Who We Are

The Health Global Access Project (Health GAP) is an action-oriented advocacy group created in early 1999 by U.S.-based AIDS and human rights activists, public health experts, fair trade advocates, and concerned individuals dedicated to achieving equitable access to treatment and care for people with AIDS in developing countries. We do this by exposing and challenging obstructionist policies and practices of the U.S. government, the pharmaceutical industry, and multilateral institutions, which create structural barriers to access and frustrate efforts to address the global AIDS crisis comprehensively. We also work to ensure that adequate resources are raised to provide universal access to treatment and care and to increase health care capacity, at the same time that we monitor program implementation to increase efficacy, efficiency, and equity. We believe that fulfillment of the human right to life and treatment for all people living with HIV/AIDS (PLWHAs) should be a first-order priority of the global response to AIDS.

What We've Done

When Health GAP was founded in 1999, the idea of affordable treatment in developing countries was seen as impossibly utopian. Since then, Health GAP has been an indispensable player in the effort to make equitable global access to treatment and care for HIV/AIDS a reality. Our first work was devoted to calling attention to the plight of millions of people without access to treatment, and to the reasons why access to affordable medications was blocked. Later, we worked to influence policies and resource allocations of the United States and other developed countries at the same time that we advocated policy reforms by international bodies including the World Health Organization, the Joint United Nations Program on HIV/AIDS (UNAIDS), the World Trade Organization, the International Monetary Fund (IMF) and World Bank, and the Global Fund for AIDS, Tuberculosis and Malaria (Global Fund). At all times, we have sought to do this work in solidarity and in alliance with people living with HIV/AIDS and treatment activists in the Global South and throughout the world.

This work has been accomplished over a five-year period through a variety of campaigns. Below is a summary and discussion of six interrelated goals: raising the profile of global HIV/AIDS on the agendas of international organizations and, especially, the United States government; mobilizing resources in support of treatment and related activities; expanding treatment access; breaking down legal barriers and intellectual property rules that interfere with developing countries' production and procurement of affordable generic medications; supporting activist and PLWHA groups in developing countries; and serving a catalyst, "change agent" role within the advocacy community of the Global North. This discussion is not meant to be exhaustive, but rather to highlight some areas of work and victories where Health GAP has had a major role.

Raising the Profile of Global AIDS

Health GAP has been a critically important actor in the drive to raise the profile of the global AIDS crisis on both the international and domestic policy agenda since the organization was founded. We have drawn on both our activist roots and the world-class expertise of our founding and subsequent members to pursue a strategy combining both grassroots protests and advocacy, and high-level consultation and negotiation. Our work in this regard puts us in league with much larger, older and more heavily-resourced organizations.

Health GAP's pivotal role has been cited in numerous publications that have been written on global AIDS, and specifically on global treatment access. Recent examples include: Global AIDS: Myths and Facts by Irwin, Millen and Fallen (2003); The Invisible People by Greg Behrman (2004); Moving Mountains by Anne-Christine d'Adesky (2004); and AIDS and the Policy Struggle in the United States by Patricia Siplon (2002). And in "At the Crossroads: A study of Federal HIV/AIDS Advocacy", a report commissioned by the Ford Foundation, Derek Hodel cited Health GAP (together with ACT UP and the Global AIDS Alliance) as "strikingly" dominant in their media work (p. 8).

The first major project undertaken by Health GAP in 1999-2000 opened the way to a major policy turnaround by the Clinton Administration on access to
affordable HIV/AIDS medications in Africa, namely the de-escalation of trade pressure by the Clinton Administration against the South African government because of its effort to access more affordable medcines.  This campaign, which resulted in the passage of an Executive Order prohibiting
trade activity that would decrease African countries' ability to utilize
TRIPS-compliant measures to access more affordable medicines elevated the African AIDS and access-to-mediicnes issues issue from total obscurity to ones receiving major media coverage. More recently, our campaign work has expanded, as discussed further below, to include greatly increased spending on global AIDS, removal of intellectual property barriers for countries
seeking to access affordable medicines, debt cancellation, and expansion of health care capacity in developing countries.

