You can download the presentation from http://www.gnpplus.net

1. The Newsletter of The Asia pacific Network
of People Living with HIV/AIDS
Working with PLHIV communities to address stigma
and discrimination and increase access to treatment
through advocacy and education
APN INSIDE
AUGUST2011
Asia Pacific network of People Living with
HIV/AIDS
51/2 3rd Floor Ruam Rudee Building lll,
Soi Ruam Rudee, Ploenchit Road 1,
Lumpini, Pathumwan, Bangkok 10330 Thailand.
Tel: (66) 2 255 7477 Fax: (66) 2 343 9399
www.apnplus.org
FREE TRADEand Access to Medicines
Co-Chairs Message
FTAs, IP & Access to
Medicines
Regional Treatment
Working Group
DNP+ Activism
Pacific Positive People’s
Gathering
myPlus Positive Network
HCV Treatment Access
GNP+ Strategic Plan
The HIV Consortium Project
APN+ Strategic Planning
Living Longer with HIV
WAPN+ update
Positive MSM update
APN+ GF update
2
2
8
8
9
10
10
11
11
12
13
14
14
15

2. As we continue our work to promote the
rights and collective interests of PLHIV
in the region, we do so against a number
of fundamental challenges that threaten to
disrupt progress over the past 10 years.
We face a critical situation ahead, world
leaders are using the global financial
crisis to justify their shifting commitment
to the fight against HIV and it is having
huge impacts on HIV funding. The money
is slowing down (flatlined, stopped) and
sustainability of treatment, care and
support is a major concern. Questions
around sustainability are even more
prominent when we consider the unmet
Universal Access targets, the delay in
the implementation of the revised 2010
WHO HIV treatment guidelines, and policy
makers’ responses to the recent HPTN
052 research result, which showed 96%
reduction in HIV transmission with early
treatment.
A cause of equal concern is the increasing
attack of Free Trade Agreements (FTA) and
other similar trade agreements, such as
the Trans-Pacific Partnership Agreement
(TPPA) and their implications for treatment
access in the region.
As we become more familiar with these
challenges and the nature of their poison,
we will simultaneously need to build
strength as community and as activists, to
align our common aims and strategically
prepare our collective voice. We need to
reach out to other like minded people to
make our voice louder. We need to hold our
governments, institutions and international
agencies accountable to the promises
made in the international arena. We
need to learn from the past 10 years and
apply our knowledge to ensure treatment
access, to develop better funding systems
and improve the outcomes of our work. We
must continue to gather in solidarity and
to strengthen our advocacy efforts at the
local, national, regional and global level as
we are central to the response.
Mr Sudin Sherchan and Ms Mukti,
APN+ Co-chairs
Message from the Co-Chairs
Free Trade
Agreements,
Intellectual
Property and
Access to
Medicines
Patent Laws and Free
Trade Agreements (FTAs):
Impact on Access to
Medicines
P
atent laws can restrict access to
medicines because when a new
drug is patented, the company that
owns the patent enjoys a monopoly1
and can set a high price for the
drug. Patent laws prevent competitors from
manufacturing and selling low cost generic
versions2
of the same drug. Patent owners can
prevent others from making, selling or importing
the medicine that is under patent for a prescribed
period, usually, 20 years.
Generic versions of medicines are usually
much cheaper than the patented equivalent
though in terms of quality both are the same.
The ability of any country’s citizens to access
generic versions of a patented medicine, either
through local manufacturing or import, depends
on the intellectual property law, including patent
law in the country concerned. A country’s patent
laws are influenced by its membership status
with the World Trade Organization (WTO) and
by the country’s trade agreements, such as its
bilateral and regional Free Trade Agreements with
other countries. WTO requires all its
member countries to comply with
the Agreement on Trade Related
Aspects of Intellectual Property
Rights (TRIPS Agreement).
The TRIPS Agreement
stipulates that member countries
are required to have in place at a
minimum,a20-yearpatentprotection
period on all medicines. Before the
TRIPS Agreement was introduced
in 1995, WTO member states were
allowed to exempt medicines from
patent laws, so that no medicines
could be patented or to have
shorter periods of patent protection.
Developing countries such as India,
Thailand were given 10 years to
comply with the TRIPS Agreement.
India was among the few developing
countries that fully used this deadline
and continued producing generic
drugs until 2005. For least developed
countries like Cambodia, they have
until 2016 to comply with the TRIPS
Agreement.3
Generic medicines are the
main engine of global HIV treatment
access and are the central reason
why HIV medicines are affordable
and accessible to more than 5
million people today. A recent
study by the International AIDS
Society calculates that 80% of
HIV medicines distributed in low
and middle income countries are
generic.4
India and Thailand continue
to produce generic medicines even
though they have to provide 20 year
patents under the TRIPS Agreement
but they are now facing situations
where newer medicines are being
patented and cannot be produced
by generic companies. Newer
HIV medicines like raltegravir and
etravirine are patented in India.
So is pegylated interferon, the
treatment for Hepatitis-C, a course
of which can cost over $10,000
in India and much more in other
countries. But the supply of generic
medicines in developing countries
faces restrictions not only when
countries become a WTO member
and have to comply with TRIPS.
When they enter trade agreements
containing requirements far greater
than those contained in the TRIPS
Agreement the access to medicines
situation which is already being
hampered the TRIPS Agreement,
becomes even more severe.5
The Case of India-
EU FTA
The ongoing trade negotiations
between the European Union (EU)
and the Government of India for a
bilateral FTA (also known as a Trade
and Investment Agreement) will
greatly impact access to medicines
across the developing world.
Currently, Indian generic
manufacturers account for more
than 80% of generic ARV medicines
– supplying the majority of developing
countries. In the case of paediatric
ARVs they account for 91% of the
supply.6
In the FTA negotiations,
the Government of India wants to
protect its generic manufacturers,
and specifically, their ability to
legally produce and sell inexpensive
medicines to the world, and yet at
the same time, the Government
of India also wants access to the
European markets for all Indian
industries, not just medicines.
