By 2020, most of people living with HIV will be living in the middle-income countries (MICs), where inequality in access is still high. HIV treatment coverage rates observed in regions like Eastern Europe and Central Asia (EECA) and Middle‐East and North Africa (MENA) and other MICs remain among the lowest in the world. Currently, middle income countries are paying high prices for medicines, particularly the newer medicines such as antiretrovirals used for second‐line and third‐line treatment as well as treatment of HIV related co-morbidities such as hepatitis C.
Several countries were represented by official delegates and shared their experiences and challenges to ensure access to medicines. Most of these countries are facing concentrated epidemics, which raises a lot of concerns in terms of accessing key populations. And it also represents challenges in terms of market size, since those groups are often marginalized in many contexts and, therefore, are not considered by the public health policies. Because of their income status, these countries are left from access initiatives by international institutions and pharmaceutical companies aiming to increase access to treatment as well as a diminution of aid by global donors. Trade and intellectual property barriers constitute and additional challenge as most of these countries are members of the World trade organization (WTO) and many have been engaged in free trade agreements with very strict intellectual property provisions that reduce drastically generic competition.
Civil society participation to the consultation was very strong although the number of organizations involved initially was quite low (4 only). ITPC succeeded to mobilize its partner organizations and secure resources to allow key activists at the front of advocacy for access to medicines in their respective countries to attend. Civil society efforts coordinated by ITPC after several weeks of online discussion and teleconferences helped to enrich the conversation on different topics such as markets and prices, intellectual property rights, regulatory issues, voluntary licensing, South-South collaboration and research & development.
Several recommendations pushed by civil society have been successfully adopted by the participants such as developing cooperation mechanisms, e.g. strengthen patentability criteria and bring MICs together to discuss patent law reform to improve access and adopting TRIPS flexibility (compulsory licensing and patent opposition) as first-line strategy for MICs instead of voluntary mechanisms. Participants also agreed on the need of more support and resources for civil society groups working on advocacy for the implementations of TRIPS flexibilities.

Drug stock outs have dominated many discussions that look at barriers to treatment access for communicable infectious diseases. The main reason for concern when stock outs occur is mostly due to the propagation of drug resistance as a result of failing regimens.
So when the custodian of a taxpaying citizen facing the dangers caused by stock outs commits sins of omission or commission due to laxity, denialism and self-interest, there are bound to be justified reactions from the affected. At the recently concluded 44^th International Union Against Tuberculosis and Lung Diseases conference held on the 30^th October to the 3^rd November in Paris, Treatment Action Group and Global TB activists exposed the inadequacies of governments & their national TB programmes and particularly shamed the Indian government for failing to acknowledge that there are anti TB stock outs in the country. The Indian stock outs are due to a below par supply management and monitoring system that ignores the involvement of civil society and affected communities.
Following this action https://vimeo.com/78345486 also reported in key local media outlets in India http://m.timesofindia.com/india/Indians-booed-at-global-meet-for-genocide-of-TB-patients/articleshow/25148964.cms, it is hoped that the momentum to pressure the Indian government (and for that matter other governments that have broken/absent/suboptimal supply management and monitoring systems) will be maintained by local activists who have over the years demanded for an end to HIV & TB medicine stock outs. Global effort from comrades all over the world will continue providing support to fellow activist demanding for an end to HIV & TB stock outs.
Suffice it to say that humanity will never achieve any Zero targets to HIV and TB if there is no commitment by governments to its citizenry in the spirit of partnership to end stock outs caused by broken or failing supply management and monitoring systems. Denialism needs to end and so does dictatorship, corruption, non-inclusion policies and practice and above all governments need to give meaning to their rhetoric to include civil society in their national responses to HIV and TB.
Bactrin Killingo
Senior Knowledge Officer
ITPC