[Ip-health] Please Endorse the 04-Stop-AIDS Platform

[Paul Davis]

[Endorsement request: please send sign on's to: pdavis@healthgap.org]

Dear comrades in the global fight against AIDS,

Please join hundreds of other organizations from across the world that have
endorsed this comprehensive platform to STOP GLOBAL AIDS. The short, 9-poin=
t
platform is below, followed by some explanatory text. The platform is being
taken to all of the candidates running for President in the United State in
2004, including President Bush. 1000 endorsements will demonstrate the
strong global demand for bold new policies to stop the scourge of AIDS.

In addition to serving as a policy guideline to US Presidential candidates,
the platform will also form the basis of a candidate questionnaire and vote=
r
education pamphlet. We are currently holding expert meetings with each of
the campaigns to educate them about the platform and the urgency of the AID=
S
crisis. The platform and the questionnaire will *not* be used to endorse an=
y
of the candidates.

Please lend your voice to this global effort. Please send organizational
endorsements of the 04-stop-aids platform as soon as possible to
pdavis@healthgap.org. In your note, please indicate your organization's
name, city, and country.


NOTE: This platform focuses on the worldwide crisis of HIV/AIDS. There is
also a companion domestic AIDS platform that deals with issues pertaining t=
o
the AIDS crisis in the United States. The combined global and domestic
platform will be shared with all the candidates when the domestic platform
is completed, and both platforms are complementary. Other organizations are
circulating the domestic platform; Health GAP is collecting organizational
endorsements _only_ for the global platform.

Thank you for your quick response. The platform text is below.

Cheers,

Paul Davis
Health GAP (Global Access Project)
e: pdavis@healthgap.org
t: +1 215.833.4102 (mobile)
f: +1 215.474.4793
w: www.healthgap.org

PLEDGE 04.STOP.AIDS: A Presidential Platform for 2004

In the face of a pandemic that threatens global security while devastating
economies and destroying the social fabric of nations, the leader of the
most powerful country must have a comprehensive plan to stop global AIDS.
With more than three million deaths expected this year in an accelerating
epidemic in its infancy, AIDS must be recognized by presidential contenders
as one of the very highest priority foreign policy issues facing the globe.

President Bush has offered strong rhetoric on AIDS, promising by 2008
"nearly $10 billion in new money to turn the tide against AIDS in the most
afflicted nations of Africa and the Caribbean" in his State of the Union
address in January 2003. Unfortunately, that rhetoric has yet to translate
into effective action. Meanwhile, the Bush Administration continues to
under-fund the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).
The Global Fund, launched in 2001, should be the premier financing vehicle
to deliver comprehensive treatment, prevention and care for the scourge of
these three diseases. Yet the Fund is cash-strapped and has been forced to
turn away high quality funding applications from impoverished countries, du=
e
to the failure of the United States to contribute a fair share of what is
needed.

The undersigned organizations urge candidates for President to adopt this
nine-pint plant to stop the global AIDS pandemic:

If elected President of the United States, I pledge to:
1. Donate the Dollars: at least $30 billion by 2008 to fight global AIDS.
The United States Government must make annual payments to the Global Fund t=
o
fight AIDS, Tuberculosis and Malaria will be made at levels equal to at
least 33% of the Fund's needs, as well as bilateral funding streams. These
donations should support rapid utilization and expansion of existing
physical and human capacity in developing countries.

2. Treat the people in immediate clinical need. The United States must
support antiretroviral treatment for people with HIV in clinical need, and
commit the resources and personnel required to reach the WHO goal of at
least three million people with HIV on antiretroviral treatments by 2005, 7
million by 2007, and towards universal treatment for all people with
HIV/AIDS by 2012.

3. Support trade policies that ensure access to affordable generic drugs.
The U.S. will remove and cease inserting provisions in bilateral and
regional trade agreements that limit countries' ability to take appropriate
measures to address HIV/AIDS and other public health problems. The U.S. wil=
l
no longer prevent countries from exporting generic medicines to developing
countries that have issued a compulsory license to meet public health needs=
,
or to countries where no patent is in effect. US Trade policy must promote
access to affordable medicine for all impoverished nations.

4. Drop the Debt. Candidates must pledge to use the power of the U.S.
Treasury, as the largest donor to the IMF and the World Bank, to fully
cancel the debts of the world's poorest countries, and put an end to the
imposition of structural adjustment policies such as user fees and
privatization of health care, education, and water.

