We are an organization of U.S.-based AIDS and human rights activists, people living with HIV/AIDS, public health experts, fair trade advocates and concerned individuals who campaign against policies of neglect and avarice that deny treatment to millions and fuel the spread of HIV. We are dedicated to eliminating barriers to universal access to affordable life-sustaining medicines for people living with HIV/AIDS as key to a comprehensive strategy to confront and ultimately stop the AIDS pandemic. We believe that the human right to life and to health must prevail over the pharmaceutical industry's excessive profits and expanding patent rights.
What does Health GAP do?
We campaign for drug access and the resources necessary to sustain access for people with HIV/AIDS across the globe. We work with allies in the global South and in the G-8 countries to formulate policies that promote access, mobilize grassroots support for those policies, and confront governmental policy makers, the pharmaceutical industry and international agencies when their policies or practices block access.
Health GAP also invests tremendous resources into rebuilding and sustaining the global AIDS movement. We actively organize students and people living with HIV/AIDS throughout the United States, supporting organizations like ACT UP NY, ACT UP Philadelphia, ACT UP Rhode Island, ACT UP Boston, ACT UP San Francisco, Florida AIDS Won't Wait Coalition, Chicago AIDS Caucus and VOCAL Westchester with staff time, resources and technical assistance. We know that our seats at the table are only as useful as the movement pushing from the outside is strong.
Sustained access cannot result from industry-controlled charity programs. Multiple strategies are needed to lower drug prices to affordable levels. These strategies include generic production, voluntary and compulsory licensing and parallel importing. A system of global bulk procurement at lowest world prices is crucial if people living with HIV in the poorest countries are to have access to treatment. We reject efforts by industry or governments to deny or restrict the right of countries to exercise these and other strategies to protect the health of their people.
Why was Health GAP formed?
Nearly 40 million people worldwide are infected with HIV and 16,000 new infections occur every day. Developing countries bear more than 90 percent of the global burden of HIV/AIDS. Sub-Saharan Africa alone is home to 28 million infected people. HIV is exacerbating growing economic, governance and public health crises simultaneously fueled by the combined effects of socio-economic, cultural and gender inequalities, the impact on public infrastructures of structural adjustment programs (SAPS), and intensified corporate globalization in the post-colonial period. After two decades of the AIDS epidemic in Africa, HIV and other communicable diseases such as TB and malaria are leading causes of early death on the continent. Countries are now facing not only immediate daunting challenges of caring for huge numbers of people affected by HIV/AIDS, but long-term catastrophic economic development impacts on labor forces, educational systems, communities and families. Elsewhere in the developing world, the unchecked expansion of the AIDS epidemic could lead to similar catastrophic public health crises.
During much of the first two decades of the AIDS crisis, the dominant public health strategy for addressing the epidemic globally was almost exclusively focused on HIV prevention. But by the mid-nineties, at least in wealthy countries of Europe and North America, a paradigm shift began to occur. Antiretroviral drugs (ARVs) for HIV and associated opportunistic infections (OIs) had become standard treatment for HIV in Western Europe and North America. We began to witness dramatic decreases in rates of death and illness among PLWHAs in these countries. Confirmation that medical interventions could substantially reduce cases of mother-to-child transmission of HIV had been established. The public health prevention benefits of linking voluntary testing with care and treatment for infected persons had been clearly established. In essence, HIV prevention and provision of treatment and care for infected people began to enter strategic public health policy discussions as inevitably linked components of a comprehensive plan to end the AIDS epidemic.
