The Foundation and ARVs
Stephen Lewis has advocated powerfully for the urgent need to make generic ARVs available for export to Africa. He has advocated tirelessly for the funds to be given so that Africans can have access to these life-prolonging drugs. Affordable (preferably free), accessible, equitable, universal treatment has been at the forefront of Stephen's agenda.
Many Canadians who want to contribute to the Foundation, want to contribute to treatment. Keeping people alive is a powerful, powerful motive for giving.This is especially true when the Canadian government has amended patent legislation to permit the manufacture and export of generic antiretroviral drugs, at very low price.
The Stephen Lewis Foundation does not currently direct money to treatment (ARV drugs).This is a desperately difficult decision, with which we continue to struggle.For the moment, however, we cannot fund treatment directly. There are four points we’d like you to keep in mind that underpin this decision.
First, when we intervene in the fields of palliative care and orphans and associations of people living with AIDS, providing food, shelter, education, psycho-social support, counselling, jobs, home-based care, training and medicines, we are effectively releasing other funds for antiretroviral treatment.That is to say, if a project we support, provides treatment in some aspect of its work, it has more money for treatment when we diminish the financial burden of its other interventions.
Second, it's a question of sustainability.Treatment is a very sensitive matter: if, for any reason, treatment is interrupted, during the course of the client's life, then the client is almost certain to die.The Foundation feels that it would be taking on too much to guarantee a flow of money for the many years that individuals are in treatment.We plan of course to keep the Foundation going for a very long time.But we have to be realistic: something unexpected can happen, something can go wrong.We would never want someone's life to hang on whether or not we can get the money to them in perpetuity.
Third, treatment must fundamentally be the responsibility of governments, through their public health systems, funded both internally and externally. It's never just the cost of drugs: there's infrastructure and capacity and training. It all requires huge amounts of money, ranging into the billions.The sources of the money for treatment are western governments, the Global Fund to combat AIDS, Tuberculosis and Malaria, the World Bank, the Gates Foundation, the Clinton Foundation, the Rockefeller Foundation, various United Nations agencies, some non-governmental organizations, and of course, the recipient governments themselves.To be sure, there are inspired limited interventions — like those of Doctors Without Borders — which are especially equipped to set an example of treatment that governments will one day emulate. But they are highly specialized, and at present well-financed.
Fourth, while the focus on treatment is critical, it is equally critical to respond to the countless people who are HIV positive, but are not yet facing full-blown AIDS.They will have what we describe as 'opportunistic infections' — a host of pre-AIDS illnesses that desperately require medication, but the medicines are nowhere to be found.Our Foundation, particularly in its support for palliative care, provides those medicines.During the same period prior to full-blown AIDS, good nutrition is vital to maintain health, and to forestall, as long as possible, the onset of AIDS.To that end, food means everything, and the Foundation will provide it.
Despite all of the foregoing, and the compelling logic which it represents, the introduction of 3 by 5 (meaning 3 million people in treatment by 2005) by the World Health Organization has changed the AIDS landscape. Every government and every community is now predictably obsessed with treatment. It has generated a level of hope where before there was only despair. In that context, we have taken a very hard look at our rationale for not funding treatment. The rationale still seems to us persuasive, but there may come those exceptional occasions when we depart from our present practice.