[Ip-health] MSF Press Release: As HIV burden overwhelmingly shifts to ‘middle-income’ countries, access to affordable medicines is under threat

Michelle French Michelle.French at newyork.msf.org
Tue Jul 21 13:51:46 PDT 2015

Just released at IAS 2015:  
As HIV burden overwhelmingly shifts to ‘middle-income’ countries, access 
to affordable medicines is under threat

Vancouver, 21 July, 2015—At the International AIDS Society (IAS) 
Conference today, the international medical humanitarian organisation 
Doctors Without Borders/Médecins Sans Frontières (MSF) warned that 
middle-income countries (MICs), which will be home to 70% of people living 
with HIV by 2020, face increasing threats to their ability to access 
affordable generic medicines, which are crucial to countries’ ability to 
reach the global UNAIDS 90/90/90* targets. 
“No one can deny the pivotal role that affordable antiretrovirals have 
played in putting 15 million people on HIV treatment, but as we look ahead 
to the next 15 million, we see that middle-income countries are 
increasingly constrained in accessing affordable generic medicines, and 
this spells disaster for the global HIV response,” said Dr. Peter 
Saranchuk, TB/HIV Advisor for MSF. 
The term ‘middle-income’ is an artificial classification that is not 
linked to public health realities on the ground – in fact, more than half 
of MSF’s medical programmes are in MICs, including India, Kenya, Myanmar, 
Republic of Congo and South Sudan.  About 70% of the world’s poor live in 
MICs, and sixty percent of people with HIV live in these countries today.  
“Multiple threats on MICs are converging to form an unprecedented assault 
on access to medicines,” said Leena Menghaney, head of MSF’s Access 
Campaign in South Asia.  “Amongst other threats, some of the most acute 
come from trading partners – like the US and Japan – who seek to impose 
intellectual property rules that will block access to generic medicines; 
and from several donor agencies, including the Global Fund to Fight AIDS, 
Tuberculosis and Malaria, whose discriminatory policies are moving towards 
reducing funding for MICs at a time when global HIV targets call for 
increasing the pace of treatment scale-up.”
Today, we see that the pharmaceutical industry pricing strategies for 
antiretrovirals (ARVs) and other medicines, including tiered pricing, 
voluntary licensing and donation programmes, deliberately exclude 
middle-income countries, and are almost entirely focused on excluding MICs 
from accessing the lowest global prices available to low-income countries. 
 This is particularly acute for third-line, or salvage regimens, which are 
priced out of reach for most countries.  For example, the raltegravir, 
etravirine, darunavir and ritonavir salvage regimen is available at the 
lowest global price for $1,854 per person per year (ppy), but 
middle-income countries often pay exponentially more:  for example, 
Myanmar pays $2,929 ppy and Ukraine pays $16,409 ppy.  Second-line 
treatments, and some newer first-line treatments, are also priced out of 
Later this week, negotiators for the Trans-Pacific Partnership (TPP) 
agreement will meet in Hawaii to try to finalize terms for a trade pact 
that will encompass at least 40% of the world’s GDP.  One third of the 12 
TPP countries are developing countries classified as middle-income 
economies who, if the deal is signed in its current form, would be forced 
to implement a range of new provisions that will lengthen, strengthen and 
expand patent and regulatory monopolies for medicines. For example, one 
proposed rule limits governments' ability to restrict pharmaceutical 
companies' efforts to pursue abusive ‘evergreening’ strategies to extend 
the life of pharmaceutical patents well beyond 20 years.  The effect is 
reduced ability to access affordable generic medicines. "
Meanwhile, the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria’s 
‘New Funding Model’ relies on a funding allocation formula based in part 
on income classifications, rather than public health needs. As a result, 
several MICs such as Ukraine and Vietnam have seen their funding reduced 
in the 2014-2016 funding period compared to previous years, limiting their 
ability to reach socially excluded groups. 
 “To make matters worse, India—known as the pharmacy of the developing 
world for its role in producing affordable generic medicines—is facing its 
own set of pressures from the US, EU and other governments to roll back 
the country’s progressive patent laws in order to restrict generic 
competition, in favour of supporting the multinational pharmaceutical 
industry’s monopoly- and profit-driven business models,” said Menghaney. 
“If these policies are allowed to continue, middle-income countries face 
nothing short of a calamity that poses a major threat to the global HIV 
response and other health initiatives.”
MSF started providing HIV treatment to people in developing countries in 
2000, and today supports more than 200,000 people living with HIV through 
MSF programmes. 
*UNAIDS 90/90/90 goal states by 2020, 90% of all people with HIV will know 
their status; 90% of people diagnosed with HIV will be on ARV treatment; 
and 90% of those on ARV treatment will have viral suppression.
More information about MSF @ IAS 2015: 

Michelle French
Sr. Communications Manager, MSF Access Campaign
Doctors Without Borders\Médecins Sans Frontières (MSF)
Office: +1.212.763.5735 | Mobile: +1.646.552.4600
michelle.french at newyork.msf.org | Skype: michellejfrench
www.msfaccess.org | twitter.com/MSF_access | www.facebook.com/MSFaccess

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