public health threats.
Afterwards, we saw countries
issuing compulsory licences for
HIV medicines, enabling the
purchase of more affordable
generic versions. The vision
of universal access to HIV
medicines, in which the fruits of
technology would be available
to all, wherever a person lived,
at last seemed realizable.
Today, however, access to
new HIV medicines, including
long-acting medicine that
requires only two shots a year,
is being denied to people
based on where they live. Large
multinational pharmaceutical
companies are determining
which countries will have access
to affordable HIV medicines and
which will be denied them. They
are denying access to many
countries in the Global South,
including countries with high
HIV prevalence and countries
in which numbers of new HIV
infections are on the rise.
The justification for excluding
these countries is that they are
“middle-income”, an arbitrary
measure based on categorizatcategorizations
made by international finance
institutions that were never
developed to determine access
to medicines. In fact, the people
most affected by HIV in many of
these countries are some of the
most economically deprived and
socially excluded people on the
planet.
So now we have early access to
HIV medicines in high-income
countries because that is where
the greatest profits are made
and where governments can
afford those prices; late and
incomplete access in lower income countries, through
voluntary licences; and access
denied in many middle-income
countries, which are explicitly prevented from purchasing
products from generic producers
granted those voluntary licences.
The voluntary nature of the
current approach to medicines
access is an inherent and fatal
flaw. People, regardless of where
they live, should never have to
depend on the determination
of a business to obtain the
medicines they need to survive.
And exclusion of countries
undermines the HIV response
globally. AIDS cannot be ended
unless it is ended everywhere.
Using the flexibilities in the
World Trade Organization
Agreement on Trade-related
Aspects of Intellectual Property
Rights (TRIPS), rather than
depending on the whims of
individual pharmaceutical
companies, constitutes the
path towards equitable access
to medicines. Countries have
the right to override patent
protections through the use
of compulsory licensing to
ensure access to medicines and
vaccines needed to address
high-priority health problems.
Claims by the pharmaceutical
industry that compulsory licences
represent an unwarranted theft
of their intellectual property
are false, because compulsory
licences still include the payment
of royalties to the patent-holder.
Just as no one should be
obstructed from access to
lifesaving medicines because of
their sexuality, no one should
be excluded because of their
nationality. Ensuring access
to affordable medicines for
everyone, everywhere, is human
rights work—and it is essential
for the world to be able to end
AIDS as a public health threat.