Fiji has a low-level AIDS epidemic, with fewer than 1000 people estimated to be living with HIV in 2014. A combination of engaged leadership, integrated multisectoral action, evidence-informed and rights-based approaches and people-centred partnerships are behind the country’s success in the response to HIV. The Fijian strategy provides important lessons to help ensure greater progress across broader sustainable development issues and goals.

“Fiji’s AIDS response has much to celebrate—and much to share,” said UNAIDS Deputy Executive Director Jan Beagle during her visit to Fiji from 30 November to 3 December. “There has been strong recognition that the most effective results can only be achieved through partnership, across sectors, through strong leadership and with community at the centre. By taking AIDS out of isolation, the impact can go far beyond the AIDS response.”

Partnership across government, communities, the health and education sectors and the United Nations system has led to focused prevention and treatment strategies and action. Responding to evidence of potential risk for key populations, Fiji has implemented a number of key policy and legal reforms, including decriminalizing sex between men and removing HIV-related travel restrictions and laws criminalizing HIV transmission or exposure.

Leaders in the country have consistently championed the HIV agenda, including through sustained activities to raise awareness in schools and among faith communities and the private sector.

In a meeting with Ms Beagle, President Jioji Konrote of Fiji expressed his personal commitment to continuing action on AIDS. Minister of Health and Medical Services Jone Usamate confirmed the country’s commitment to implementing the UNAIDS Fast-Track approach to increase action and front-load investments on HIV over the next five years and to end new HIV infections among children within the next two years.

“We need to continue the solid work in Fiji and use the experience and opportunity to strengthen efforts on climate change, noncommunicable diseases and gender-based violence,” he said, underlining the alignment of Fiji’s new National AIDS Plan with the UNAIDS strategy towards ending the AIDS epidemic by 2030.

Partners in the Fijian AIDS response agree that further scale-up must be continued to ensure sustained progress in the country and across the Pacific region.

“We cannot afford complacency on HIV and we need to keep it on the agenda, because we know that progress here is also having benefits across health, development, gender and rights issues,” said Speaker of the Parliament Jiko Fatafehi Luveni, a prominent advocate for HIV and women’s issues.

The newly elected Secretary of the Fiji Council of Churches, Simione Tugi, underlined the important role of faith-based communities and organizations across multiple religions to reach people in greatest need.

“Established networks, particularly within the faith community, help reach people even in hard to reach areas,” Mr Tugi said. “We will continue to be advocates for HIV through these structures so that we leave no one behind.”

Active involvement of people living with and affected by HIV is heralded by all partners as one of the key enablers for progress in the AIDS response.

Jokapeci Tuberi Cati of FJN+, Fiji’s network of people living with HIV, said, “We have made our voices heard and have been listened to, but we need ongoing focus, commitment and resources allocated to HIV. And we need to keep fighting stigma and discrimination for a more equal Fiji and safer society for all.”

A young man wearing a striped red T-shirt and faded blue jeans enters a popular bar in downtown Quezon City, the Philippines. He starts speaking to the owner and is soon joined by several other young men. It’s 10 p.m. and the group blends in seamlessly with the other bar customers. The young men are not here to relax, though. They are peer educators and health workers employed by Quezon City’s health department.

“You just get used to it,” said Mai. “The night is to us what the day is for others. It’s the job.”

Outside, a street lamp casts an orange glow on a city ambulance that purrs softly, parked and waiting unobtrusively for clients. The group of men has come to conduct HIV counselling and testing with bar patrons and staff, who are mostly gay men or other men who have sex with men. On this steamy night they test around 50 people.

With nearly 3 million residents, Quezon City is the Philippines’ most populous urban centre and has made stopping a burgeoning AIDS epidemic a top priority.

“Quezon City is unrelenting in its effort to pursue and sustain its programme of zero new HIV infections, zero discrimination and zero AIDS-related deaths. We remain committed to providing preventive interventions, treatment, care and counselling to ensure our people receive a better quality of life,” said Mayor Herbert Bautista.