Mobilizing Resources

Recognizing that the lack of resources constitutes a separate barrier to access of treatment and care, Health GAP joined with other groups to pressure the United States government and other governments of wealthy countries as well as the United Nations system to initiate major programs to provide to support treatment and care for the millions who need it. After prodding by global AIDS activists, including Health GAP, UN Secretary General Kofi Anan at a announced the formulation of the Global Fund to Fight AIDS, TB, and Malaria at a series of international meetings in Abuja, Nigeria, New York City and Genoa, Italy in 2001. Similarly, the Presidential AIDS Initiative, crafted by a small group of organizations including Health GAP, served as the blueprint to the 5-year 15-billion dollar President's Emergency Plan for AIDS Relief (PEPFAR), announced by President George W. Bush during his 2003 State of the Union address.Having advocated for the creation of the Global Fund, Health GAP pushed the United States government to recognize its growing needs and the U.S.'s obligation to pay its equitable share of Global Fund resources. Through work in coalition with key Washington-based advocacy organizations and with key grassroots constituencies, Health GAP continues to support this critical multilateral effort.

Sustainability of the work aided by the Global Fund and PEPFAR will require ever-increasing financial commitment from developing country governments. To enable this commitment, Health GAP has been a stalwart ally in the international campaign to Drop the Debt of these countries. This work has spanned more than five years, from incorporating the message into demonstrations and rallies in 2000 and 2001 up to recent work with European allies in preparation for the 2005 G-8 meeting in Gleneagles, Scotland, which culminated in successful pressuring of world leaders to drop the debt of 18 heavily indebted nations ($40 billion, freeing up $1.5 billion/year for spending on health and education) as well as the global call for universal access to HIV/AIDS treatment by 2010.

Expanding Treatment Access

That committing resources to procure antiretroviral medications in developing countries is desirable, indeed obligatory, seems obvious now. Yet only a few years ago the global consensus — among donor governments, multinational entities including the World Bank and public health experts Ð was that it treatment was impossibly expensive to and impossible to implement HIV-prevention was believed to be the only option. Expansion of treatment access first required a sea change in attitudes about both the affordability and feasibility of treatment. Heavy lobbying and advocacy by Health GAP and a coalition of other groups at all levels — among government officials, diplomats, and international organizations and through major press campaigns Ð brought about this paradigm shift in perception. During the period between the 2000 International AIDS Conference in Durban, South Africa and the 2001 United Nations General Assembly Special Session (UNGASS) meeting on AIDS in New York City, this was a major focus of Health GAP's work, and the turnaround in attitudes marked both a major success and a foundation upon which to build future initiatives.

These later initiatives have taken a wide variety of forms but include, among others: the insistence that the new Global Fund as well as the PEPFAR place equal emphasis on providing resources for treatment as on prevention: pushing these programs to make use of generic medications and bunk procurement mechanisms to maximize the number of people who can be treated with available resources; calling for technical assistance to help developing countries rapidly scale up existing programs; and organizing for treatment literacy to ensure that people living with HIV understand their medication regimes, adverse effects, and the crucial importance of adherence.

Breaking Down Intellectual Property and other Legal Barriers to Affordable Medications

A key goal that has guided Health GAP's actions since its founding is the need for countries to be able to legally produce and/or import the most affordable quality drugs possible, most often generics. This ideal has been repeatedly blocked by intellectual property rules (patent rights and data protection rules) in so-called free trade agreements. Thus, a defining role of Health GAP has been to advocate against global, regional, and bilateral trade agreements that elevate intellectual property protections over public health needs.

