Trends and Economic Stress: A Challenge to Universal Access to Antiretroviral Treatment in India

Initiatives to challenge patent barriers and their relationship with the price of medicines procured by the Brazilian Unified National Health System

Since 1996, when antiretroviral (ARV) treatments started being guaranteed to people living with HIV in Brazil, the government has faced the challenge of ensuring sustainability of this policy within a context of incorporating patented medicines. This article sought to analyze the historical series of the price of lopinavir/ritonavir (LPV/r) in Brazil and in the international market also considering the initiatives to challenge patent barriers between 2001 and 2012. The methods used were mapping initiatives to challenge LPV/r patent barriers and the analysis of historical series of its price in Brazil and in the international market. Results show that, between 2001 and 2003, there were efforts to use compulsory licensing as a threat. From 2005 to 2007, initiatives by different satkeholders were identified: declaration of public interest, pre-grant opposition ("support to examination") and civil action. From 2006 to 2008, compulsory licensing initiatives in other countries resulted in a price reduction in Brazil. Between 2009 and 2012, there was a 30% reduction in the Brazilian purchasing price.

Pretreatment loss-to-follow-up after HIV diagnosis from 27 counseling and testing centers across India: findings from a cohort study

Individuals testing HIV positive were interviewed at testing centers, followed prospectively and interviewed again when they registered at referral antiretroviral therapy (ART) centers (ARTCs). Those who did not register at ARTCs were traced and interviewed in the community. A total of 1057 newly diagnosed people living with HIV (PLHIV; 52% women; mean age, 34.7 years) were recruited. A total of 73.5% of PLHIV registered at referral ARTCs within 60 days, 17.9% did not register and were interviewed in the community, and 8.6% were not interviewed. The 2 main reasons cited for not registering were a perception of good health (30%) and work/family engagements (22%). Single clients (adjusted relative risk [ARR]: 1.54; 95% confidence interval [CI]: 1.02-2.34), participants who had not disclosed their HIV status (ARR: 2.32; 95%CI: 1.77-3.05), participants who knew a PLHIV (ARR: 1.89; 95% CI: 1.41-2.53), and participants from laborer households (ARR: 2.66; 95%CI:1.15-6.15) were more likely to not register. In conclusion, the majority of newly diagnosed PLHIV do reach ARTCs. Disclosure concerns and a perception of good health prevent PLHIV from accessing services.

The ethics of intellectual property rights in an era of globalization

Since the 1980s, developed countries, led by the United States and the countries of the European Union, have sought to incorporate intellectual property rights provisions into global trade agreements. These countries successfully negotiated the World Trade Organization's 1994 Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which required developing countries to adopt intellectual property provisions comparable to developed countries. In this manuscript, we review the policy controversy surrounding TRIPS and examine the two main ethical arguments articulated in its support--a theory of natural rights and a utilitarian argument. We contend that these theories provide insufficient bases for an intellectual property rights regime that compromises access to essential medicines in the developing world. While the policy community has engaged in active debate around the policy effects of TRIPS, scholars have not thoroughly considered the full ethical underpinnings of those policy arguments. We believe that a more robust understanding of the ethical implications of the agreement should inform policy discussions in the future.

HIV Insurability in India: Early History and Current Status

HIV and AIDS have been long recognized as developmental concerns that require a comprehensive approach in prevention, treatment and impact alleviation. In India, HIV has been recognized as one of the most important public health issues. Despite a free antiretroviral therapy (ART) programme, treatment costs due to hospitalization continue to be a source of economic strain on household affected by HIV/AIDS. This article traces the various initiatives taken in India to provide financial protection to individuals with HIV/AIDS, before and after the free ART programme, to put into perspective current efforts to mainstream HIV into existing health insurance programmes.