UNAIDS has encouraged cities to accelerate their AIDS response by front-loading investments and reaching critical HIV prevention and treatment targets. In the Philippines, Quezon City is leading the push to implement the UNAIDS Fast-Track Strategy in urban areas.

On 4 December, Quezon City hosted a meeting with representatives from cities in the Metro Manila area on how to end the AIDS epidemic by 2030. Participants adopted the Fast-Track approach.

UNAIDS estimates there were 6400 new HIV infections nationwide and 36 000 people living with HIV in the country in 2014. HIV prevalence among men who have sex with men was 3.3% in 2013, compared to 1.68% in 2011. Among the general population aged 15–49, the estimated HIV prevalence was lower than 0.1% in 2014.

Quezon City: a trailblazer in the country’s HIV response

While a network of facilities catering to the health needs of sex workers has existed since the 1990s in the Philippines, in 2012 Quezon City became the first city in the country to open a clinic providing services for men who have sex with men and transgender people.

Klinika Bernardo, popularly known as the Sundown Clinic, is located along a busy highway. It operates from 3 p.m. until 11 p.m., allowing a maximum number of clients to visit.

“We cater to men who have sex with men from all over the Philippines,” said Leonel John Ruiz, head physician at Klinika Bernardo. “Only 40% of our clients are from Quezon City.”

From the start, demand for services at the Sundown Clinic was high. Almost 250 HIV tests and pre- and post-test counselling services were conducted in its first two months of operation and 18 people tested HIV-positive. By the end of 2014, the clinic had conducted more than 2500 tests, of which a little more than 200 were HIV-positive. The first Sundown Clinic was so successful that the city opened a second one earlier this year.

The Sundown Clinic: a safe space for men who have sex with men and transgender people

While same-sex sexual relations are legal in the Philippines, such relationships are viewed negatively by many people and there is a high degree of stigma and discrimination towards gay men and other men who have sex with men. Fear of being outed and ostracized prevent many men who have sex with men from accessing traditional health services. Studies by city health officials show that two thirds of men who have sex with men in Quezon City have never had an HIV test.

With its row of potted plants and bright green decor, Klinika Bernardo exudes a cheerful atmosphere. It has 10 staff members, with four peer educators, who include men who have sex with men and a transgender woman. Clients can choose the educator who best suits their needs. Instead of documenting and calling clients by their name, the clinic maintains their anonymity by giving each person a number.

Staff are skilled at reassuring jittery clients.

“This is my first HIV test. I do not know what to expect,” said one young man while filling out registration forms. “I tried to read up on HIV so I would have some background information, but it took me awhile to gather the courage to come here. My partner came here with me, too, after hearing about it from our friend. We’re taking the test together.”

The young man found the staff supportive and skilled at easing his fears.

People who test HIV-positive receive counselling on antiretroviral medicines and are accompanied by staff through their initial months of HIV treatment, which is free in the Philippines.

Quezon City’s HIV programme becomes a model for other cities

Quezon City operates the Sundown clinics and has significantly increased investments in its HIV programmes in the past few years. And the city's efforts to scale up HIV testing are getting results. The number of gay men and other men who have sex with men being tested almost quadrupled between 2011 and 2014.

“In the three years that we have been operating, the perspective has definitely changed,” says Mr Ruiz. “Before, we would have a hard time inviting people for testing. Now, most of our clients are walk-ins. People are personally and actively seeking information.”

Quezon City won the prestigious Galing Pook Award for outstanding local governance in 2014 for its pioneering HIV clinics. Several other local city governments are starting to adapt the Quezon City model and establish their own clinics.

While the Sundown Clinic staff are proud of their achievements, they are looking forward to closing shop one day.

“I pray before sleeping,” says Adel, the only female peer educator at Klinika Bernardo. “I pray that there would come a day when there will be no one in need of our services. That’s what I am working for.” 