Beginning in 1999, we targeted the WTO multilateral Agreement on the Trade-Related Aspects of Intellectual Property Rights (TRIPS), as well as the bilateral pressure the US government and pharmaceutical companies were placing on South Africa and other developing countries. By 2000, we were also protesting the US unilateral threats of sanctions against the Dominican Republic, the Philippines, Thailand and Argentina and in 2001 we protested a U.S. WTO complaint against Brazil. Later in 2001, Health GAP was an important member of the broad civil society coalition that won a key victory at the WTO Ministerial Meeting held in Doha, Qatar. The resulting "Doha Declaration" was a critical interpretation of TRIPS that explicitly prioritized public health over intellectual property, and that emphasized the obligation of governments to provide access to medicines for all.

The struggle between pharmaceutical companies seeking to extend intellectual property protections for their products and developing countries seeking to provide affordable and universal treatments for their citizens is ongoing. The strategies of the pharmaceuticals and the governments that support them take many forms in international, regional and bilateral trade agreements. The U.S. Trade Representative has sought heightened intellectual property protections and elimination of existing lawful flexibilities for accessing more affordable medicines in multiple venues including the Free Trade Agreement of the Americas, the Central American Free Trade Agreement (pending), the Andean Free Trade Agreement, the Southern African Custom Union Free Trade Agreement and many, many others. In these agreements, the U.S. seeks not only to extend patent rights and reduce TRIPS-compliant flexibilities, it is also seeking to erect a new barrier called data exclusivity that will delay or prevent registration/marketing approval of bioequivalent generic medicines. In each of these contexts, Health GAP has worked in alliance with civil society and activist communities in a wide variety of countries to oppose the expansion of drug companies' monopoly rights.

Supporting Developing Country Activists

Our colleagues in the global south, including people living with and marginalized populations at risk of HIV/AIDS, have achieved inspirational victories and must remain in the forefront of global campaigns against the pandemic. Health GAP has sought to support activist colleagues and organizations in a variety of ways. Two notable examples occurred at International AIDS Conferences, first in Durban, in 2000 and then in Bangkok in 2004. In both cases, Health GAP sent staff and volunteers in advance of the meetings to help support the South African and Thai activists with strategizing, logistics and organizing. These efforts helped to make the issues raised by local and national groups in the host countries Ð treatment access in the first case and government persecution of injection drug users in the second Ð defining foci for the conferences.

Health GAP also seeks to support our colleagues in responding to requests for both capacity building assistance and participation in actions called by other activist organizations. For example, in the spring of 2001, Health GAP helped coordinate a global day of protest against a drug-company lawsuit seeking to enjoin South African legislation that would have permitted easier access to more affordable medicines, a protest that resulted in the withdrawal of the lawsuit a few days later. In August 2002, Health GAP was one of a small number of northern organizations invited to travel along with over seventy delegates from twenty-one African countries to Cape Town, South Africa to help launch the Pan-African HIV/AIDS Treatment Access Movement (PATAM). In summer 2004, when South Africa's Treatment Action Campaign called for a global day of protest against Bush administration AIDS policies, Health GAP worked with a small number of other US-based organizations to coordinate rallies at Bush campaign headquarters across the country. In November 2004, Health GAP staff worked with grassroots groups in Kenya and Tanzania to organize over 150 AIDS activists and people living with AIDS to protest the Global Fund Board meeting being held in Arusha, Tanzania. And in June 2005 Health GAP staff returned to Nairobi to investigate treatment delivery there, and explore the possibility of further collaboration in new campaigns.

In addition to supporting international calls for solidarity from activists in Africa, Health GAP also supported campaigns in Brazil, Thailand, and India, including those related to 2005 amendments to the Indian Patent Act and the threat of Brazil to issue lawful compulsory licenses for AIDS medicines. Two of Health GAP's volunteers are internationally recognized experts on intellectual property rights and trade issues and have consulted extensively with developing countries on these issues.