The EU has claimed a
commitment to global access to life-
saving medicines, including ARVs,
but has also argued in the interest of
its own multi-national pharmaceutical
industry for provisions, which if
adopted, could severely limit access
to life-saving generic medicines.
These are known as TRIPS-plus
measures and require India to impose
even more restrictions on the supply
of generic medicines than those
required by the TRIPS Agreement.
These provisions include :7
About APN+
APN+ was established in 1994 to create a collective voice
for HIV positive people in the Asia Pacific region. APN+
is committed to improving the quality of life of people
living with HIV/AIDS (PLHIV) and to supporting regional
responses to widespread stigma and discrimination and
better access to treatment and care. APN+ is the regional
network partner of the Global Network of People living
with HIV (GNP+) and works closely with other community
driven organisations like International Treatment
Preparedness Coalition (ITPC) to improve access to
treatments, care, support and lobby for equal representation
of PLHIV on all relevant decision making bodies. APN+
works alongside 30 country members represented by
national networks of PLHIV or smaller organisations of
PLHIV.
APN+ Steering Committee
Co-Chairs
Ms Mukti (Bangladesh)
Mr Sudin Sherchan (Nepal)
Treasurer
Mr Jun Hatori (Japan)
Members
Ms Jeanne Darc Truong (Vietnam)
Mr Denovan Abdullah (Indonesia)
APN+ Newsletter
Editorial working Group
John Rock
Naoko Kawana
Robert Baldwin
Andrew Tan
Shiba Phurailatpam
Sowat Borisuth
Lissa Giurissevich
Photography
Rico Gustav
Design & Layout
thaipublishing@gmail.com
Contact us
Asia Pacific Network of People Living with HIV/AIDS
51/2, 3rd
Floor, Ruam Rudee Building III
SOi Ruam Rudee, Ploenchit Road
Lumpini, Pathumwan, Bangkok
10330, Thailand
Phone: +66 2 255 7477
Fax: +66 2 343 9399
www.apnplus.org
apnplus.communication@gmail.com
The APN+ newsletter is kindly funded by UNAIDS
1
Monopoly exists when a specific individual or an enterprise has
sufficient control over a particular product or service to determine
significantly the terms, including pricings on which other individuals
shall have access to it.
2
A generic must contain the same active ingredients as the original
formulation. According to the U.S. Food and Drug Administration
(FDA), generic drugs are identical or within an acceptable bioequivalent
range to the brand name counterpart with respect to pharmacokinetic
and pharmacodynamic properties. By extension, therefore, generics
are considered (by the FDA) identical in dose, strength, route of
administration, safety, efficacy, and intended use.
3
WTO (1995) Agreement on Trade-Related Aspects of Intellectual
Property Rights.
4
Waning B, Diedrichson E, Moon S. A lifeline to treatment: the role of Indian
generic manufacturers. Journal of the International AIDS Society 2010, 13:35
5
See: Correa C. (2006) Implications of bilateral free trade agreements on access
to medicines. Bulletin World Health Organization 2006, 84(5):399-404
6
Waning B, Diedrichson E, Moon S. A lifeline to treatment: the role of Indian
generic manufacturers. Journal of the International AIDS Society 2010, 13:35.
Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2944814/
7
See EU-India FTA - Consultation draft on IPR chapter (Apr 2010) at http://
www.bilaterals.org/IMG/doc_23_April_2010_Preliminary_Consultation_
Draft_on_IPR_Chapter_of_EU_India_FTA.doc,
India-EU FTA: draft text on IPR (July 2010) at
http://www.bilaterals.org/IMG/pdf_ip_euindia_july2010.pdf and
EU-India FTA: proposed EU negotiating mandate on investment (2011) at
http://www.bilaterals.org/spip.php?article18960
New Delhi 2nd March, 2011
Bangkok, 2011
South Korea protest,
2 March 2011
2 • AUGUST 2011 www.apnplus.org • 3

3. i. Patent term extensions
beyond the 20 years required by
TRIPS. Such a requirement would
greatly delay the entry of generic
competition on medicines in the
market.
ii.Dataexclusivity.Currently,
when a generic manufacturer applies
to register a version of an already-
registered medicine, the drug
regulatory authority relies on the
efficacy and safety data provided
by the original manufacturer. If data
exclusivity protections are in place,
the only option for the generic
manufacturer would be to repeat
the clinical trials if it wants to be
approved or to wait for 5 – 11 years
before it can be registered and
reach patients. This is known as
data exclusivity and the high cost
of clinical trials means that generic
manufacturers would be prohibited
from producing and marketing the
drug during the data exclusivity
period. Data exclusivity applies
to patented and non-patented
medicines and in effect creates
a monopoly on even off-patent
medicines. In Jordan, after the
Jordan-US FTA brought in data
exclusivity, a study showed that
of the 103 new medicines on
the market, 79% had no generic
versions even though they
were off-patent because of
data exclusivity.8
Not only
does such a requirement
raise serious ethical concerns as
it requires repeat clinical trials on
human beings of a medicine that
has already been proved to be safe
and effective; it will further delay
the registration and production of
the generic medicines and gravely
undermine access to treatment.
iii. Border measures. During
the past decade, European customs
officials have repeatedly disrupted
or delayed shipments of generic
medicines in transit from India
to other non-EU countries (such
as shipments from India to Brazil
passing through European ports).
These types of border measures
also allowed EU customs authorities
to seize Indian-produced generic
ARVs en route to Africa. Through
border measures, international trade
in generic medicines can be blocked
by allowing custom authorities to
seize any medicines suspected of
infringing patents in the countries
through which they transit. The EU is
attempting to get other countries to
adopt similar customs rules through
FTAs and such provisions already
exist in the EU-South Korea FTA.
iv. Enforcement measures.