5. Implement disease prevention policies be guided by science, not politics=
.
The U.S. must support effective, science-based prevention strategies, rathe=
r
than politicized and unscientific approaches such as abstinence-only
interventions. The U.S. must commit adequate resources to ensure access to =
a
global supply of HIV prevention information, programs, and commodities to
avert 29 million of the most preventable new adult HIV infections projected
between now and 2010.

6. Stop the crisis amongst orphans and vulnerable children. The U.S. should
commit billions of additional funds to address the needs of children
orphaned by HIV/AIDS. The U.S., working with other nations, should ensure
the implementation of policies that provide total support to orphans and
children in developing countries infected and affected by AIDS, through
enrollment in school, housing, and access to health and social services.

7. Invest in the empowerment of women and girls. The U.S. must support
policies that reduce the vulnerability of women and girls to infection and
needless death, including greater access to female condoms; the development
of vaginal microbicides to prevent sexual transmission of HIV by 2008;
greatly expanded access to HIV, STD and reproductive health services; and
programs preventing maternal-to-child transmission while ensuring treatment
for mothers and family members.

8. Fight tuberculosis and malaria as part of a comprehensive plan to combat
HIV/AIDS. The U.S. must uphold the targets set out with leaders of other
wealthy nations in the G8 Okinawa 2000 agreement to reduce tuberculosis
deaths and prevalence of the disease by 50% and reduce the burden of diseas=
e
associated with malaria by 50% by 2010. For successful treatment of malaria=
,
the U.S. should help finance the implementation of artemisinin-based
combination therapy (ACT) in areas of high resistance to first-line
treatments.

9. Ramp up research and development. The United States should commit
considerable new resources towards developing effective vaccines and
microbicides as well as simplified antiretroviral treatment and monitoring
tools adapted for use in resource-poor settings along with novel and
adaptive treatments for tuberculosis and malaria.

This platform has been endorsed by:

ACT UP Atlanta, GA
ACT UP Cleveland, OH
ACT UP East Bay, CA
ACT UP New York, NY
ACT UP Paris, France
Africa Action, USA
African Women Economic Policy Network (AWEPON), Int'l
Agency for Cooperation and Research in Development (ACORD), Int'l
AIDS Empowerment and Treatment Int'l (AIDSETI), Int'l
AIDS Law Unit, Legal Assistance Centre, Namibia
AIDS ReSearch Alliance, West Hollywood, CA
AIDS Treatment Data Network, USA
AIDS Treatment News, USA
AIDS.ORG, USA
AIDSPAN, USA
American Jewish World Service, USA
American Medical Student Association, USA
Americans Mobilized Against Spread of AIDS in Africa (AMASAA), NY
AMSA (American Medical Student Association), Loyola Chapter, IL
Artists Against AIDS Worldwide, NY, USA
Artists for a New South Africa, CA
Bay Area Jubilee Debt Cancellation Coalition, CA
Bioethics Interest Group (BIG), Loyola Chapter, IL
Canadian HIV-AIDS Legal Network, Canada
Capuchin JPE Commission, Midwest Province, MI
Center for Economic Justice, NM, DC
Center for Health and Gender Equity (CHANGE), USA
Center for Policy Analysis on Trade and Health (CPATH), USA
Centers of Excellence, HIV/AIDS & Substance Abuse, East Timor
Centers of Excellence, HIV/AIDS & Substance Abuse, India
Church and Society - Livingstonia Synod, Malawi
Dignitas, Int'l
DuPage Glocal AIDS Action Network
END AIDS NOW!, NY
Episcopal Misi=F3n San Juan Bautista, NY
Essential Action, USA
European AIDS Treatment Group, Int'l
Fondazione Villa Maraini, Italy
Foundation for Children's Rights, Malawi
Foundation for Integrative AIDS Research, NY
Franciscan Friars of St. Barbara Province, JPIC Office, CA
Friends of Canon Gideon Foundation (FOCAGIFO), Uganda
GayPoz.com, USA
Ghana AIDS Treatment Access Group (GATAG)
Global AIDS Alliance, USA
Global Justice Columbia Chapter, NYC
Global Network of People with AIDS (GNP+) International
Grupo Portugu=EAs de Activistas sobre Tratamentos de VIH/SIDA (GAT), Portug=
al
GTZ-HIVAIDS Project, Malawi
Harvard AIDS Coalition, MA
Health GAP (Global Access Project), USA
Helpless Rehabilitation Society, Nepal
Hope for African Children Initiative, Zambia (HACI)
Housing Works, NY
Immigrating Women in Science Project, Society for Canadian Women in Science
and Technology, Canada
Inter-Religious Council of Uganda
INTERSECT, NY
Jubilee USA Network, USA
Justice Committee of the Congregation of St. Joseph, OH
KAIPPG/International, USA
KAIPPG/Kenya, Mumias, Kenya
Keep A Child Alive, NY, USA
Kentucky Refugee Ministries, KY
Kiota for Womens Health and Development, Tanzania
Lesbian and Gay Human Rights Federation, South Korea
Living Hope Organization, Nigeria
Lynx Africare Network (LAN), Ghana
Massive Effort Campaign, Switzerland
Metro Justice Rochester, NY
Mother Africa Child Care Organization (MACCO), Ghana
National Forum of People Living with HIV/AIDS Networks and Associations,
Uganda
Nebraska AIDS Project, NE
NW Coalition for AIDS Treatment in Africa (NCATA), WA
NW International Health Action Coalition (NIHAC), WA
People's Health Coalition For Equitable Society, South Korea
Philadelphia NOW (National Organization of Women)
Physicians for Human Rights (PHR), Loyola IL Chapter
Physicians for Human Rights, USA
Positive Art, South Africa
Positive Women's Network, South Africa
Presbyterian Church, USA
Priority Africa Network, CA
Progressive Organization of Gays in the Philippines
Queers For Peace And Justice Network, USA
Resources For Survival, NY
Robert F. Kennedy Memorial Center for Human Rights, USA
San Francisco Bay Area Jubilee Debt Cancellation Coalition, CA
SEULTO (Group for People with HIV), South Korea
Share International, USA
Sisters of St. Joseph of Carondelet, St. Louis Province, USA
Society for Advancement of Women, Malawi
Society of Women against AIDS in Africa (SWAA), Mali
Solidarity and Action Against the HIV Infection In India (SAATHII)
St. Joseph Health System, CA
Student Global AIDS Campaign, USA
Student National Medical Association (SNMA) Loyola Chapter, IL
Students for International Change, AZ, CT and Tanzania
Students Teaching AIDS to Students (STATS), Loyola Chapter, IL
Sudan Council of Churches, Khartoum, Sudan
The Freedom Foundation, India
The Women's Center, Montefiore Medical Center, NY
Title II Community AIDS Action Network, USA
Treatment Action Group, USA
UKIMWI Orphans Assistance, Tanzania
United Church of Christ Network for Environmental and Economic
Responsibility, MD
United Trauma Relief, MA
Washington Biotechnology Action Council, WA
Washington Office on Africa, USA
Wesleyan Student Global AIDS Campaign, CT
Wesleyan Women's Resource Center, CT
Women At Risk, CA
Women's Union of the Presbyterian Church of Egypt


WHY ARE THESE 9 STEPS CRUCIAL TO STOP AIDS?

1. Donate the Dollars: at least $30 billion to fight global AIDS between
2004 and 2008

Experts have detailed the costs of mounting a credible initiative to contro=
l
the global pandemics of AIDS, tuberculosis and malaria. In addition to
out-of-pocket spending and cash outlays from poor country governments, at
least $14 billion dollars annual investment from wealthy nations is needed
by 2005 and $18 billion by 2007 according to international agencies.1 The
cost of investment in infrastructure, essential for scaling up of effective
interventions and healthcare systems, has been calculated to be $13.6
billion to $15.4 billion by 2007.2 At 34.8% of the global economy, the
United States should contribute at least 33% of these sums annually,
totaling $30 billion for years 2004-2008.3

Adequate investment and commitment, on par with the spread of HIV and its
effects to societies and economies, during the next five years could
effectively stop the world's most disastrous pandemic. Without it, the U.S.=
,
other donor countries, and affected nations will face exponentially larger
costs in the future.

Instead, the Bush Administration has been cutting some existing bilateral
programs (including the Mother-to-Child-Transmission initiative), which nee=
d
immediate increases. The new Emergency Plan for AIDS Relief is promising,
but will take several years to reach a significant scale.

The Global Fund faces an immediate budgetary crisis, thanks to chronic
underfunding from the Bush administration and other donor countries. The
Global Fund must to be funded at a level that will enable a one-year surplu=
s
over projected needs - a safety cushion to ensure that high quality
applications are not turned away due to a lack of resources. The success of
the Fund will complement efforts of the U.S. bilateral program, once
launched, to build programs integrated with national healthcare systems.
Accordingly, the Global Fund should receive a third to one-half of all
contributions designed to fight the three diseases.