Catalyzing the Global North Advocacy Community

Health GAP has played an important leadership role within the Global North advocacy community. Since our first campaigns dedicated to making the perceived impossibility of universal treatment into an imperative, Health GAP has developed a specialized function of identifying issues that stand at the juncture of pressing need and political opportunity and bringing media and activist pressure to bear. We have sought to become, as one observer put it, "the crowbar in the crack". Health GAP's small size, highly qualified and engaged volunteers, and unique organizational structure mean that it is very cost efficient, adaptable and effective. It has also meant that Health GAP has needed to hone its organizational ability to serve a catalyzing role within the AIDS advocacy community in mobilizing and supporting much larger coalitions to provide the human and financial resources for multi-country, large-scale campaigns.

Domestically, Health GAP has helped bring together activists and advocates from a variety of constituencies, including student groups, AIDS activist organizations, human rights groups, and faith-based communities to work on projects ranging from the Coca-Cola Treat Your Workers Campaign to the 04 Stop AIDS Campaign in 2004. Internationally, it has performed a similar function, facilitating the organization of the advocacy community within the global north. Such facilitation is sometimes short-term, as when Health GAP has provided the communications tools and staffing for global or regional days of action involving events coordinated across whole continents, and sometimes longer term, as when Health GAP helped European colleagues organized the Fund the Fund Campaign designed to pressure the leadership of all wealthy nations to provide the necessary support for the Global Fund

In large part as a result of victories from previous campaigns, Health GAP must now pursue two strategies. The first is to continue to aggressively advocate for new and bold initiatives for programs and resources to stem the raging global pandemic. The second is to monitor the programs that have already been created to ensure that they are being funded and implemented in ways that provide cost-effective, high quality treatment and services to the largest number of people possible, and in ways that fully respect and empower the communities they are intended to serve. In particular, Health GAP emphasizes equitable access of people of color, women, children, rural populations and disfavored constituencies including injecting drug users, sex workers, and men who have sex with men. New Initiatives

A key Health GAP strength is its willingness to extend the "politics of the possible." Health GAP is known for pushing the envelope Ð in demanding treatment in developing countries when others thought it impossible, in proposing unprecedented programs, and in seeking funding levels which were initially denigrated, then ultimately adopted by donors. As treatment programs continue to unroll through the Global Fund, PEPFAR, and other programs, new major challenges are emerging that, if left unaddressed, threaten to undermine the progress of treatment that has occurred over the last several years.

One such challenge, particularly in sub-Saharan Africa, is the shortage of health care workers and health system infrastructure needed to administer newly expanded treatment programs. This shortage has several sources, including: insufficient funding for educational and training programs for health care professionals, the "brain drain" of these professionals to developed countries in search of higher salaries to sustain their families, and the loss of profession to HIV/AIDS. In addition, international financial institutions, the World Bank and the International Monetary Fund, impose public sector spending limits that prevent rehabilitation and expansion of failed health systems in developing countries. Solutions to the health care capacity problem will need to be similarly multifaceted, requiring both more money and policy changes that will allow investment in public health sector reform and the employment of community health workers at the front line of treatment and care. In response to this health systems capacity crisis, in 2005 Health GAP joined forces with several other organizations to begin a new Health Care Workers Campaign.

An additional emerging crisis involves orphans and vulnerable children. The impact of HIV/AIDS on children, particularly because of the loss of parents and the infection of children themselves, is enormous, especially in sub-Saharan Africa. As one of the most vulnerable populations affected by the pandemic, there is an urgent need for broad and comprehensive initiatives to deal with this crisis. Health GAP is exploring the dimensions of the problem, with an eye to finding a way to contribute that optimizes its skills and focus areas. One of the critical problems involved with providing treatment for children with AIDS is that there are few pediatric formulations of AIDS medications, and fewer still that are remotely affordable. Thus, Health GAP is considering launching a Pediatric AIDS Campaign with other organizational partners.

Maximizing Past Achievements

The global treatment access movement, within which Health GAP is an acknowledged leader, has come a long way since 1999. Yet accomplishments Ð whether in the form of international agreements, important new initiatives, or major concessions Ð rarely translate into improved realities for the people most affected by them without vigilant and continuous pressure and monitoring for efficient, compassionate and informed implementation. Most of Health GAP's work in its earliest years was devoted to reversing the international consensus opposing universal AIDS treatment and to securing commitments from the US and other donors to help make such treatment possible. The accomplishment of these goals, however imperfect, places Health GAP in the position of working to monitor and expand upon what has been achieved.