Courts and judges play an important
role in ensuring that patent claims
of companies do not undermine
access to medicines. Courts in
India have refused to prevent the
marketing of generic versions of
expensive patented medicines
simply because allegations of patent
infringement are made. Even if a
generic medicine infringes a patent,
judges can ask the generic company
to pay royalties to the patent holder
instead of stopping the cheaper
medicine from reaching patients.
So-called enforcement measures
change all this by requiring greater
powers for judges to stop generic
versions of patented medicines
from reaching patients. They also
allow patent holders to not only
sue generic companies but to drag
all actors in the manufacturing
and supply chain into court – from
manufacturers of machines and
packaging companies to pharmacies
that stock the generic medicines. By
creating a fear factor among all
other actors who work with generic
companies, such enforcement
measures can seriously hamper
the supply of generic medicines
and could even affect the work of
humanitarian agencies.
v. Investment. The EU wants
India to agree to include intellectual
property rights within the definition of
“investment”. If the EU is able to get
India to agree to this, multinational
pharmaceutical companies can then
file cases against the use of TRIPS-
flexibilities (such as compulsory
licensing including by alleging that
the process for the issue of
8
All costs, no benefits: how TRIPS-plus intellectual property rules in the US-Jordan FTA affect access to
medicines, Oxfam Briefing Paper, March 2007, available at http://www.oxfam.org.uk/resources/issues/health/
downloads/bp102_trips.pdf
Anand Grover, UN Special Rapporteur on
the Right to Health ,New Delhi 2011
Nepali protestors at the
Nepal -India Border - on
the way to Delhi
Indonesia, 2 March 2011
New Delhi protest 2nd March, 2011
4 • AUGUST 2011 www.apnplus.org • 5

4. the compulsory licenses does not
comply with TRIPS) or adoption
of other measures (such as price
control or regulatory controls of
the pharmaceutical industry) by the
Government of India on the ground
that it affects their “investment”. India
will then have to pay compensation
to these companies or refrain from
adopting measures to protect public
health and promote access to
medicines for all. These challenges
by multinational pharmaceutical
companies will not take place in
Indian courts and be subject to
public scrutiny – they will take place
in secret international arbitration
panels thus preserving the public
image of the company as their
actions are not revealed to people
living with HIV or the public.
The FTA that is currently being
negotiated between India and the
EU will strongly affect access to
antiretroviral medicines (ARVs)
and other life-saving medicines
(e.g. cancer medicines). This
agreement will impact access to
treatment not only for people in
India, but also for all patients living
in developing countries. In the
2000s, the competition of generic
drugs (mainly exported by India)
allowed the significant reduction
of the cost of HIV treatments, and
therefore millions of people to have
access to it.
The Case of the
TPPA
The Trans-Pacific Partnership
Agreement (TPPA) is currently
being negotiated between the United
States and several countries on
the Pacific Rim - Australia, Brunei,
Chile, Malaysia, New Zealand, Peru,
Singapore and Vietnam. The leaked
text from the U.S. proposals for the
intellectual property chapter show
that the US is likely to demand
the same provisions as the EU
such as patent term extension
and data exclusivity. However in
addition the US is asking for the
removal of pre-grant oppositions
to patent applications - a strategy
that has been used in India by
PLHIV groups to keep lamivudine/
zidovudine, nevirapine syrup and
tenofovir off patent in India. The US
also wants developing countries in
the TPPA negotiations to grant 20
year patents on old medicines if a
company makes small changes to it.
For example, in India a patent is not
permitted when a company takes an
existing medicine which is in tablet
form and makes it into a syrup. This
is called evergreening – a practice
by which multi- national companies
extend their patent monopolies
on old medicines by making small
changes to the medicine. But under
the US TPPA, Malaysia and Vietnam
will not be able to follow India’s
example. The TPPA provisions will
require countries to make changes to
their patent laws that will strengthen
intellectual property protections
and enforcement, and place new
restrictions on generic competition.
The TPPA poses as serious a threat
as the EU FTA. Activists in the
U.S., New Zealand, Vietnam and
Malaysia will continue to demand
accountability and transparency
around the TPPA negotiations.
Even if India is able to reject
the demands of the EU, if countries
that import medicines from India or
hope to make generic medicines
themselves, agree to these same
provisions in their own FTAs with the
US and EU, access to medicines in
their own countries will be seriously
undermined.
Where Patent
Laws and FTAs
Can Impact
Universal Access
On” Revolutionizing Pre-
vention, Getting to Zero
Infections”
9
KAP includes people who inject drugs(PWID), men who have sex with men (MSM), sex workers (SW),
spouses of PWID, MSM, and SW, and women.
10
http://www.nytimes.com/2011/05/13/health/research/13hiv.html?_r=1
11
http://aidsdatahub.ort/regional-profile/women-and-children#
12
http://aidsdatahub.org/regional-profile/women-and-children#
13
WHO/UNAIDS/UNICEF (2010) Towards Universal Access: Scaling up priority HIV/AIDS interventions in
the Health Sector
14
WHO/UNAIDS/UNICED (2010) Towards Universal Access: Scaling up priority HIV/AIDS interventions in
the Health Sector
• Access to bio-medical
interventions: While there is no silver
bullet for stopping the spread of HIV
and that comprehensive approaches
represent the best option for HIV
prevention, evidence *suggests
that the use of antiretroviral (ARV)
medicines as a prevention tool, also
known as pre-exposure prophylaxis,
has the potential to be a valuable
addition to the current set of available
interventions in addressing the risk
of HIV infections in key affected
populations (KAPs).9
• Treatment IS prevention: The
recentHPTN052study,whichshowed
early treatment can sharply reduce
the rate of HIV transmission by 96%,
further affirms the role of treatment
in prevention. As in the words of Dr.