Candidates must commit at least $30 billion to fight global AIDS between
2004 and 2008, and to provide challenge incentives to other wealthy
countries to contribute commensurately.4 By 2007, annual contributions by
the U.S. should reach at least $7 billion to fight AIDS, TB, and malaria.5
Payments to the Global Fund should be made annually at levels equal to at
least 33% of the Fund's projected needs plus additional contributions
towards creating a 12-month safety margin beyond projections. The guiding
principles of these expenditures should be the rapid utilization of existin=
g
capacity, investment in medical infrastructure, systems, and personnel, and
a rapid rollout of universal coverage at the national level.


2. Treat the People: commit to treat those in immediate clinical need

In mid-2003, over 43 million people are living with HIV, 95% in developing
countries. In these poor countries, fewer than 5% of people with full-blown
AIDS have access to the medicines that have dramatically reduced mortality
in wealthier nations. Although the pandemic's current locus is sub-Saharan
Africa where over 30 million people are infected, this viral holocaust is
inexorably shifting to the North and East; thus, it is estimated that five
populous countries- Nigeria, Ethiopia, Russia, India, and China - will, by
themselves, have between 50 and 75 million infected people by 2010.6

In May 2003, the World Health Organization (WHO) estimated out of the 38
million people living with HIV in developing countries, 6 million people ar=
e
in immediate clinical need of anti-HIV medications. However, as of that
date, only 300,000 people with HIV in developing countries had access to
antiretroviral therapy, nearly a third of whom live in one country, Brazil.

The WHO has projected that, with adequate resources, it is feasible to
provide anti-AIDS treatment for at least three million people by 2005.
According to UNAIDS, there is existing treatment capacity for another
600,00-700,000 persons in treatment today - a performance gap that could be
closed in months while programmatic capacity continues to expand in the
future. In addition, more and more developing countries are evidencing a
commitment to national prevention, care, and treatment programs as
represented by the historic announcement of the South African cabinet on
Friday, August 8, 2003, that it will undertake a national AIDS treatment
plan, including antiretroviral therapy.

Although President Bush pledged that the U.S. would treat 2 million people
with HIV by 2008, that number is a small portion of the 8-10 million who
should be on therapy by that time. Current Global Fund projects from Rounds
One and Two will treat another 500,000 during that time period, but that
number too will fall far short of achievable WHO/UNAIDS goals. More
investment is needed from the U.S. and other donors immediate to utilize an=
d
expand existing treatment capacity.

The benefits of such treatment will be enormous and cost effective. For
example, the World Bank has recently concluded that it is significantly mor=
e
cost effective to treat AIDS than not to do so, especially in an era of
plummeting drug prices. Moreover, "Large scale comprehensive treatment will
reduce the growing orphan problem, benefit the health sector, and reduce
pain and suffering.7"

Candidates should pledge to commit the resources and personnel required to
lead a global initiative utilizing the Global Fund as well as other bi- and
multilateral initiatives to provide treatment for the WHO goal of at least
three million people with HIV by 2005, the UNAIDS target of 7 million by
2007, and working towards universal treatment for all people with HIV/AIDS
in developing countries by 2012 (8). In order to reach coverage targets, th=
e
U.S. should urge countries with an historic bias against funding
antiretroviral therapy in developing countries to earmark a portion of
existing bilateral programs, up to $7.5 billion globally by 2007 for
treatment and care.9


3. Medication for Every Nation: trade policies that ensure access to
affordable generic drugs

Although Administration officials have recently pledged that countries that
receive funding from the U.S. bilateral initiative will not be prohibited
from legally obtaining low-cost quality drugs, including generics, the
current Administration has consistently obstructed poor nations' efforts to
gain access to affordable generic medicines needed to address public health=
.
Backpedaling away from the World Trade Organization's Ministerial
Declaration on the TRIPS Agreement and Public Health ("Doha Declaration"),1=
0
the U.S. has attempted through multilateral, regional, and bilateral
negotiations to restrict access to affordable medicines. Ongoing
negotiations to address the export of medicines to poor countries with
little or no manufacturing capacity (11) have been stymied by the Bush
administration. Moreover, regional and bilateral agreements pursued by the
U.S.-for example the U.S.-Chile, U.S.-Singapore, U.S.-Jordan, and
U.S.-Morocco Free Trade Agreements, and the Free Trade Area of the Americas
and South African Customs Union agreements-seek more stringent patent
protection than is required by the TRIPS Agreement. These provisions
advanced by the U.S. will have the effect of reducing or eliminating generi=
c
competition, the most important factor for guaranteeing continued downward
pressure on the prices of drugs and for enhancing the ability of developing
countries to provide access to affordable medicines.