Fiji has shown significant leadership and commitment to the response to HIV. On the occasion of World AIDS Day 2015, UNAIDS has appointed the country’s former President, Ratu Epeli Nailatikau, as a Regional Goodwill Ambassador for the Pacific. The announcement was made by Jan Beagle, Deputy Executive Director of UNAIDS, during a World AIDS Day ceremony in Suva attended by representatives of government, civil society and international organizations.

“Fiji has some important lessons to share in a number of areas, including leadership, multisectorality, integration and partnership, that can benefit the region, and beyond, as we strive to reach the goal of ending AIDS by 2030,” said Ms Beagle. “His Excellency Ratu Epeli Nailatikau has been a steadfast advocate and at the forefront of these efforts, championing the HIV response and the meaningful inclusion of key populations.”

Building on his experience and years of commitment, Mr Epeli Nailatikau will help mobilize political support for the UNAIDS Fast-Track approach across the region, to accelerate and front-load investment over the next five years as a critical step towards ending the AIDS epidemic as a public health threat by 2030. In his new role as Regional Goodwill Ambassador he will also work with UNAIDS to help to ensure that the human rights of people living with HIV and key populations at higher risk of HIV are protected and respected, and that young people, women and girls and people living with and affected by HIV are meaningfully engaged in the HIV response.

With the exception of Papua New Guinea, HIV prevalence is low across the Pacific. However, a combination of factors could lead to a rise in the HIV epidemic in the region. These include widespread migration and mobility, high levels of multiple sexual partners, a large caseload of untreated sexually transmitted infections (STIs), low knowledge about HIV and STIs, high levels of transactional sex and significant levels of intimate partner violence. Stigma and discrimination towards key populations at higher risk of HIV is also high.

Former President Ratu Epeli Nailatikau said, “To get where we need to be, I believe it is time to Fast-Track the HIV response. As UNAIDS Regional Goodwill Ambassador I will work tirelessly to end the AIDS epidemic not only in Fiji but throughout the Pacific. You can count on me.”

Cities have a primary role to play to Fast-Track the end of the AIDS epidemic by 2030 says a report by UN-Habitat and UNAIDS.

Ending the AIDS epidemic: the advantage of cities was presented at the Africities Summit, held in Johannesburg, South Africa. The summit, held every three years, marks a critical time as cities enter the new era of the Sustainable Development Goals.

On the eve of World AIDS Day, it was announced that more than 150 cities have signed the Paris Declaration to commit to Fast-Track the end of the AIDS epidemic by 2030. The report outlines that cities and urban areas are particularly affected by HIV, with the 200 cities most affected by the epidemic estimated to account for more than a quarter of all people living with HIV around the world.

“The Fast-Track Cities approach will help urban leaders and communities to capture this opportunity,” said Alioune Badiane, UN-Habitat’s Director of Programmes. “A Fast-Track AIDS response means quickening the pace to prevent HIV infections and AIDS-related deaths. It means being focused and working with fragile communities, using methods that are known to work.”

The report highlights that city leaders have a unique opportunity to seize the dynamism, innovation and transformative force of the AIDS response to not only expand HIV services in cities but also address other urban challenges, including social exclusion, inequality and extreme poverty.

“Fast-Track cities means accelerated action—I can think of no better place than the Africities Summit to encourage leaders to commit to ending AIDS by 2030,” said Annemarie Hou, UNAIDS’ Director of Communications and Global Advocacy. “We are counting on cities to take the lead in innovating new health delivery systems to reach people who might otherwise be left behind.”

In almost half (94) of the 200 cities most affected, HIV is transmitted mainly through unprotected heterosexual sex. In the remaining 106 cities, sex work, unprotected sex between men and injecting drug use are the main drivers of the epidemics. In the Asia–Pacific region, about 25% of all people living with HIV are estimated to reside in 31 major cities, while in western and central Europe, an estimated 60% of all people living with HIV reside in just 20 cities.

According to the new report, data from 30 countries that have conducted nationally representative household-based population surveys show that HIV prevalence among people 15–49 years old living in urban areas is higher than among those living in rural areas in most countries.