Julio Montaner, a prominent global
HIV specialist said, “How much more
evidence do we need before we
implement what we know works?”10
• Scale up of prevention
of mother-to-child transmission
(PMTCT) programs: About 47% of
the women in East Asia and the
Pacific and 24% of women in South
Asia who needed ARVs for PMTCT
were receiving them in 2009, with
coverage for all low and middle-
income countries range from 15%
in 2005 to 53% in 2009.11
As of
2009, single-dose Nevirapine (NVP)
was the most common PMTCT
ARV regimen in India, Nepal and
Vietnam.12
Implementations of
HAART (the use of three ARVs)
based PMTCT regimens relay greatly
on access to potent and effective
ARVs.
• Access to future drug
pipelines, including an HIV vaccine.
On “Catalyzing treatment,
care and support, Getting to
Zero AIDS related Deaths”
• Expansion and delivery of
antiretroviral therapy (ART) programs
to adults and children: As of the end
of 2009, over 33 million people are
living with HIV around the world, it
is estimated that 14.6 million are in
need of ARV treatment. This number
is up from the 10.1 million people,
the estimate prior to WHO’s 2010
revision of ARV guidelines.13
In the
Asia Pacific region, approximately
2.07 million adults and children are
in need of ART as of the end of 2009.
Of which, only 44% of the children
and 30% of adults in the region in
need of ART were actually receiving
it.14
• This year governments
around the world committed to
getting 80% of those in need of
treatment on ARVs by 2015. An
estimated 18 million will be in need
of treatment by 2015. For those
currently on treatment many will
need newer medicines or “second”
line treatment. And the need for third
line treatment and salvage therapy
in developing countries will have
increased significantly.
• Access to hepatitis C
(HCV) treatment and other HIV-
related diseases: The World Health
Organization (WHO) reports that
people who inject drugs are most
at risk of HCV infection with the
prevalence of HCV ranging from
89% in Pakistan, 90% in Thailand,
92% in India and 98% in Indonesia.
Large proportions of those with
HCV are also co-infected with HIV.
Although hepatitis C is a treatable
and curable disease, the medicines
are prohibitively expensive and
out of the reach of the majority of
those infected resulting in poorer
quality of life and in many cases,
death from complications of liver
disease, particularly during HIV
treatment. The patents on HCV
treatment medicines held by two
pharmaceutical companies severely
limit access to treatment for those
who most need it.
• Access to future drug
pipelines, including HIV cure.
On “Human Rights and
Legal Environments”
• The right to health is
fundamental to human rights: The
2009 report of the UN Special
Rapporteur on the Right to Health
Malaysia protest, 2011
Cambodia
Indonesia Bangkok
CPN+ represent at the New Delhi protest on access to medicines
concluded:
The framework of
the right to health makes it
clear that medicines must
be available, accessible,
acceptable, and of good
quality to reach ailing
populations without
discrimination throughout
the world. As has been
evident, TRIPS and (free
trade agreements) have
had an adverse impact on
prices and availability of
medicines, making it difficult
for countries to comply with
their obligations to respect,
protect, and fulfill the right
to health.15
On “Increasing Sustain-
able Financing, National
Ownership and Capacity
for Improved Programmatic
Effectiveness”
• Effective use of the already
stretched funding resources such as
GFATM and PEPFAR: From 2003 to
2008, in HIV programs supported
by donor organizations like GFATM,
Indian generic drugs accounted for
more than 80% of the drugs used to
treat HIV, including 91% of pediatric
ARV products, and 89% of the adult
nucleoside and non-nucleoside
reverse transcriptase inhibitor (NRTI
and NNRTI) markets. India is also
the most important source of generic
drugs for cancer, heart disease, and
other disease and conditions.16
• Sustainability of ART
p r o g r a m m e s b y n a t i o n a l
governments: Studies have shown
that the cost of health spending
has drastically risen in developing
countries that have signed such
agreements in the past. A
study conducted by Oxfam
International indicated that
drug prices rose “drastically”
in Jordan after the Jordan-US
FTA, which included stronger
intellectual property protection
like data exclusivity, went into
effect in 2000.17
The increase in
medicine prices greatly threatens the
financial sustainability of government
public health programs.18
Similar
findings were found after the signing
of the Guatemala-US FTA.19
WHAT DOES IT ALL
MEAN?
Simply put, the manufacture, import
or export of life-saving generic
medicines must be protected.
Free Trade Agreements
jeopardize the right to health of
all people well beyond access to
treatment for people living with HIV.
If enacted, they will gravely restrict or
render useless the ability of national
governments to sustain public health
programmes and hinder progress
made thus far on addressing the
global HIV epidemic now and well
into the future.
15
Human Rights Council (2009) Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental
health, Anand Grover to the Human Rights Council, 11th session, A/HRC/11/12 31 March 2009
16
Waning B, Diedrichsen E, Moon S. A lifeline to treatment: the role of Indian generic manufacturers in supplying antiretroviral medicines to developing countries,
J Int AIDS Soc2010; 13:35
17
All costs, no benefits: how TRIPS-plus intellectual property rules in the US-Jordan FTA affect access to medicines, Oxfam Briefing Paper, March 2007, available
at http://www.oxfam.org.uk/resources/issues/health/downloads/bp102_trips.pdf
18
According to the Jordan 2005 National Health Strategy, the “rise in the pharmaceuticals bill” represents one of the main “challenges that face continuation of
health programmes and sustainability of funding for those programmes.”
19
Shaffer and Brenner, A Trade Agreement’s Impact on Access to Drugs, Health Affairs, 2009, available at http://www.cptech.org/ip/health/trade/cafta/msf022005.html
6 • AUGUST 2011 www.apnplus.org • 7

5. REGIONAL TREATMENT WORKING GROUP
Who we are & what do we intend
to do
In September 2010, APN+, International
Treatment Preparedness Coalition (ITPC),
Médecins Sans Frontières – Access
Campaign (MSF-Access), and TREAT Asia
established the Regional Treatment Working
Group. The goal of the new partnership
is to ensure the continual expansion of
quality HIV treatment care and services by
looking at strategies that best capitalise
on both individual and collective strengths,
knowledge, experiences and resources.