But in the global South, no such shift occurred, despite the efforts of people with AIDS and treatment activists there to expand access to medicines. Instead, the AIDS epidemic continued its devastation in parts of Africa, Latin America and the Caribbean, and Asia. People with AIDS continued to suffer and die with no access to medicines and with grossly inadequate health care. Glaring global inequities in HIV disease burden were scarcely addressed in mainstream global AIDS policy discussions - neither by governments of wealthy donor nations nor by the multilateral institutions that they had created to lead the economic, political and public health development in the post-colonial global South. Rather, treatment delivery for the vast majority of the global population of people with AIDS was essentially dismissed as prohibitively expensive and logistically impossible. HIV prevention continued to be viewed as the only possible solution to the AIDS epidemic in the developing world. Serious efforts to challenge the incongruity of approaches to the epidemic in the global North and South were not advanced, and dominant public health responses to the escalating global AIDS crisis were notable primarily for their inertia.
By the summer of 1998, when the 12th International AIDS Conference convened in Geneva, people with AIDS from developing countries and allies from both the North and the South had found this inertia intolerable, and unjust. It had become immoral and unconvincing to talk about HIV prevention as the only solution to the global AIDS crisis when 40+ million people were already infected, most of whom were in resource-poor countries where their illness and premature deaths were reversing decades of development and robbing those countries of any future development. Only treatment and care could intervene in that situation.
In Geneva, where conference participants gathered under the slogan "Bridging the Gap", access to treatment and care was addressed neither systematically nor comprehensively. Scientists and clinicians from the wealthy nations were barely present at sessions where AIDS in poor and developing countries were thematic, and plenary session debates were devoid of reference to expanding treatment access or even how the global pandemic could be slowed in light of new treatments. At the same time, the pharmaceutical industry, which to a considerable extent has underwritten these global gatherings for the past decade, again spent millions of dollars to entertain and influence doctors and researchers. The conference ended with no proposals on how to "bridge the gap" between the North and South.
People with AIDS who were being denied access to treatments and care, and their activist allies from around the world, faced with such inertia, realized that only social mobilization would spark an urgently needed shift in the global response to AIDS. It had, after all, been social activism which catalyzed advances in science, medicine and health care delivery which led to the introduction of treatments and care for people with AIDS in the North. A decade of sustained social and political pressure by people with AIDS on drug companies, public health institutions, and governmental agencies delivered ARVs and other effective medicines to infected people in Western Europe and North America. The science and medical interventions now existed, but it would take a worldwide social movement for challenging political and economic barriers to ensure that to equitable global access to treatment and care would become a reality.
The formation of Health GAP in early 1999 was the U.S.-based activist response to the international call for global social action.
Who formed Health GAP?
Health GAP was formed in early 1999 by Dr. Alan Berkman, a veteran civil rights activist and clinician in New York City, who brought together fair trade lawyers and economists, progressive clinicians, such as Dr. David Hoos, human rights activists, international health and development advocates, and direct action-oriented AIDS activists such as Eric Sawyer, John Riley, Bob Lederer, Paul Davis, Asia Russell and Sharonann Lynch, willing to confront U.S. government trade policies and the drug lobby. Individuals from groups and institutions including the Columbia Mailman School of Public Health, ACT UP New York, ACT UP Philadelphia, Doctors without Borders, The Consumer Project on Technology, Essential Action, AIDS Treatment News, Mobilization Against AIDS International, the International Gay and Lesbian Human Rights Commission, Search for a Cure, Fed Up Queers and others interested in forging a U.S.-based action-oriented strategy toward reducing barriers to equitable global access to treatment and care were initial founders of Health GAP. Together, and in dialogue with activists from the South, this group forged the basis of a new synergistic strategy toward the global epidemic rooted in ideals of the human right to life and health, and committed to social mobilization as key to confronting the epidemic. Health GAP's specific contribution to the global treatment access movement were identified as:
- educating others and building a broad-based social mobilization effort in the U.S. to challenge obstructionist U.S. policies of the U.S. government in particular,
- exposing U.S. government supported international trade policies at the multilateral level which were impeding access and advocating for policy alternatives,
- providing support for South-based activist campaigns and actions focused on their own government policies and practices, as well as the policies and practices of multinationals operating in their countries, and
- engaging with international treatment access activists in coordinated actions, activities and campaigns directed toward obstructionist multilateral policies, the pharmaceutical industry, or multinational corporations.