The global AIDS response requires emphasis on the people not reached by essential services, the places that are hardest hit and the people who bear the brunt of social inequality. Robert Carr’s entire professional life as a social worker, academic, advocate and activist was dedicated to pointing the Caribbean, and the world, in that direction.

On 10 November, UNAIDS Executive Director Michel Sidibé visited the Kingston, Jamaica, offices of the Caribbean Vulnerable Communities Coalition—founded by Mr Carr in 2004—where he paid his respects to Mr Carr, who died in 2011, and recommitted to his legacy. Ending AIDS as a public health threat would not happen without concrete investments in addressing social exclusion and promoting human rights, Mr Sidibé said.

Mr Sidibé said, “I will always hold dear the memory of Robert Carr, because he helped us understand we will never end the AIDS epidemic if we don’t deal with people who are excluded.”

Mr Carr was a past Co-chair of both the Global Forum on MSM & HIV and the Global Coalition on Women and AIDS. He was at various times Policy and Advocacy Director of the International Council of AIDS Service Organizations and a member of both the UNAIDS Reference Group on HIV and Human Rights and the nongovernmental organization delegation to the UNAIDS Programme Coordinating Board. 

In the Caribbean he mobilized partners around the goal of addressing the deep-seated prejudices that left people excluded and often criminalized, pushing them away from HIV services.

Carolyn Gomes, Chairperson of the Caribbean Vulnerable Communities Coalition, said, “Robert’s vision is beginning to take shape.” She pointed to several aspects of the organization’s work, including helping to strengthen the Caribbean Sex Worker Coalition, collaborating with the Caribbean Forum for Liberation and Acceptance of Genders and Sexualities and supporting burgeoning transgender groups in different countries.

“We try to continue Robert’s special legacy, his subversiveness”, Ms Gomes said. “He spoke truth to power but also had a genuine heart and insistence that voices be heard.”

During the visit Mr Sidibé paid tribute to Mr Carr’s parents, Peter and June Carr. He was presented with Who cares? The economics of dignity, a book Mr Carr co-authored that calls for increased emphasis on people who provide care and support to people living with HIV.

Mr Sidibé reaffirmed his commitment to the Robert Carr Civil Society Networks Fund, which seeks to strengthen international collaboration and provide funding to civil society networks assisting inadequately served populations. Community organizations, he emphasized, are critical to reaching the Fast-Track Targets.

Munsu has been living with HIV for 20 years and has played an active role in the Republic of Korea’s AIDS movement. However, like thousands of people in his situation, he has not shared his HIV status with his family because he is fearful of their reaction and the social isolation that such a disclosure would most likely bring about.

He is all too aware of the stigma and discrimination faced by HIV-positive people in his country.

Munsu is a founding member of the Korean Network of People Living with HIV/AIDS (KNP+), a Seoul-based organization with some 2000 members, established in 2011 to bring five existing organizations under one umbrella and to provide a concerted and connected voice for the country’s HIV-positive community. On 30 October 2015, after several years of effort, KNP+ opened its first official office and community space.

An epidemic of fear

According to the Korea Centers for Disease Control and Prevention, there are more than 10 000 people living with HIV in the country. The Republic of Korea’s epidemic is heavily concentrated among gay men in urban settings, with men representing 92% of all HIV infections since data collection began in 1985.

Despite the country’s low HIV prevalence, fear of HIV is a problem. A national survey conducted in 2005 indicated that only half of respondents would care for a family member if he or she were HIV-positive. Reports also indicate that HIV phobia is present in health-care facilities.

At the KNP+ community centre event, Minji Kim, a young doctor and a volunteer with KNP+, shared the ignorance towards HIV she encountered in medical school. “One of our classes focused on AIDS and I was shocked at my classmates’ reactions,” said Minji. “They were making fun and mocking people living with HIV. I knew I had to do something to change this.”

Munsu thinks one of the reasons HIV is so feared in Korean society is that it is linked to homosexuality, transgender sexuality and other issues that are negatively viewed. This “double dose” of exclusion, he said, forces many people living with HIV to be isolated, especially from their family.