Key activities so far:
• Develop and
facilitate community
a d v o c a c y
c a m p a i g n s f o r
t h e c o u n t r y
adaptation and full
implementation of
the revised 2010
WHO Guidelines on
antiretroviral therapy
(ART) for adults
and adolescents,
preventionofmother
to child transmission
(PMTCT) and ART
for infants and children;
• Mobilize and campaign against
the foreseeable and damaging impacts
of free trade agreements (FTAs)
on access to affordable generic
medicines, including antiretroviral
medicines (ARVs) for people living with
HIV; and
• Promote and engage community
in the monitoring and evaluation
of treatment programs through the
development of community driven
monitoring indicators, data collection
and analysis.
The Treatment Working Group has
developed a number of publications
that aim to enhance community
understanding around issues
related to treatment quality and
access:
• Community-friendly factsheets
summarising the revised 2010 WHO
ART Guidelines for adults, adolescents
and PMTCT are available in English.
Translation into Mandarin Chinese,
Khmer, Nepalese, Vietnamese,
Bahasa Indonesian, and others will
be available shortly.
• An issue brief
which examines
the cross-cutting
i m p a c t s o f
prevention and
treatment scale
up, impending
threats of Free
Trade Agreements
( F T A ) t h a t g o
beyond the Doha
Declaration and
the World Trade
Organization’s
T r a d e - R e l a t e d
Aspect of Intellectual Property Rights
(TRIPS) Agreement and the reduction
in donor funding commitment to HIV
programs..
• A six-country survey on access to
PMTCT programs for positive women in
collaboration with Women of APN+ and
national networks of PLHIV. Results will
be available soon.
• Supporting the “Day of Action against
India-EU FTA” rally in Delhi, India, 2 March
2011.
Please contact the APN+ Secretariat
Office to learn more about the Treatment
Working Group.
O
ver fifty positive people from nine
Pacific countries and territories
participated in the historic Pacific
Positive People’s Gathering held in
Fiji in April 2011. The energy was
electric as people met and were motivated by peers
from other countries for the first time. The Gathering
fulfilled a long-expressed wish of APN+ and its
Pacific members, Igat Hope (PNG) and FJN+ (Fiji),
the two national networks in the Pacific to date, for
an opportunity to share experiences, along with
their peers from other parts of the Pacific, including
Kiribati, Samoa and Solomon Islands.
The President of Fiji, Ratu Epeli Nailatikau,
opened the Gathering with a stirring speech
indicatinghissupportforpositivepeopleandadeep
understanding of HIV and the issues surrounding
it. He talked about the importance of eliminating
stigmaanddiscriminationanddevelopingsupportive
legislation to achieve the equality others take for
granted.
Shiba, the Executive Director of APN+,
addressed some of the issues affecting PLHIV
throughout the Asia Pacific region, in particular the
role of APN+ in advocating for continuing availability
ofgenericARVsinthefaceofthreatsfromFreeTrade
Agreement negotiations.
Positive Pacific Islanders facilitated most
sessions which covered a broad range of topics.
Participants described the familiar range of feelings
on diagnosis including devastation, anger, loss
of hope, low self-esteem, fear of rejection, grief,
confusion, guilt, denial. Challenges in the Pacific
include geographical isolation, poor treatment
adherence, weak health systems with high staff
turnover, faith healing, and lack of meaningful
involvement of PLHIV.
Inoneoftheliveliestandemotionallypowerful
discussions on HIV and pregnancy, women spoke
of coercion in agreeing to tubal ligation. Many
women were sterilised, are now on ARV meds and
healthy, and want to have children but are unable
to. People also spoke about mandatory testing
of all pregnant women in public hospitals without
informed consent.
Genderinequalitywasraisedasaseriousissue
in the Pacific, where fear and silence surrounding
gender-basedviolenceisthenorm,leadingtodenial
of women’s rights. Transgender participants spoke
out about discrimination they face. A PNG delegate
talked of her work in sensitising the police; others
talked about dispelling stigma among health care
workers,developingworkplacepolicies,andbuilding
awareness in schools.
The issues of sustainability of ARV supplies
raisedthespiritofactivismaspeoplewerewarnedof
the limited second-line options in the Pacific and the
reliance on generic producers outside the region.
By the end of the week, participants clearly
wanted to continue regional networking to improve
collaboration and exchange information, including
in relation to ARV treatment and supplies. A Pacific
Positive Working Group was set up to help establish
a Pacific Positive Network with representation from
all Pacific countries, enabling PLHIV in the Pacific
to speak with one voice.
‘WalkwithMe.PositiveinthePacific’–areport
of the Pacific Positive People’s Gathering
[ John Rock, Susan Paxton ]
Condolence Message
APN+ would like to extend heartfelt condo-
lences to the family, friends, colleagues and
community of Nigel De Silva, who passed
away in December 2010 at Dardens Hospital
in Colombo, Sri Lanka. Nigel was an ex-
tremely enthusiastic, energetic and committed
activist who stood fierce in his position as
Lanka plus+ country representative to APN+.
Nigel will be long remembered for his tireless
efforts to uphold the rights and wellbeing of
positive people in his community, country and
across the region.
I
got a tip off that Ms Carla Bruni, first lady of
France and AIDS Ambassador was going to
visit the ART Centre at Safjardung Hospital in
New Delhi on December 6th 2010. With the
FTA negotiations happening between India
and the EU this was too good an opportunity
to miss.
That day I arrived at the ART Centre and as
predicted, the whole area was heavily guarded. I
found out that Ms Bruni was expected by 10:30
am, with no time to lose I took off my jacket as I
wanted the bright yellow DNP+ ‘HIV POSITIVE’
T shirt I was wearing to be noticed. We were
no sooner approached by the head of security,
followed by police who directed us downstairs to
register our attendance. We took the opportunity
into our own hands however, and made a move
toward the HIV testing desk.
