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AIDS 2006; Toronto, Canada; August 13-18, 2006

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The Body Covers: The XVI International AIDS Conference
XVI International AIDS Conference: An Interview With Mark Milano

August 18, 2006

Listen (5MB MP3, 14 min.)
This is Bonnie Goldman. I'm here at the International AIDS Conference with Mark Milano, who's a long-time AIDS activist. He's going to recap some of the actions that happened at this conference because he was, I think, involved in most of them. Mark, tell me a little bit about what you did here, and why.

Mark Milano
Well, we had a number of different targets, as we always do at AIDS conferences. In terms of the pharmaceutical industry, the major target clearly was Abbott. Abbott had reserved the space for a booth where all the companies have their big, fancy booths, and then never showed up. So apparently they were pretty frightened of being targeted by activists and didn't put a booth up. A number of groups, including ACT UP Paris and Health GAP took over their space and created our own booth, and sold t-shirts and had activists' meetings, and said basically, "Abbott, where are you?" We put up a banner, saying, "ACT UP. Your booth is empty like your promises." We were there [in the booth] for a couple days, just hanging out and having our own activists' booth right next to all the drug companies.

Then we disrupted their [Abbott's] satellite meeting. They had a satellite conference. As it began, about 50 of us [activists] took the stage and made a number of demands. Abbott, as you may know, has a history as one of the most greedy drug companies of all the drug companies, from the initial lottery they held for Norvir [ritonavir] in '95, where they only had enough drug for 1,000 people. But two months later, they got early approval and had drug for anybody who could pay for it; to the horrible Norvir price hike. They quintupled the price in 2003, just because they felt like it. And they refused pressure from all corners; refused to lower their price. The current issue is that they have, as you know, a new form of Kaletra [lopinavir/ritonavir] that is heat stable.

When you say heat stable, what do you mean?

It doesn't need to be refrigerated. And the old version, if it goes above a certain temperature -- I think it's in the 70s [degrees Farenheit] -- it can destabilize. So the new version doesn't need refrigeration, and it's very important in developing nations, many of which are in tropical climates. [Abbott is] refusing to register that in many countries. Where they have registered it, they are charging a price that is exorbitantly expensive and they are refusing to share the technology on how to make that new version with generic manufacturers. Many groups, from ACT UP to Health GAP, to the Clinton health initiative, are asking Abbott to make this technology available to people.

In general, the problem in the developing nations is that, in some areas, the price of combination therapy for HIV has dropped to as low as $130 [a year]. Now you know, here in the U.S., we pay sometimes $15,000 a year for that. So you can see what level of that price is mark-up. It's -- what is that? Ten thousand percent? I don't know. But it's a huge percent. So we have these cheap regimens, $130 a year. But if you fail first-line therapy and need to move to second-line therapy, the price goes up ten times.

In the developing world.

In the developing world -- to $1,500 [a year]. And so we need companies like Abbott to either lower these prices themselves, or license the drug to manufacturers so they can make it cheaper, or share the technology to allow generic competition.

So we took the stage and read these demands -- [and] also a demand for dropping the price of Norvir. The problem was that Abbott refused to allow any media to enter the session. So it's the first time, I think, in the history of AIDS conferences where the media was blocked from reporting on a session at the AIDS conference. And we were quite shocked by that.

Another important issue that we had actions about was the so-called free trade agreements [FTAs] that the Bush administration is pushing. The U.S. government, in 2001, agreed to a series of talks with the World Trade Organization that would allow developing countries to manufacture or import generic medications if there was a need for them, and they could not afford them.

This was all worked out, and the U.S. signed it to great fanfare. It was a great victory for us, that these poor countries could now access generic versions of the drugs.

Immediately, the U.S. government began secretly going behind the scenes and negotiating one-on-one with countries free trade agreements, and those agreements pretty much remove that ability to import or make generic medications. You have all these stipulations you have to do. And it virtually makes it impossible for new drugs to be made available generically in these countries.

So what does that mean, for instance, in Thailand? What was the manifestation of that on a patient level?

On a patient level, it means that the drugs that are older drugs are going to be [available] -- Thailand has a great program where they make antiretrovirals at a very cheap cost, and make them available to many of their citizens. So those drugs remain available. But newer drugs -- and as new drugs are developed -- they [developing countries] will not be allowed to access those drugs for, say, 20 years. The company will have a monopoly on those drugs. Which means that, once again, if you fail first-line therapy -- and how many people with HIV do you know who have failed first-line therapy -- there will be no option, because the country will not be able to make them themselves, and the drug companies will not lower the price to a level where it can be afforded.

So if these free trade agreements -- they have gone through in some areas already -- if they go through in the current ones, the one in Thailand is pending; there's one in South Korea that is pending; one in Malaysia. There are a number of them pending. They add these extra requirements that will make it virtually impossible for newer medications to be made available at a cheap price.

