Some info about the Barcelona conference [the fourteenth International AIDS conference, convened in July 2002] that may be helpful to this discussion:
The most recent Barcelona conference was very different from the Durban conference [the thirteenth International AIDS conference, July 2000]. In Barcelona, everyone seemed to agree about the need for treatment access and renewed prevention efforts. WHO and UNAIDS have even presented dollar amounts needed to build structures to administer new massive treatment and prevention programs. The problem vexing everyone at the conference was “scaling up” – the establishment and coordination of massive administrative structures to handle the enormous amounts of capital required, and to do so effectively. This was the problem now being considered. The new global administrative structures would have to take the form of ensemble efforts among NGOs, governments and community organizations. Who can organize this? What are the dominant macro-subjects leading the coordination? (There was much flailing at the conference and one could glimpse emerging competitiveness among giants.) Delivery of treatment to the millions who need it exists as an idea that everyone (seemingly) now agrees to, but this represents a kind of coordination that’s unprecedented in public health.
It was proposed (by former U.S. President Clinton, surprisingly) that the following framework be used:
(1) The U.S. and other wealthy nations should pay what they owe to the global fund immediately. Although the U.S. has given, or pledged to give, more than any other country (around 800 million), the U.S.’s total responsibility in view of the national income adds up to somewhere between 2 and 3 billion a year. The U.N. has estimated 10 billion per year for the world effort. This does not represent a one-time-only donation for anybody. We’re talking about 20 billion or more per year for the next decade, perhaps more.
(2) As with the recent example of the Caribbean nations – Clinton suggested that poor countries strike deals with the pharma companies, as pharma is now willing to lower prices due to public pressure.
(3) If a poor country cannot reach a deal with a pharma company, they should purchase quality generics from Brazil, India or Thailand. (So Clinton, in an uncharacteristically short statement delivered the night before his longer closing statements the following day, said.)
There are three (perhaps more) sites where HIV drugs have been made available consistently to very small numbers of people, in Haiti, Peru (I think) and South Africa. These sites (Haiti and Peru are run by Paul Farmer, South Africa by Medecins sans frontieres) provide models of distribution. They provide health care, education (treatment and prevention) and support needed by patients, in addition to treatments. Farmer provided encouraging data proving that delivery of treatments in poor settings produces comparable reductions in mortality achieved in rich countries.
So, I think the imperative to “act now” has a different content than before and it has a substantial amount of backing….