Thus, a number of current and potential campaigns are designed to perform these functions of monitoring and expansion of previous gains. To continue to grow the grassroots network that was begun with the work of the 04 Stop AIDS Campaign, Health GAP has been an active organizing partner in the Campaign to End AIDS, a U.S. nationwide domestic initiative begun in May 2004 that is organizing caravans of AIDS-affected individuals to travel throughout the country in fall 2005 to culminate in a week of political activity in Washington, DC in October.

Our work on the legal barriers to accessing affordable medications continues through various projects, including our advocacy against adoption of stringent intellectual property regimes through proposed free trade agreements between developing countries and the US. Ongoing campaigns also including tracking the policies and use of resources by PEPFAR and the Global Fund, and promoting greater resources and better policy implement for scaling up human resources for health at the country level. This work expands on Health GAP's goal to work in close cooperation with developing country allies by allowing us to work in partnership with activist groups in East Africa. The first of these campaigns, the PEPFAR WATCH Project, enables Health GAP to work in conjunction with both another US-based advocacy group, the Center for Health and Gender Equity (CHANGE), and a number of grassroots organization in Kenya, Tanzania and Uganda, to track and report on the implementation and impact of PEPFAR programming for treatment and prevention in East Africa. Fix the Fund provides capacity-building and strategic support for groups to identify problems of, and advocate for solutions to, the implementation of grants received by these governments from the Global Fund. Health GAP also continues to work on placing the issues of health care worker shortages squarely on the international community's global HIV/AIDS agenda.

Since our founding in 1999, there has been significant progress in the fight for global treatment access. Hundreds of thousands of people in developing countries have access to treatment that did not exist five years ago, and the money made available from bilateral and international donors has multiplied from millions to billions of dollars. Yet 5.5 million people are still without treatment, and the resources that have been made available remain a fraction of what is required. As we move forward in the struggle against the global crisis that is the HIV/AIDS pandemic we will continue to rely on our founding organizational characteristics Ð openness to a wide variety of advocacy tactics and strategies, careful and critical analysis of AIDS treatment policy, and above all, a passionate commitment of staff and volunteers to our goals.

Health GAP is administered by Mobilization Against AIDS International a 501(c)3 tax-exempt non-profit organization

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January 2002 — December 2002

January 2001 — December 2001

January 1999 — December 2000

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"No more than the Germans in the Nazi era, nor more than white South Africans during apartheid, can we at this conference say that we bear no responsibility for the 30 million people in resource-poor countries who face death from AIDS unless medical care and treatment is made accessible to them." -- Justice Edwin Cameron of South Africa, XIII International AIDS Conference in Durban

• $ 100 - transports activists from Philadelphia or NY to Washington DC so that they can sit across th table from the US Trade representatives and hold them accountable to the line that was drawn at the WTO meeting in Qatar, where it was acknowledged that the rights of public health need to be respected within the agreement of Trade and Intellectual Properties Rights.
• $ 500 - pays for most of a month's cell phone bills for our small staff of 3 who sometimes have to make press calls from such places as Qatar after having spent months trying to negotiate our way into those meetings. We had 2 Health GAP members who were amongst only 2 dozen US activists who were allowed into Qatar. They spent 23 hours a day relentlessly pushing so that the agreement would be reached.
• $ 1000 - is what it costs to bring a packed busload of low-income people living HIV and their loved ones from Philadelphia to protest in Washington DC and hold the government accountable for standing in the way of treatments that they have seen keeping their neighbours and loved ones healthy. It pays for the bus bills, food for the day and transport tokens. This enables us to reduce the barriers that stop people from protesting on the issues that impact them. We can often fill 12 to 15 buses for each protest and often our largest barrier to bringing people out to protest is not the interest, it's the cost.