India has been the main supplier of antiretrovirals to the developing world, and [the] main supplier of generic medications for the developing world, because they didn't recognize international patents. As you may know, from the U.S. there was a tremendous amount of pressure, and as of 2005, they [India] had begun recognizing patents. Luckily, when the law was passed, activists got loopholes in the law that allows them to fight these patents. For example, AZT [known generically as zidovudine, brand name: Retrovir], 3TC [known generically as lamivudine, brand name: Epivir], are not patented in India because they were before this law was signed. But GSK [GlaxoSmithKline] wanted to patent Combivir in India, but the only thing they could patent was not the two drugs, but the way they combine them. Well, the activists said, well, you're basically using silicone to combine them -- which is basically sand -- so you're asking for a patent on sand. And they got Glaxo to withdraw that patent application. If they had [not], all the generic versions of Combivir that were made in India would have been off the market, and you would have only had GSK Combivir, which you know nobody could afford.

So they are taking these tactics, going one by one, trying to get around these agreements and we have to put out each fire individually, in each country, to make sure these FTAs either are blocked or are rewritten to avoid adding extra burdens for medicines. And, as you know, free trade agreements in general pretty much usually don't help poor people. They help the rich corporations. So there is a call out for a moratorium on all FTAs until we can really look at them and find out how to make them help people, rather than hurt people.

Another major issue we're working on ...

Before you continue ... which groups are working on the free trade agreement issue around the world? If somebody wants to help, who could they call? Or what group can they join?

I think the best place to start is with Health GAP. Go to and there's a lot of information there, and contacts, from that point to move forward, as to who to talk to. A lot of good information about what FTAs are, and I think that's the best starting point.

The other issue really we're focusing on [is] the lack of trained health care workers [in the developing world]. One of the real problems is that now that we finally are beginning to see some access to medicine -- not nearly enough, but it's starting -- we need health care workers to administer this medication. And unfortunately, rich countries are really sapping health care workers from a lot of nations, because they [the health care workers] can make a lot more money [working in developed countries]. As you know, many Filipino nurses come to the U.S. because they speak English well, and they make more money here.

So there's an incredible drain of health care workers from these nations to the rich nations. So we're saying that we need funding to train local health care workers, and to maintain local health care workers. And not to send -- there's a bill in Congress now that they would send American doctors [to developing countries] for a couple of years. That isn't the solution. The solution is to develop local health care workers who know the culture, who know the country, and who stay there and can administer not only HIV medications, but other medications.

You don't want to also be moving workers out of other health care clinics into the HIV clinics, and having no health care for people without HIV. So it's a very important balance. The main thing is that we need more funding for more local health care workers. That was a very critical issue at the conference.

Two things: Who do you expect to provide the funding? And then, the second question: Who's working on that issue?

ACT UP is working on the issue. Health GAP is working on the issue. The American Medical Students Association is working on the issue. Right now we are pushing for U.S. funding for this, and there has been some interest from the Administration in this issue. So we are hoping that we can -- I believe Mrs. Bush, [First Lady] Laura Bush, is interested in this issue. There is a bill in Congress that, if it can be modified, the Durban bill; if it can be modified it would be a good bill. So we're going to be focusing on the Administration and on Congress to try to get funding for these local health care workers.

What were people's reactions to your protests, as you went through the hall?

As is usual at the AIDS Conferences, people applaud, people cheer. Sometimes they are confused, but generally, they are pretty happy. We did a great action where we marched through the conference looking for Abbott. And because they had no booth, they really were not present unless you knew where to find them. So we were searching for Abbott. And ACT UP Paris came up with a song, based on the Spiderman theme: [singing to the tune of Spiderman] "Abbott guy, Abbott, guy. Where is the Abbott guy?" So we were singing the Abbott Guy song as we marched through the conference. And people love that stuff. That's great.

For the FTA action we had an activist dressed as Uncle Sam with a machine gun, and he was sticking up various countries and forcing them to sign free trade agreements against their will. So we did some good theater.

The problem is that we would wish more delegates would join with us as we march through. They tend to kind of want to watch and stand back, and just observe, rather than join. But sometimes they do join in. Generally, the response has been good, as long as ... if we shut down a session, people get angry. But if we take the stage and make our point and don't actually prevent the flow of information, people usually are supportive. So we got, generally, I think, a positive response. And the conference has been, as most conferences [are], pretty accepting of demonstrations.

Did you demonstrate on the streets of Toronto at all?

There was a demonstration because the current prime minister of Canada [Stephen Harper] has closed down the only needle exchange -- the only safe injection site -- in Canada; and is working against needle exchange programs. So there was a major action on the street with that. There was also an action at the Chinese consulate -- don't quote me on that.

The American consulate, I think.

Was it the American consulate? And that was from Housing Works?

Yes, and CHAMP [The Community HIV/AIDS Mobilization Project].

And CHAMP, yes. I would talk to them, because I wasn't really involved in that action. They were planning on risking arrest there, but they actually agreed to come down and meet with them and accept letters. So there was no arrest.

You mean the people at the American consulate?

Yes. The police actually negotiated that they would actually come down and meet with them. So that was surprising. Trust me; New York police would never negotiate anything like that. So Toronto police were a little more helpful than New York police.

I heard there was something with [U.S. National Institute of Allery and Infectious Diseases Director] Tony Fauci?

Yes, there was.

About testing? Universal testing?

Yeah, and I wasn't there.

OK. Well, thank you.

Got comments? Want to get involved? Click here to e-mail Mark Milano.

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