As the attachment to loved ones is particularly strong in Korean society, rejection by family members can mean that many people living with HIV are abandoned and segregated from social events. This situation extends to the provision of health care, he noted. “Many people living with HIV cannot be admitted to hospital because they have no family member to be responsible for them, to be their caregiver. This is essential in Korea if you want medical services,” said Munsu.

Overcoming stigma as a priority

As stigma in daily life is one of the top concerns most cited by members of KNP+, the organization and its partners are prioritizing efforts to respond. With its permanent office in place, KNP+ is preparing to compile Korea’s first People Living with HIV Stigma Index.

The Stigma Index initiative is a collaboration between the Global Network of People Living with HIV, the International Community of Women Living with HIV/AIDS and UNAIDS. The initiative aims to document HIV-related stigma and discrimination and provide a mechanism to compare experiences in different settings and across time. Findings will be used to advocate for change and progress to redress the situation. The Stigma Index is also important in that it empowers people living with HIV in the process, involving them directly in the design, deployment and analysis phases. This participatory approach is led by organizations of people living with HIV with support of international and domestic partners.

The Stigma Index will be carried out in 2016. A research team to oversee its development and deployment is expected to be operational in January 2016.

KNP+ is optimistic that the results of the Stigma Index will influence policies, particularly around human rights, improve psychosocial support programmes for people living with HIV and boost service uptake by making it easier for people to come forward. The organization also hopes to use the data collected to shape a national zero stigma campaign it plans to launch in 2017. Most importantly for the organization, the Stigma Index should kick start a long overdue dialogue on removing the deep-rooted fear of HIV in Korean society.

Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific, applauded the organization for taking the Stigma Index forward, stating that it is a key tool in bringing about change for people living with and affected by HIV.

“Our experience in all of the countries in our region that move forward in compiling the Stigma Index show that some remarkable things happen—a greater dialogue and understanding is established and a space for political mobilization is created,” said Mr Kraus. “It is in turn used for advocacy on budgets, on policies, on programmes and especially for reaching out to the community to make sure that no one is left behind and everybody feels included in the national response.” 

The UNAIDS Programme Coordinating Board called for stronger global solidarity and shared responsibility to end the AIDS epidemic by 2030 during a thematic segment held on 28 October in Geneva, Switzerland.

The thematic session, part of the Board’s 37th meeting, brought together distinguished speakers representing governments, civil society, the private sector and the international community to inform the discussion around a sustainable AIDS response.

In his keynote address, Ibrahim Assane Mayaki, Chief Executive Officer of the New Partnership for Africa’s Development (NEPAD) Planning and Coordinating Agency said that the unique governance mechanism that made the AIDS response successful should be replicated in broader health issues.

Participants agreed that achieving AIDS-related targets in the United Nations Sustainable Development Goals (SDGs) can only be done through a Fast-Track approach which is adequately funded, equitable and addresses the needs of key populations at higher risk of HIV infection.

In recent years, several countries have been increasing domestic AIDS investments through various mechanisms, including levies, and have focused resources on high impact programmes. But significant additional funding will be required to achieve the 90-90-90 treatment target by 2020.

Participants agreed that community responses are central to the governance and implementation of the AIDS response and that ensuring the effective participation of civil society, people living with HIV and other key populations in policy development mechanisms is essential.

“Strategic investments in community responses will not happen without structural changes in the way the governments and donors allocate funds. We need a systematic way to ensure that funding reaches community groups,” said Alessandra Nilo, Co-founder and Executive Director of Gestos, an AIDS organization located in Brazil,. She added, “Indicators of inclusion, empowerment of all people, transparency, promotion and guarantee of rights-based policies will be fundamental.”

In closing the session, Luiz Loures, UNAIDS Deputy Executive Director noted that the key to achievement of the SDG targets lies in innovation in the means of implementation. Strengthening the components of shared responsibility that are financing and governance to ensure efficiency will be critical factors to reaching an End of AIDS where no one is left behind.

