MSF has worked in Guatemala since 1982.
Angela (not her real name) is 35 years old. She is an indigenous woman who lives in extreme poverty with her six sons, the youngest of whom is also HIV-positive. Her children are living fatherless because Angela's first husband died of tuberculosis and her second husband abandoned the family. The community where she lives is rejecting her. She is one of the most vulnerable of the most vulnerable: a woman, indigenous, living in poverty, living with AIDS, the object of discrimination.
|"I have been threatened with death since they found out that I was HIV-positive. My sons were taken away while I was in the hospital."
– Angela, Guatemala City, May 2003
Improving the quality of life of those with AIDS: a worthwhile goal
Angela is one of the estimated 100,000 people in Guatemala infected with HIV/AIDS. She is also one of only 1,800 people nationwide who are receiving antiretroviral (ARV) treatment, which can make AIDS patients feel better and prolong their lives. Around 550 of these people receive ARV treatment through MSF, at Roosevelt Hospital (where Angela is treated) and Yaloc clinic in Guatemala City and at a clinic in the city of Coatepeque, in the southwest. MSF also reaches thousands more people through prevention programs and through monitoring, care and treatment of opportunistic infections, nutritional support and home care. A key objective of MSF's work is to provide the Ministry of Health with a model for developing a comprehensive public HIV/AIDS program. To provide ARV therapy, MSF currently imports generic medicines. The Guatemalan government, as of July 2003, was buying a mix of generic and brand-name drugs (countries like Guatemala are often under great pressure to buy brand-name drugs). Should the Guatemalan government decide to launch a national treatment program and use generic medicines, under today's laws it could freely buy the affordable registered medicines that MSF is purchasing. Unfortunately, new, more stringent intellectual property rules in Guatemala mean that access to affordable medicines will be much more difficult. "The situation for access to medicines in Guatemala is awful," says Luis Villa, MSF Head of Mission in Guatemala. "If there is any compromise on the ability to buy generics, then it will become almost impossible to treat HIV/AIDS patients here." Although generic competition has begun to bring drug prices down dramatically in some Latin American countries (and elsewhere in the world), this positive dynamic is now threatened by bilateral and regional trade agreements that are putting drug company profits above people's health. These agreements are creating stringent intellectual property protection that is crushing the most vulnerable people underneath. This is not the spectacular, violent death of intense conflict. It is the slowly accumulating, officially sanctioned deprivation of one the basic necessities of life.
Data protection: the back door to profits in Guatemala
In April 2003, under pressure to adopt US standards, the Guatemalan government modified its national intellectual property bill by passing Decree 9-2003, which stipulates five-year data exclusivity for submitted test data used to show that drugs are safe and effective. Practically, this means that drug regulatory authorities will not be able to rely on such data to approve generics for five years, and therefore generic competition will be delayed despite the fact that none of the existing ARVs is under patent in Guatemala today – thanks to the lack of patent protection for pharmaceuticals in the previous patent law. Passage of the decree makes Guatemala the only country in Central America to give five-year data protection. The five-year data exclusivity provision makes this a TRIPS-plus law: it is even more restrictive than prevailing world standards. Data exclusivity acts as an obstacle that denies poor people access to affordable medicines. This means that people like Angela will be less likely to get the drugs they need to save their lives.
Free Trade Agreement of the Americas
Unfortunately, intellectual property provisions such as those in Guatemala's Decree are a foretaste of what is planned for the new trade agreement currently under negotiation in the region, the Free Trade Agreement of the Americas (FTAA). If formally implemented, the FTAA will create the largest free trade zone in the world: a US $13 trillion market covering more than 800 million people in 34 countries in North, Central and South America and the Caribbean (except Cuba). The draft FTAA contains provisions on intellectual property rights which could reinforce monopolies and put essential medicines out of reach of those who need them most. If the FTAA strengthens patent and data protection, it will destroy the dynamic of competition that has caused ARV prices to plummet in some low- and middleincome countries in the Americas.
The US is already putting bilateral pressure on countries in the hopes of wearing down resistance to the restrictive provisions planned for the FTAA. Guatemala's Decree is one example of how this is being done. MSF continues to work with NGOs and governments to advocate for a public health interpretation of intellectual property law. In August 2003, MSF formally launched a campaign and petition designed to raise awareness of the potential harmful consequences of certain parts of the FTAA. And, at the time of going to press, MSF and other organizations were still urging the Guatemalan government to repeal Decree 9-2003.
The big picture
In 2001, in Doha, Qatar, World Trade Organization (WTO) member states adopted the groundbreaking Doha Declaration, which unequivocally recognizes that access to medicines should have primacy over commercial interests. However, since that time, the spirit and intent of the Doha Declaration has come under attack. In negotiations in August 2003 aimed at finding a solution for countries with insufficient manufacturing capacity to import medicines, WTO members adopted cumbersome and economically risky provisions which may actually hamper access to medicines. Hailed as a "success" by many countries, the provisions are instead a sign of the WTO's failure to safeguard the spirit of Doha. In addition, the negotiating process itself revealed to what extent many negotiators were acting in bad faith vis-Ã -vis the Doha Declaration.
MSF, along with other NGOs, pointed out that the WTO's August deal on medicines was a "gift" bound tightly in red tape, and that, as a measure of trade policy, it contradicts the basic principles of the WTO and free trade. Nonetheless, MSF is urging countries to make use of these provisions in order to test them and see what can be improved before they are reviewed and used to amend the TRIPS agreement in 2004.
The failure to safeguard Doha in the recent multilateral talks has made the outcome of regional and bilateral negotiations, such as those underway for the FTAA, all the more important. In a multilateral context, developing countries have more clout. They can vote in blocks and use their numbers as leverage. In a bilateral or regional setting, it is much more difficult for developing countries to stick up for pro-public health positions, when faced with the enormous pressures exerted by wealthier countries. It is also harder for NGOs to influence the process on these countries' behalf. MSF firmly believes that there should be no "TRIPS-Plus" – and no "DOHA-Minus" – intellectual property agreements. The Doha Declaration should be the guideline for providing access to generic drugs. MSF is therefore calling for intellectual property provisions to be dropped from FTAA, to date the most far-reaching and extreme attempt to weaken the Doha Declaration. There is already a multilateral agreement on intellectual property that most countries are happy with. Why negotiate another?
In addition to its HIV/AIDS care and advocacy work in Guatemala, MSF continues to address the medical and psychological needs of children living on the streets in Guatemala City. MSF teams at the Tzitze clinic provide 200 medical and 220 psychological consultations each month. In the therapeutic crèche "Casa del Patojo" in Lomas de Santa Faz, a slum area on the outskirts of the capital, MSF provides medical assistance and psychological and social support to young mothers and their at-risk children. Recently two new programs opened on the Atlantic Coast: in Puerto Barrios, focusing on HIV/AIDS; and in Olopa, focusing on treatment of Chagas disease (read more about Chagas disease here).
MSF also responds to natural disasters. In slum areas of Guatemala City, MSF provides structural and logistical support to help mitigate the effects of potential natural disasters and supports a local health center. Community training focuses on developing the capacity to respond to emergencies.