Candidates must commit that the U.S. will cease seeking provisions in
bilateral and regional trade agreements that limit countries' ability to
take appropriate measures to address HIV/AIDS and other public health
problems. The U.S. must exclude intellectual property from negotiations ove=
r
any such agreement. The World Trade Organization's agreement on
trade-related aspects of intellectual property (TRIPS) already sets a
minimum global standard for intellectual property protection; countries
should not be required to do more than they are already obligated to do
under TRIPS. Countries must not be prevented from exporting generics
medicines to countries that have issued a compulsory license to meet public
health needs, or where no patent is in effect.


4. Drop the Debt

In the face of human suffering, it is immoral to hold communities hostage t=
o
odious debt, much of it accumulated by corrupt cold war alliances and
questionable mega-investment projects.

Sub-Saharan Africa pays international financial institutions such as the
World Bank and the International Monetary Fund approximately $15 billion
each year in debt repayments. These debts incurred by often-departed
governments far exceed the entirety of all foreign assistance payments
combined. Further, the discredited and failed economic policies such as
health and education user fees imposed by the lending institutions have mad=
e
it impossible for the sick to afford clinic visits and for families to send
their children to school. Given the crushing burden of poverty combined wit=
h
the ferocious onslaught of the AIDS crisis, these debts can never be repaid=
,
and must be dropped immediately. Instead the money saved can be utilized fo=
r
more productive public health purposes. For example, Uganda, as a result of
limited debt relief, was able to increase health spending by 270%. $1.3
million of Uganda's debt relief has been specifically earmarked for their
national HIV/AIDS plan.

We require that candidates pledge to use the power of the U.S. Treasury, as
the largest donor to the IMF and the World Bank, to fully cancel the debts
of the world's poorest countries, and put an end to the imposition of
structural adjustment policies such as user fees and privatization of healt=
h
care, education, and water.


5. Science, not politics, should govern prevention policies

Forty five million new adult HIV infections are projected to occur between
now and 2010. President Bush's Emergency Plan for AIDS Relief promises to
prevent 7 million new HIV infections by 2008 but does not go far enough in
committing the U.S. to bring to scale necessary the combination of
science-based and proven prevention interventions.12 According to experts,
"Implementation of the comprehensive prevention package by 2005 would reduc=
e
the total number of infections by 29 million (63%) between 2002 and 2010,
lowering the annual incidence of new infections in adults to about 1=B75
million per year once the package has been implemented fully."13

Extremists have misconstrued the facts about effective HIV prevention,
promoting irresponsible policies that place religious ideology over science=
.
Attempts to require global AIDS programs to adopt abstinence-only approache=
s
reflect a new willingness to utilize foreign aid as an instrument of
religious coercion. While abstinence is part of any comprehensive sex
education program, the American Medical Association, World Health
Organization, National Institutes of Health, UNAIDS, and other experts have
issued reports detailing research in support of comprehensive sexuality
education-education that includes information about abstinence,
faithfulness, and contraception in the prevention of HIV. The Allan
Guttmacher Institute found that the balanced approach of the ABC model
(Abstinence, Be Faithful, Condoms) was the reason for Uganda's success in
turning around the HIV pandemic - and that abstinence may have played the
smallest role.

Donor countries and national governments of affected countries should commi=
t
to scaling up programs that can reduce by half the risk of vertical
transmission of HIV from mother to child. The U.S., as an endorser of the
United Nations Declaration of Commitment on HIV/AIDS, should mobilize
resources and leadership to meet the goals of reducing the proportion of
infants infected with HIV by 50% by 2010 by providing at least 80% coverage
to pregnant women access to short-course treatment of antiretroviral drugs,
counseling, and prenatal services.14

The U.S. should commit adequate resources and ensure access to a global
supply of HIV prevention commodities and programs to meet the goal of
averting 29 million of the 45 million new adult HIV infections projected
between now and 2010. In addition to ceasing the promotion or requirement o=
f
abstinence-only programs, the U.S., as the world's most influential donor
should avoid supporting strategies such as mandatory HIV testing, isolation
of people with HIV/AIDS, or other coercive measures curtailing the rights o=
f
individuals and compounding the problems of stigma.