The global tuberculosis (TB) death rate has fallen by almost half since 1990, but more than 4000 people a day are still dying from this preventable disease, says the World Health Organization’s (WHO) Global tuberculosis report 2015, released on 28 October.

TB ranks alongside HIV as a leading cause of death, with 1.5 million people dying from the disease in 2014, 400 000 of whom were HIV-positive. 

There have been notable successes in the TB response and effective diagnosis and treatment have saved 43 million lives in the last 15 years. The TB target of Millennium Development Goal of halting and reversing TB incidence by 2015 was achieved both globally and in 16 of the 22 countries where 80% of cases occur.

According to WHO Director-General Margaret Chan, “The report shows that TB control has had a tremendous impact in terms of lives saved and patients cured.” She added a note of caution, however. “These advances are heartening, but if the world is to end this epidemic, it needs to scale up services and, critically, invest in research.”

As well as this increased investment, new diagnostics, vaccines and medicines must be developed and funding improved. The report argues that the main cause of gaps in detection and treatment is a significant funding shortfall, which in 2015 amounted to US$ 1.4 billion of the US$ 8 billion needed to implement TB programmes.  

Funding is also critical to finance the ambitious move away from controlling the disease to ending the global TB epidemic, due to begin in 2016. WHO Member States have now adopted the End TB Strategy, which provides a road map for countries to reduce TB incidence by 80% and deaths by 90% by 2030, while also ensuring that families are not crippled by expenses owing to the disease.

“Ending the TB epidemic is now part of the Sustainable Development Goal agenda,” said Eric Goosby, the United Nations Secretary-General’s Special Envoy on Tuberculosis. “If we want to achieve it, we’ll need far more investment—at a level befitting such a global threat. We’ll also need progress on universal health coverage and poverty alleviation. We want the most vulnerable communities worldwide to gain first, not last, in our efforts.”

Ahead of the United Nations General Assembly Special Session (UNGASS) on the World Drug Problem that will take place in New York in April 2016, senior representatives of several United Nations agencies have taken part in a high-level multi-stakeholder perspective in Geneva, Switzerland. The aim of the event was to explore ways to transform the current drug control system into a measurable response that is people-centered and grounded in respect for public health concerns and human rights.

The meeting, co-hosted and co-chaired by Switzerland and Colombia, covered several key themes that will be further debated during preparatory consultations by the Commission on Narcotic Drugs in Vienna in the run-up to the UNGASS.

Introducing the panel, Switzerland’s Ambassador to the United Nations in Geneva said that stakeholders had already demonstrated their engagement to explore the global drugs issue through the lens of human rights and public health.

“We want to continue to build on this momentum by reiterating our commitment for drugs policies that are people centered and by underscoring the powerful nexus between human rights and public health,” said Ambassador Alexandre Fasel.

In his contribution to the debate, the Executive Director of UNAIDS, Michel Sidibé, said it was crucial for public health to be at the heart of future drug and criminal justice policies.

“The criminalization of people who use drugs is fueling the HIV epidemic,” said Mr Sidibé, “It is an injustice that people who use drugs are being left behind in the AIDS response when we know what works. Investment in harm reduction is a crucial foundation of an efficient drugs policy that not only saves lives but is also cost-effective. Everyone has the right to health.”

Harm reduction strategies such as opioid substitution therapy (OST) and needle-syringe programmes have proved successful in several countries, including Australia, the Netherlands, Portugal and Switzerland. However, less than one third of countries provide needle and syringe programmes for people who inject drugs. People who inject drugs are 28 times more likely to become infected with HIV than the general population. Only 14% of people who inject drugs living with HIV have access to antiretroviral medicines.

Also present on the panel was the Deputy Executive Director of the UNODC, Aldo Lalé-Demoz, who underlined that public health considerations have not been prominent enough in international drug policy and the criminal justice system.   

