CAFTA will harm HIV care, according to critics

Final agreement helps drug companies, they say

Creation of a Central American Free Trade Agreement (CAFTA) will result in more deaths from AIDS in the Central American nations participating in the agreement, charge several organizations that work to provide health care to poor populations.

President George W. Bush and his administration pushed for new intellectual property rules that will obstruct access to medicine by increasing medicine prices and delaying or blocking generic competition, says Asia Russell, director of international policy for Health GAP of New York City. Russell and other international health care advocates spoke at a news conference held in early December, during the CAFTA negotiations.

CAFTA is designed to establish a trading area between the United States and five Central American countries — Guatemala, Honduras, Costa Rica, Nicaragua, and El Salvador. When the CAFTA talks concluded in December, Costa Rica opted out of the negotiations, although it still might continue. The U.S. Congress is expected to consider CAFTA in 2004.

What’s at stake with regard to HIV is CAFTA’s protection of intellectual property rules, which will make it less likely that countries that have signed the agreement will have access to generic versions of antiretroviral medications. Places that are able to use generic AIDS drugs have seen 98% reductions in costs. Antiretroviral drugs that normally cost $10,000 per person, per year, now cost $140 per person, per year, meaning many more people in poor nations will have access to them, Russell and other international health experts explain.

"The dynamic within the negotiations is that the U.S. makes extensive demands on intellectual property and patent protection," says Robert Weissman, co-director of Essential Action of Washington, DC.

"There is more or less resistance from the countries that the U.S. is trying to impose these standards on, but they are normally not well-positioned politically or economically to resist too hard," he adds.

Now that CAFTA has concluded, it will be up to the U.S. Congress to either pass or reject it, Weissman explains.

"There will be an up or down vote on the agreement," he says. "Because it will be governed by the fast-track procedures, it will not be possible for members of Congress to support amendments to the agreement or the deletion of any of the harmful enhanced patent protections."

Health care clinicians who work in Central America say the differences between brand name antiretroviral drugs and generic drugs can be spelled out in human lives.

Generics preferred

Even when poor nations purchase brand name HIV drugs at a greatly reduced price, the cost still is much higher than if they were able to purchase generic versions.

For example, the Honduran government purchases the nongeneric versions of zidovudine, lamivudine, and nevirapine at an annual cost of $850 in U.S. currency. Roughly, 1,200 people have been receiving these medications within the past two years, says Alain Rias, field coordinator, MSF Honduras, Doctors Without Borders/Medecins Sans Frontieres (MSF).

Rias, who provides HIV treatment in Honduras to about 300 patients, says the organization purchases generic drugs at a cost of about $400 per year, less than half what the Honduran government pays.

"In conversations we’ve had with our partners over the months, we’ve come to realize that the Honduran government is under pressure to continue buying brand names," he says. "They fear retaliation from the U.S. trade representative for crossing them."

The people who have access to antiretroviral treatment have recovered very quickly and have started to work again, earning money to feed their families, Rias points out.

Most of the HIV patients seen at his clinic are women who often are raising children without male partners, and their lives are very difficult, he says. "For these women, their main preoccupation is staying alive to see their children grow up."

Since HIV medicine continues to be inaccessible for most Hondurans, the country has one AIDS death every two hours, and AIDS is the first cause of mortality among women of childbearing age, Rias adds.

Guatemala’s epidemic, which is expected to pass 70,000 people living with HIV/AIDS, also may be hurt by CAFTA’s intellectual property rights agreements, says Ruben Mayorga, MD, director of the Organization de Apoyo a una Sexualidad Integral frente al Sida and the advocacy coordinator of the Central American Network of People Living with HIV/AIDS.

Guatemala, as part of a national social security program, currently has HIV treatment for 1,300 adults and 300 children, and the Doctors Without Borders is treating 6,700 people with generic antiretroviral medications, he says.

A Global Fund proposal would have Guatemala treat 2,000 more people in 2004, 4,000 more people in 2005, and so on until the government is treating 8,000 more people in 2008, Mayorga explains.

"With the curtailing of the government’s ability to use generic medications, this would not be possible, and more than 15,000 Guatemalans would die in the next few years, unnecessary deaths," he says.