6. Stop the crisis amongst orphans and vulnerable children

HIV/AIDS has a devastating impact on children. According to UNICEF, 13.4
million children already have lost one or both parents to AIDS, including 1=
1
million in sub-Saharan Africa. The number of AIDS orphans will soon swell b=
y
additional millions who are now living with sick and dying parents. The
projected total number of children orphaned by the disease will nearly
double to 25 million by 2010.15

These children lose not only their families, but also the possibility of
education and future livelihood. Indeed, orphans are at greater risk of HIV
infection, discrimination, violence, exploitation, and sexual coercion than
children from stable families. The United States must do more to directly
address this growing crisis, both for the sake of the children, and for the
stability of the countries which do not have the current capacity to preven=
t
the destabilizing effects of huge populations of children growing up withou=
t
homes or hope.

The best interventions to reduce the number of orphans is for the U.S. to
support national comprehensive prevention and AIDS treatment programs that
could avert the deaths of children's parents and caregivers. According to a
study by experts in South Africa, the number of orphans could be reduced by
almost 30% if voluntary counseling and testing coupled with availability of
AIDS treatment for people living with HIV/AIDS were available.16 Of course,
in addition to treating parents, the U.S. must commit to identifying and
treating HIV-positive children as comprehensively as possible.

While President Bush has pledged to provide care for 10 million HIV-infecte=
d
individuals and AIDS orphans by 200817, more should be done to support
communities grappling with growing numbers of AIDS orphans and children
expected to lose parents to AIDS.18 The U.S., working with other nations,
should ensure the implementation of national policies and strategies to
provide total support to orphans and children infected and affected by AIDS
through universal enrollment in school, housing, and access to health and
social services by 2005, according to U.N. agreements.19

Candidates should commit billions of additional U.S. spending for addressin=
g
the needs of orphans and vulnerable children to provide necessary basic
services to ensure the health, social and economic well being of 15 million
children


7. Invest in the empowerment of women and girls

Women and girls are especially vulnerable to infection of HIV and the
onslaught of AIDS and currently represent 58% of people living with HIV/AID=
S
in Africa according to UNAIDS.

The U.S. should support strategies to empower women and girls to protect
themselves from HIV infection. "Abstinence-only" is not an option for the
millions of women worldwide that are expected to be sexually available to
their partners on demand. Therefore, the U.S. should support science-based
interventions that provide for a combination of prevention information and
technologies including female and male condom use. A minimum of $35 million
annually should be spent by the U.S. to increase women's access to female
condoms. Also, the U.S. should support through increased funding for
research, the development by 2008 of effective vaginal microbicides that ca=
n
be used to prevent sexual transmission of HIV. 20

The U.S. should work towards expanding access to HIV, STD and reproductive
health information and health services including pre- and post-natal care
and access to programs preventing maternal-to-child transmission while
ensuring treatment for mothers themselves.

The U.S. should support policies to reduce gender violence, sexual coercion=
,
stigma, and discrimination in its own and in other countries. National
policies and practices including child marriage, widow inheritance, dowry,
laws against land rights and the disregard of the rights of women in
prostitution must be changed. The U.S. should also support policies that
promote economic and social empowerment by increasing women's access to
education and training and formal labor markets, and other productive
resources.

Candidates should pledge U.S. support for policies to reduce the
vulnerability of women and girls to infection and needless death such as:
greater access to female condoms; the development of vaginal microbicides t=
o
prevent sexual transmission of HIV by 2008; greatly expanded access to HIV,
STD and reproductive health services; and programs preventing
maternal-to-child transmission while ensuring treatment for mothers
themselves.


8. Fight tuberculosis and malaria as part of a comprehensive plan to combat
HIV/AIDS

TB is the single greatest curable infectious killer globally and the leadin=
g
killer of people living with HIV. One-third of the people with HIV/AIDS are
estimated to be co-infected with TB, and up to half of those living with
HIV/AIDS can be expected to develop TB in their lifetime. TB treatment for
individuals co-infected with TB and HIV can increase people's life span fro=
m
weeks or months to years. Expanding effective TB treatment is crucial to
controlling the spread of TB in communities with high levels of HIV/AIDS,
including protecting health care workers. The World Health Organization
recently estimated that some 70 percent of persons co-infected with HIV and
TB in Africa do not even have access to effective anti-TB drugs (costing $1=
0
for a full course of treatment).