“Public health needs have not been sufficient in international drug policy and the criminal justice system,” he said. “Access to HIV prevention, treatment, and care for people who use drugs is far below what is needed.”            

Many panelists stressed that the UNGASS presented an historic opportunity to recast the international response to the world drug problem. 

“As we approach next year’s UNGASS, we have a once-in-a-generation opportunity to rebalance international policies on drugs and to increase the focus on public health, on prevention, on ensuring treatment, on care and on harm reduction.” said Marie-Paule Kieny, Assistant Director-General of the World Health Organization.        

In a special video message, the United Nations High Commissioner for Human Rights, Zeid Ra’ad Al-Hussein, called on States to consider the decriminalization of the possession and use of drugs and establish stronger public health responses, as recommended by the UN’s Special Rapporteur on the right to health.    

“Criminalization of possession and use of drugs causes significant obstacles to the right to health,” said Mr Ra’ad Al-Hussein. “Drug users may justifiably fear that they would be arrested or imprisoned if they seek health care. They may even be discouraged about seeking information about safe practices for drug use.”

Panelists also agreed on the need for alternative development strategies that enabled sustainable livelihoods to reduce dependence on organized crime, drug trafficking and drug production.     

Also on the panel were Colombia’s Ambassador to the United Nations in Geneva, Beatriz Londoño Soto, the Chair of the International Drug Policy Consortium, Mike Trace and, appearing via video link from New York, the UN Assistant Secretary-General for Policy Coordination and Inter-Agency Affairs, Thomas Gass.          

The high-level panel discussion took place as a group of more than 120 law enforcement officials in the United States called for fewer people to be imprisoned for minor offences including the possession and use of small quantities of drugs.      

The Law Enforcement Leaders to Reduce Crime and Incarceration said many inmates jailed for minor offences such as shoplifting and possession of small quantities of drugs were in need of care and treatment unavailable in prisons.  

Twenty years ago, the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) set international standards to protect intellectual property. The TRIPS Agreement brought about significant changes to intellectual property, with far-reaching implications for the pharmaceutical sector.

During the 2015 WTO Public Forum, on 2 October Trade Works, UNAIDS, Médecins Sans Frontières (MSF), the People’s Health Movement and the Third World Network held a session to discuss developments that have taken place since the TRIPS Agreement was adopted and its impact on accessing medicines in the developing world.

The challenges and opportunities in the public health context were explored during the event. Mariangela Simão, Director of Rights, Gender, Prevention and Community Mobilization at UNAIDS, highlighted the importance of discussing access to medicines under the framework of the recently approved Sustainable Development Goals. “The global community needs to find a balanced intellectual property regimen that works for the achievement of the health targets, including access to innovation, as recommended by the Global Commission on HIV and the Law,” said Ms Simão.  

The participants discussed the outcomes of the use of the 2001 WTO Doha Declaration on the TRIPS Agreement and Public Health—a landmark achievement for lessening the impact of intellectual property protection on public health. According to Ellen ‘t Hoen, the use of some mechanisms provided in the Doha Declaration “have helped international agencies like UNICEF and UNITAID to procure affordable generic drugs for least developed countries without any legal impediment, since such countries are benefiting from a TRIPS waiver for pharmaceutical products.”

Preserving the policy spaces paved by the Doha Declaration for the least developed countries will be one of the central issues to be addressed at the upcoming TRIPS Council meeting to be held later this month in Geneva, Switzerland.

Despite the opportunities presented by the flexibilities within the TRIPS Agreement, countries still face difficulties when trying to implement them. New provisions in bilateral and regional free-trade agreements that go beyond what is established under TRIPS are making the policy spaces for the use of such flexibilities even stricter.

The participants also examined intellectual property trends in promoting innovation within the health sector since the adoption of the TRIPS Agreement. Hu Yuanqiong, Legal and Policy Advisor, MSF Access Campaign, noted that the current “patent-centric research and development model is not working to address the health needs, including for people living in the developed world, since the new treatments for hepatitis C and other noncommunicable diseases are simply unaffordable.”