Maximizing TRIPS flexibilities to increase access to HIV treatment in Indonesia

Maximizing TRIPS flexibilities to increase access to HIV treatment in Indonesia

Project

Over the span of three years Indonesia AIDS Coalition has successfully advocated to ensure the possibility of local manufacturing of ARVs by local pharmaceutical companies. Prices of ARVs reduced from US$28 to US$15 per bottle, which means that an additional 45,482 people living with HIV can be treated.

Indonesia AIDS Coalition managed to meaningful involve communities in the extensive advocacy process and successfully ensured that harmful TRIPS (Trade-Related Aspects of Intellectual Property Rights) clauses were not implemented in Free Trade Agreements.

Project details

Time frame
02 January 2018 - 31 December 2020
Budget
€ 227,800
Active in
Indonesia

Objectives

As of 2017, the number of people on HIV treatment is only 14% (85.000) of the total estimated number of people living with HIV. Indonesia AIDS Coalition targets to increase the number of people on treatment to 40% by 2020 (270.000).

In order to meet the targets, three overarching, interlinked strategies guided the implementation of this project: research, capacity-building and advocacy.

The research conducted analysed the regulations on TRIPS Flexibilities in the new Patent Law, the related intellectual property rights chapter in the free-trade agreement and the current use of TRIPS Flexibilities in Indonesia.

The result of those studies have been used to develop advocacy strategies and to increase community capacity to mobilize and engage relevant stakeholders. This way they could be involved in advocacy activities to eliminate the TRIPS clause in the free-trade agreement, to strengthen the TRIPS flexibilities regulation in the patent law and to encourage the government to utilize the maximum TRIPS flexibilities.

Community groups

People living with HIV in Indonesia

Background

Indonesia has an increasing rate of new HIV infections, with approximately 46,000 people newly diagnosed per year which is among the highest in the region. According to a government survey, an estimated 640,000 people are living with HIV in Indonesia, but only 20% of them are receiving crucial HIV treatment, which is the lowest in South East Asia.

Since 2004, HIV treatment has been available free of charge for patients, with treatment fully subsidised by the government. However, due to the inefficiency of the procurement system, the price of ARVs paid by the government is among the highest in the world. Annually, the government pays approximately US$92m to purchase medication for approximately 180,000 people living with HIV. This leaves a large number of people with no access to life-saving treatment. This significant treatment gap is resulting in 38,000 preventable deaths from HIV-related illnesses each year (source: UNAIDS).

At the same time Indonesia is facing the transition to an upper middle-income country which means it is no longer eligible to receive funding from external donors, which is one of the requisites to scale up treatment.
 

What are TRIPS flexibilities?

TRIPS (Trade-Related Aspects of Intellectual Property Rights) flexibilities are legal mechanisms enabling member states to express specific needs in terms of public health, in spite of the patent protection in force.

Removing patent barriers - Results of 3 years of advocacy

  • Communities discussed harmful TRIPS clauses with the Ministry of Trade

Indonesia AIDS Coalition ensured communities were heard by providing representatives of the community to join discussions with the Ministry of Trade. Representatives expressed their objections to clauses that are harmful for the community, one of which was the clause regarding TRIPS

  • TRIPS clauses excluded from free-trade agreements

During the project implementation period, several Free Trade Agreements were established Through advocacy efforts Indonesia AIDS Coalition ensured that no clauses were adopted which were harmful for the availability of medicine.

  • ARVs registered as first line treatment

In Indonesia, medicine patents have caused a limited availability of ARVs in some regions. Based on WHO recommendations, Indonesia AIDS Coalition has encouraged to also register ARV as first line regiment.

  • Local ARV manufacturing leads to price reduction

Through capacity building for communities and workshops for stakeholders such as clinicians and drug manufacturers, Indonesia AIDS Coalition illustrated the health and economic benefits of ARVs. Due to these workshops local pharmaceutical companies started manufacturing ARVs locally. In 2020 the price of ARVs reduced from its previous price of US$ 28/bottle to US$ 15/bottle, which is roughly 48% reduction, which can add up to 45.482 PLHIV to be treated.

  • Contribution to the national HIV acceleration plan

Indonesia AIDS Coalition works closely with the staffs of Executive Office of the President in its HIV acceleration plan and in advocacy to encourage further ARV price reduction. Its policy brief is considered as reference in this effort by the Executive Office of the President.

Recommendations for effective advocacy

Indonesia AIDS Coalition has published a policy brief based on its achievements in the past 3 years. It includes several feasible policy options available to the Government of Indonesia to reduce ARV prices by increasing transparency and allowing for greater price competition.

What are next steps?

Several free trade agreements are still in the process of negotiation. A coalition has been established, existing of activists with different backgrounds, that will continue to advocate for repelling harmful clauses in free trade agreements and improved access to affordable medication.

To ensure involvement of the community, raising awareness among people living with HIV must continue. Social media is seen as an effective method to spread campaign messages and to reach a wider audience.

Furthermore, the impact of the free trade agreement on the economy and public health needs to be assessed. This is important to alleviate any possible negative effects. However, understanding the technical details of an impact assessment is complicated and specialists who are familiar with econometric and health theories and models are scarce in developing countries. This lack of technical knowledge and support, needs follow up.

Challenging intellectual patent barriers programme

This advocacy project has been implemented under the Challenging Intellectual Property Barriers programme funded by Aidsfonds, aiming to increase access to affordable medicine for people living with HIV. Seven projects supported civil society organisations in Bangladesh, Indonesia, Kenya, Mozambique, Myanmar, South Africa, Uganda, Ukraine, Vietnam and Zimbabwe, in holding their governments accountable for access to essential medicines and lowering costs of pharmaceuticals.

Interview: the road to affordable HIV medicine in Indonesia

Indonesia has an increasing rate of new HIV infections, with approximately 46,000 people newly diagnosed per year. Fuelled by stigma and discrimination directed towards people living with HIV, the number of people living with the virus in Indonesia is among the highest in the region. Since 2004, HIV treatment has been available free of charge for patients, with treatment fully subsidised by the government. However, due to the inefficiency of the procurement system, the price of antiretroviral (ARV) medicines paid by the government is among the highest in the world.

In 2016, our partner Indonesia AIDS Coalition started to advocate for accessible treatment for all. After three years, they managed to make an impactful change. In this interview, we spoke to Aditya Wardhana, the Executive Director of IAC, to dive into the grassroots victory for affordable HIV medicines in Indonesia.

Interview: the road to affordable HIV medicine in Indonesia

Goals

Everyone living with HIV worldwide receives treatment
100%
Contributed within this project

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