Benefits of scaling up TB and malaria treatment would include not only
significantly reducing morbidity and mortality associated with these
diseases and co-infection with HIV, but also the potential to use expanded
DOTS (directly observed therapy) programs and malaria initiatives as a poin=
t
of entry to HIV counseling and means for identifying patients for scaling u=
p
AIDS treatment. According to WHO projections, by identifying patients
treated under DOTS who are co-infected with HIV/AIDS, some 500,000 people
who are prime candidates for ARVs could be quickly identified for AIDS
treatment programs-as a key part of reaching the 3 million people on
treatment by 2005.

New treatments are also essential. Although tuberculosis and malaria each
kill close to 2 million people every year, new novel treatments have been
not been developed for almost 30 years.21 Drug resistance will continue to
hinder efforts to curtail deaths from AIDS because the rate of co-infection
is high in developing countries. Already the leading killer of people with
AIDS, multi-drug resistant (MDR) strains of TB will exact a huge toll unles=
s
better treatments are developed and made widely available.

Candidates must uphold the targets set out with leaders of other wealthy
nations in the G8 Okinawa 2000 agreement: to reduce tuberculosis deaths and
prevalence of the disease by 50% by 2010 and to reduce the burden of diseas=
e
associated with malaria by 50% by 2010.22 For successful treatment of
malaria, the U.S. should finance the implementation of artemisinin-based
combination therapy (ACT) in areas of high resistance to first-line
treatments.23


9. Research and Development

The National Institute of Health's (24) must scale-up efforts to develop an=
d
evaluate treatment regimens, lower-cost ARVs and fixed-dose combinations,
and strategies for changing treatment regimens. The NIH should support the
development of clinical management approaches appropriate for
resource-constrained settings including simpler diagnostic methods such as
novel, affordable, simple, rapid, robust, point-of-care tests for monitorin=
g
antiretroviral therapy, including CD4+ T-cell counts, viral load, and
measures of drug toxicity. The NIH should also support the evaluation of
strategies for promoting treatment adherence and different models of
delivery, e.g., AIDS care linked to STD programs/TB programs versus
stand-alone approaches; community-based versus healthcare worker-based
monitoring of therapy. Finally, the NIH must increase funding for research,
development, and clinical testing of vaccines against AIDS. Thereafter, the
U.S. must work in partnership with other governments and international
organizations to make credible commitments to purchase AIDS vaccines, when
licensed, so that they are readily available internationally.

The U.S. must expand funding for AIDS, TB, and other neglected disease
research,25 for international clinical trials, and for expanding laboratory
research capacity of AIDS treatments, vaccines, and microbicides in
developing countries. In particular, the U.S. should plan to meet
commitments made at the G8 Summit in Okinawa in 2000: "to increasing our
support at the global level for the research and development of the
international public goods such as AIDS vaccines; treatment drugs of AIDS,
TB and malaria; microbicides; and other health commodities."26 U.S.
scientists should work on simplifying and streamlining clinical research in
developing world settings, especially important for large studies for
vaccines and microbicides, while at the same time ensuring continuing acces=
s
to appropriate therapies for trail participants.

Candidates must commit to considerable new resources towards developing
effective vaccines, microbicides, simplified antiretroviral treatment and
monitoring tools adapted for use in resource-poor settings as well as novel
and adaptive treatments for tuberculosis and malaria.
1 Cost for global AIDS from UNAIDS "Financial resources for HIV/AIDS
Programmes in Low and Middle Income Countries over the next Five Years,"
December 2002. Cost of TB interventions from Stop TB and malaria costs from
Roll Back Malaria (RBM).
2 Commission on Macroeconomics and Health (CMH) "Investing in Health: A
Summary of the Findings of the Commission on Macroeconomics and Health,"
2000.
3 The equitable contribution for the U.S. is based on estimates of global
need to fight AIDS, TB, and malaria and investment in infrastructure needed
to deliver services. According to UNAIDS, and the experts with Stop TB and
Roll Back Malaria, global needs to fight the three diseases will be at leas=
t
$14.2 billion in 2004 and $18 billion by 2007. According to the Commission
on Macroeconomics and Health (CMH) led by Jeffrey Sachs, infrastructure
investment should reach an additional $13.6-15.4 billion by 2007. Annual
contributions for the U.S. spread out over four years should be at least
$3.5 billion in 2004, $4.5 billion in 2005, $6 billion in 2006, $7 billion
in 2007, $9 billion in 2008.
4 The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 had provisions to challenge other donor countries to contribute
to the GFATM.