We posed as patients registering to test for
HIV, and with registration card in hand we were
now eligible to wait in the 5th floor corridor – just
20 feet from the ART Centre. Once again the
police intervened by harassing for our test to be
prioritised over others waiting in the queue. We
resisted. I soon understood that some of the police
may have recognised my ‘HIV POSITIVE’ T-shirt
from recent anti India-EU FTA rallies outside the
Ministry of Commerce. They kept a close eye on
us as we waited to be tested, crazy as I’ve known
I am HIV positive for 17 years!
Later on, as I waited outside the post test
counselling centre, Ms Carla Bruni appeared
on the 5th floor and in no time the place was
crowded with people eager to catch a glimpse.
Ms Bruni was then escorted to Room 557 to
meet with senior hospital staff. With police and
security focused on her movements, we took a
chance to mix in with the crowd. Once she had
emerged and posed for a photograph, I forced
my way through the crowd until I was in front
of Ms Bruni. Even though someone caught my
shoulder and tried to pull me back, I stood firm
and said “Ms Carla Bruni, I am a person living
with HIV and work for Delhi Network of Positive
People, I will be obliged if you could please give
me two minutes of your valuable time.” “Yes, Yes,
sure” she replied. I wasted no time, and informed
her “Please help us - if the India-EU Free Trade
Agreement is signed with the strong intellectual
property rights component it will hamper the
production and supply of generic medicines
to India and other countries that rely on Indian
generic ARVs.” I continued “The agreement is
trading away our lives!!” She tried to calm me
down as she thought I was panicking. I could also
hear people mumbling “Oh No” and “How is he
here”. She assured me that she would personally
read through the documents and respond to this
matter. On the way back to DNP+ office, smiling
to myself I felt hopeful that giving my precious 5
ml blood would not be a waste in the end.
Vikas Ahuja tells his story
Vikas is president of the Delhi Network of Positive People (DNP+)
and works with ITPC South Asia
8 • AUGUST 2011 www.apnplus.org • 9

6. S
ince March 2009 APN+
has been implementing
the Positive Capacity
Development Initiative,
a p r o j e c t o f T h e
HIV Consortium, funded by the
Australian Government through
AusAID, and kindly auspiced by
AFAO (because APN+ is not an
Australian organisation). The year
July 2010 to June 2011 was
supposed to be the last year of
the project, however it has been
extended until June 2012. After
that the current HIV Consortium
model will end and AusAID will invite
proposals for a new mechanism,
and one which will include regional
organisations such as APN+. Such
an arrangement would complement
the work APN+ is doing in Capacity
Building, especially the Global Fund
project, and APN+ will work hard
to position itself to submit a good
quality proposal when the time
comes.
THE HIV CONSORTIUM
PROJECT
PAVING THE WAY
TO HCV TREATMENT
ACCESS
1
Walsh N, Higgs P, Crofts N. Recognition of hepatitis C virus co-infection in HIV-positive injecting drug
users in Asia. J Acquir Immune Defic Syndr 2007; 45(3): 363-5.
2
WHO HIV/AIDS Care and Treatment for People Who Inject Drugs in Asia and the Pacific: An Essential
Practice Guide, 2008, pg 39.
The Global Network of PLHIV
(GNP+), like APN+, has also
been conducting a strategic planning
process. This process commenced in
2010 with a review involving more
than 1,600 respondents, including a
consultation with the APN+ Board
in August facilitated by Rachel
and Robert (APN+ nominated
representatives to the GNP+ Board).
After many discussions, debates,
meetings and document drafting,
GNP+’s new Strategic Plan (2011-
2015) is about to be released. Included
in the Plan is an ongoing commitment
to guiding principles such as
GIPA, needs of all positive people,
transparency, accountability, evidence
based advocacy, human rights,
equity, gender equality, diversity, cost
effectiveness and sustainability.
The GNP+ Strategic Plan (2011-
2015) says “the mission of GNP+
is to improve the quality of life of
PLHIV. The vision is a powerful
united worldwide social movement of
PLHIV, with PLHIV leadership and
voices at the centre of the response to
the HIV pandemic.”
Goal: Equitable access to health and
social services for PLHIV by focusing
on social justice, PLHIV rights and
PLHIV involvement
Purpose: Greater and more
meaningful involvement of PLHIV in
program and policy development as it
relates to PLHIV.
The GNP+ Strategic Plan (2011-2015)
has three strategic objectives:
Global Advocacy: to influence
policies, programs and services
relevant for PLHIV;
Global Knowledge Management:
to generate, analyze and disseminate
strategic information for programming
on advocacy and network
strengthening;
Global PLHIV Community
Development: to engage, consult, and
support PLHIV and their networks.
The GNP+ Board is now working
hard on creating implementation
plans based on these new strategic
objectives; including developing an
advocacy agenda and the restructuring
of the Board to better reflect the
diversity of all positive people and
their needs. Check out www.gnpplus.
net for the release of GNP+’s new
Strategic Plan (2011-2015).
Enquiries welcome to:
Shiba: shiba@apnplus.org , Rachel: rachel.ong.gfatm@gmail.com or
Robert: tuntablecreek@bigpond.com
STRATEGIC PLAN
2011-2015
myPlus - a network
for People living
with HIV/AIDS in
Malaysia is now an
officially registered
organisation! On the 17th of April
2011, myPlus held its first Annual
General Meeting (AGM) where its
ExCO was elected by more than 70
representatives of the community
who were present.
For the next two years, myPlus
will be led by its President - Andrew
Tan assisted by a team of 9 ExCO
members, who represent the many
affected communities in Malaysia –
Transgender, IDU, Women, Men,
Parents of Infected Children and
MSM. Each of them brings a wealth
of experience, knowledge and skills
in uniting the voices of PLHIV in
Malaysia.