6 National Intelligence Council, The Next Wave of HIV/AIDS: Nigeria,
Ethiopia, Russia, India, and China ICA 2002-04 D
http://www.cia.gov/nic/other_products/ICA%20HIV-AIDS%unclassified%20009230
(2002).
7 -"The HIV/AIDS Treatment Acceleration Program for Africa" World Bank,
Africa Region Concept Paper, June 2003.
8 UNAIDS "Financial resources for HIV/AIDS Programmes in Low and Middle
Income Countries over the next Five Years," Paper for the thirteenth meetin=
g
of the Programme Coordinating Board, Lisbon 11-12 December 2002.
9 Ibid
10 Ministerial Conference, Fourth Session, Doha, Nov. 9-14 2001, WT/MIN
(01)/DEC/2 (Nov. 20, 2001) (hereinafter Doha Declaration). Pursuant to
paragraph 4, all WTO members agreed "that the TRIPS Agreement does not and
should not prevent Members from taking measures to protect public health.
Accordingly, while reiterating our commitment to the TRIPS Agreement, we
affirm that the Agreement can and should be interpreted and implemented in =
a
manner supportive of WTO Members' right to protect public health and, in
particular, to promote access to medicines for all."
11 Pursuant to paragraph 6 of the Doha Declaration: "We recognize that WTO
Members with insufficient or no manufacturing capacities in the
pharmaceutical sector could face difficulties in making effective use of
compulsory licensing under the TRIPS Agreement. We instruct the Council for
TRIPS to find an expeditious solution to this problem and to report to the
General Council before the end of 2002."
12 The U.S. should support programs utilizing a combination of strategies,
as agreed to at the G8 Conference on Infectious Diseases, held in Okinawa,
Japan in 2000: "We should continue to focus on the preventive measures that
have proven to be effective. Those include: Promotion of healthy and safer
sexual behaviors, especially among young people; Ready access to the
essential commodities for prevention; Prevention of mother to child
transmission especially in countries and regions where prevalence of HIV
infection among pregnant women is high; Voluntary counseling and testing;
Treatment of STI (Sexually Transmitted Infection); Control measures for
those most at risk for HIV; Safe blood transfusion; and Prevention of
transmission related to substance abuse."
13 J. Stover et al., Can we reverse the HIV/AIDS pandemic with an expanded
response? Lancet July 6, 2002, Volume 360, Number 9326.
14 Other goals in the UNGASS Declaration of Commitment and the G8 Okinawa
action plan on health include reducing the number of HIV/AIDS-infected youn=
g
people by 25% by 2010.
15 UNICEF "Orphans and Other Children Affected by HIV/AIDS" July 2002
16 "Projecting numbers of orphans in the presence of an AIDS epidemic." A
paper by L. Johnson and R. Dorrington, presented at the Population
Association of America Conference, Atlanta, USA, 9-11 May 2002.
17 H.R. 1298 United States Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Act of 2003
18 The Global Action for Children Campaign calls for global investment of
$15 billion per year for a host of services including healthcare as well as
the elimination of user fees and levies which curtail access to education
and health services. Global Action for Children: A Civil Society Campaign
Ensuring Comprehensive Support for AIDS Orphans, Vulnerable Children, and
Children-at-Risk. Draft as of 29 July 2003.
19 United Nations Declaration of Commitment on HIV/AIDS, 2001
20 Center for Gender & Health Equity: "Women and the Global AIDS Epidemic: =
A
Ten-Point Plan of Action for the United States" May 2003.
21 Zumla, Ali. "Refection & Reaction: Drugs for Neglected Diseases," Lancet
Vol 2 July 2002
22 Okinawa International Conference on Infectious Diseases Report, January
2001. The Conference was held in Okinawa, Japan, December 7-8, 2000.
23 Stop TB Partnership: "The Global Plan to Stop TB," October 2001.
24 Office of AIDS Research, National Institute of Health "Global AIDS
Research Initiative and Strategic Plan," December 1, 2000
25 Currently, only 10% of worldwide research and development is dedicated t=
o
finding cures, treatments, and diagnostics for diseases that account for 90=
%
of the global disease burden. World Health Organization. Investing in healt=
h
research and development. Report of the ad hoc committee on health research
relating to future intervention options. Geneva: WHO, 1996.
26 Okinawa International Conference on Infectious Diseases Report, January
2001. The Conference was held in Okinawa, Japan, December 7-8, 2000.