Preceding the AGM, myPlus
organised a two-day workshop for
the community. Nearly all 14 states
of Malaysia were represented, and
the workshop titled ‘Advocacy and
- a Malaysian Positive
Network
I
n the Asia Pacific region it is
estimated that 750,000 injecting
drug users (IDU) are living with
HIV/AIDS.1
It is further estimated
that 60%-90% of IDU living with
HIV/AIDS in Asia are also co-infected
with hepatitis C virus (HCV).2
The
numbers underestimate the actual
scale of HIV/HCV co-infection,
and this is further complicated by
the many legal, social and other
barriers that often isolate IDUs from
accessing health care.
Positive networks and
other community groups in India,
Indonesia, China, Nepal, Thailand
and Vietnam have been paving the
way by leading advocacy campaigns
that include; community mobilisation
for expanded research on HIV/HCV
co-infection in the region, access
to affordable HCV treatment and
Meanwhile plans are being
developed for the last year of
the current model (July 2011
to June 2012). The funding is
restricted to certain AusAID focus
countries: Vietnam, Lao, Cambodia,
Indonesia, Myanmar, Timor Leste,
Yunnan and Guanxi provinces of
China, and the Pacific. There is also
a component that funds Capacity
Building within the Secretariat. The
activities are varied and respond to
needs identified by PLHIV networks
in each country. They include
work around establishment and
institutional strengthening of PLHIV
groups and networks, reaching
into provincial or more remote
areas not yet covered, working
with positive MSM and women’s
groups, and public speaking. The
recent Positive People of the Pacific
Gathering would not have been
possible without HIV Consortium
funding.
TheAPN+projectiswellvalued
and respected within the HIV
Consortium which comprises
nine members of Australian
NGOs working in HIV. The
Review of the APN+ Strategic
Plan 2006-2010 that took
place at the 2010 APN+ AGM
also showed that there was a
hugecapacityincreaseamong
positivenetworksinconsortium
project countries. Assuring the
requiredAustraliancomponent,
the project is implemented
by three Australian Advisors,
Susan,RobertandJohnunder
the overall management of
Shiba and at the direction of
the Steering Committee.
testing, production of generic HCV
treatment (e.g. pegylated interferon), and
the inclusion of HCV treatment on the
WHO essential medicines list. ANPUD
is also conducting an assessment in four
countries: India, Indonesia, Malaysia
and Nepal to identify challenges faced
by people who use drugs in accessing
HCV testing and treatment.
Advocacy strategies include
increased community mobilisation to
address HCV literacy, securing meetings
with key government ministries and UN
agencies to raise more awareness
about the real implications of patent
laws and applying pressure for the
development of national HIV/HCV
treatment guidelines.
Contact us to find out more about
our work on HIV/HCV co-infection
Network Strengthening’ focused
on Building Capacity of all the
participants. The workshop also had
the honour of hosting representatives
from Indonesian counterparts -
Spiritia Foundation and JOTHI
who shared their experiences of
initiating and mobilising grassroots
organisations. The workshop
concluded with participants mapping
out programmatic strengths and
gaps as well as service provisions in
their respective states. These results
will form the framework for the ExCO
to work on in the next two years
of service, in addition to continual
feedback from each state’s focal
points.
The ExCO of myPlus is grateful
for the honour and trust invested
in them by the PLHIV community
in Malaysia, as well as the many
parties who were instrumental in
assisting them to be recognised as
a legal entity - namely the Malaysian
AIDS Council, the Malaysian Ministry
of Health, the local United Nations
Theme Group on HIV, UNAIDS,
APN+ and the Coalition of Asia
Pacific Regional Network on HIV/
AIDS (Seven Sisters).
[ Shalina Azhar and Andrew Tan ]
10 • AUGUST 2011 www.apnplus.org • 11

7. T
he APN+ Strategic Plan (2006-2010)
Review process commenced in mid-
2010 and was structured around the
five strategic objectives (advocacy,
network capacity building, growing
the network, knowledge sharing and Secretariat
capacity building) as described in our current
Strategic Plan. We looked at overall progress
made, key successes, key limitations/challenges,
and future opportunities in relation to each
strategic objective. The Review process included
consultations with APN+ Board Members and
A
s presented at the AIDS 2010
Conference in Vienna, Austria,
there is increased interest
in the possible correlation
between HIV and aging. Most
of the current research, however, focuses
on the perspectives of biomedicine rather
than the quality of life of people living with
HIV. Furthermore, as most studies have
so far been in the Western context, little
is known about the lived experience of
living longer with HIV in the Asia Pacific
region.
To fill this gap, APN+ is proposing to
embark on a research project to provide a
broad view of living longer with HIV. With
the key objective of raising awareness
of living longer with HIV (10+ years), we
intend to capture stories and identify
issues from the perspective of positive
people while balancing between the
understanding of social, psychological
impacts and physical, clinical effects of
HIV. The proposed study will adopt a
flexible study design in order to cover all
positive people from different constituency
groups (for example, women, MSM, drug
users). We hope the study will provide a
platform to address emerging issues while
responding to current research findings.
Designed and coordinated by
APN+, the study will be implemented
in collaboration with country-member
networks. Tangible outcomes of the
study are to provide a positive response
on the topic in the Asia Pacific and key
findings will be used to develop regional
and national advocacy action plans.
STRATEGIC
PLANNING
for a better future
Secretariat, interviews with APN+ Advisors, key
people linked to APN+ and representatives from
partner organisations.
The Review confirmed the current
relevance of our five strategic objectives and
their interconnectedness, especially the need
for continuing capacity building of our member
national networks, lead individuals and the
Secretariat. The review also allowed us to see
a way forward in regards to preparing our next
strategic plan. The Review Report is now available
at www.apnplus.org, including a translatable
version of the Summary, please have a look
now!
The rest of 2011 will allow us time to
consider the review findings and move forward the
process for the development of our next Strategic
Plan, including a consultation with the Board at
our Annual General Meeting in October 2011. The
APN+ Strategic Plan Working Group (SPWG) will
now guide and drive this process. Members of the
SPWG include some of our Steering Committee,
our Executive Director, Staff, Advisors and an
external expert.
The APN+ Strategic Planning processes link
in nicely with the Global Network of PLHIV (GNP+)
Strategic Planning which is also happening now
(see separate article in this Newsletter).
All enquiries welcome to:
Shiba shiba@apnplus.org or Robert tuntablecreek@bigpond.com
LIVING LONGER
WITH HIV: A proposed
research study by
positive people in the
Asia Pacific [ Martin Choo and Rachel Ong ]
12 • AUGUST 2011 www.apnplus.org • 13

8. A
PN+ Women’s working group
continue to mobilise and develop
the capacity of positive women in
the Asia Pacific region, WAPN+
organised a number of in-country
training forums in Indonesia, Vietnam, Cambodia
and China in addition to a regional Treatment
A
PN+ positive MSM working group
launched its Young Positive MSM
Leadership development program
in early 2011. The program is
designed to run for two years
and seeks to mobilise and build the capacity
of potential leaders among young positive
MSM communities in the Greater Mekong Sub
Region.
I
n early 2010, national network members
from 11 countries decided to submit a
multi country proposal to the Global Fund
(GF) Round 10. The submission came
about as a result of positive networks’
consistent experience of being unacceptably
under resourced. Without core funding to
support what we know will make a difference
on the ground, it is near impossible for PLHIV
to actively and meaningfully participate in
service delivery, represent community, and
grow individual and organisational capacity.
Between March and June 2010, the
11 countries worked consistently to design
country level activities to fill existing service
gaps. Before final submission, three countries
voluntarily withdrew as a result of challenges
they faced while trying to obtain endorsement
of the proposal with the country CCM. One
country voluntarily withdrew for other reasons.
The final submission included 7 countries, and
although we have achieved a small victory, it
is regretful that 90% of the original proposal
was cut. Despite this, APN+ and country
networks adapted the proposal to focus on
activities that support our collective advocacy
agenda.
The grant involves two activities. The
first is to establish a ‘Regional Treatment
Database’ in response to widespread
community sentiment about current HIV M&E
systems. Many AIDS activists feel that M&E
systems do not accurately capture information
about what PLHIV are really facing at the grass
roots level.
Evidence generated from the first
activity leads into the second activity ‘The
Asia-Pacific Treatment & Prevention Forum’.
The round table forum will provide a regional
platform to share experiences and collaborate
on a set of coordinated action plans. It will also
provide opportunities for advocacy & resource
Update
Global Fund Round 10
Literacy and Advocacy Training and Regional
Program Review Meeting in Bangkok. The
in-country training focused on organisational
development, positive speaking and networking
among key positive women identified through the
women’s network in each country. A treatment
dissemination forum was conducted with key
positive women and local stakeholders in 6
countries to highlight findings of the report “A
Long Walk”.
WAPN+ has also undertaken a research
project as part of the current Ford Foundation
work plan. In partnership with the Regional
Treatment Working Group (APN+, ITPC,
TREAT Asia & MSF), country networks have
been involved in conducting quantitative and
qualitative surveys funded by UNAIDS-RST
titled “Improving access to Reproductive and
Maternal Health Care and Services for women
living with HIV” in 6 countries – Bangladesh,
Cambodia, India, Indonesia, Nepal and Vietnam.
The objective of the survey is to understand the
experience of positive women and girls (from
the age of 16 onwards) when accessing health
care services, and in particular during pregnancy.
The results will provide strong evidence and
recommendations to governments, UN agencies,
medics, and other health care providers.
To continue to thrive as the positive
women’s network, WAPN+ will seek to secure
future core funding in order to be able to carry
out its vision to empower more women living with
HIV and to establish a pool of positive women
leaders at both country and regional levels.
Focus areas include: concentrating on CEDAW
and positive women’s rights, ensuring that more
programs and activities are aligned to support
the mobilisation of positive women in rural areas
and to increase support for women’s networks in
country to educate positive women about sexual
and reproductive health issues and maternal child
care services.
mobilisation by facilitating communication
between PLHIV groups, multilateral agencies,
governments and other major stakeholders.
APN+ aims to enter grant signing in
September and start implementing the activities
from October 2011. APN+ will act as principle
recipient and national PLHIV networks in
Bangladesh, Indonesia, Laos, Nepal, Pakistan,
Philippines and Vietnam will act as implementing
entities.
Update
at which point we will develop the 2012-2015
working group plan.
ThepositiveMSMWGhasalsosubmitted
two regional abstracts to ICAAP X in Busan,
SouthKorea:wewillpresentthetencountryFGD
research and another on regional community
research experiences. The working group also
assisted three country level networks with their
abstracts based on the APN+ positive MSM
access to treatment research.
The program will look at building a network
of young leaders to become national and
regional level advocates and activists. Strategies
will include capacity building and skill building
training sessions, in country internship programs,
participation at regional and international meetings
and conferences, mentoring, coaching and a
model of field visits to encourage cross learning.
The first training took place June 2011.
Part one of our ten country focus group
discussion research report has been finalised
for stakeholders, and is available on the APN+
website. The second part is a series of fact
sheets to support community advocacy. Research
findings will be disseminated in all ten countries in
the near future.
In 2011 we are finalising research which
looks at access to treatment for positive MSM
in China. This will build upon APN+ research
investigating treatment access conducted in
India, Indonesia, Myanmar, Malaysia, Nepal and
Singapore in 2009. Our annual positive MSM core
working group will meet face-to-face in late 2011,
14 • AUGUST 2011 www.apnplus.org • 15

9. Your voice counts!
We welcome stories from your own network, letters and other feedback. If you have comments,
suggestions, photos or inquiries, please send to us apnplus.communication@gmail.com
“My idea of a better
ordered world is one
in which medical
discoveries would be
free of patents and
there would be no
profiteering from life
or death”
•
Indira Ghandi, Prime Minister of India,
at the World Health Assembly,
Geneva, 1981