This paper, intended as a resource for parliamentarians, is the result of long-standing, close collaboration between the Inter-Parliamentary Union (IPU) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). IPU and UNAIDS hope it will inspire and help parliaments and parliamentarians everywhere take strong political leadership and fully exercise their legislative, budgetary and oversight powers to end the AIDS epidemic in their communities and countries.
The information and case studies provided in publication indicate the range of practical measures that can be taken to accelerate greater access to HIV treatment. To recap the main points:
- Countries can help to end AIDS as a public health threat by 2030 by rapidly scaling up HIV testing and treatment and meeting the 90-90-90 targets of the Fast-Track approach. Achieving the targets requires a series of detailed actions, and parliamentarians can play a central role.
- As legislators, parliamentarians can take action to ensure laws are in place that guarantee access to essential medicines and good-quality treatment and care services, and that protect people living with HIV from discrimination. Issues connected with intellectual property rights have been highlighted as an area requiring particular consideration, given the impact pharmaceutical patents can have on the affordability of HIV treatments. Parliamentarians are urged to familiarize themselves with TRIPS flexibilities, such as compulsory licensing and parallel importing, and to review intellectual property laws to ensure those flexibilities are used. Parliamentarians can also support laws that provide a framework for sustainable financing, for example through trust funds, levies and the inclusion of HIV treatments under universal health coverage schemes.
- In overseeing national programmes, parliamentarians can ensure that treatment programmes are comprehensive, addressing the needs of women, children and all key populations. The complex care needs of children, often overlooked, require particular attention. Parliamentarians should actively reach out to people living with HIV to help inform the response, eliciting their views on ways to expand treatment access. These could include new, more accessible approaches to HIV testing and treatment at the community level, greater involvement of nurses and pharmacies, and integration of HIV services with other health services.
- In their budget oversight role, parliamentarians can advocate sustainable mechanisms for funding HIV treatment. Governments should avoid excessive dependence on international donors, identifying instead where domestic sources can be developed to sustain HIV programmes. Parliamentarians can urge governments to systematically analyse future HIV treatment costs, to plan for sustainability and to consider options for 52 innovative domestic financing and for social health insurance coverage of HIV costs. To help sustain health budgets, parliamentarians can highlight the significant savings that can be achieved by expanding access to generic medicines.
- As representatives and opinion leaders, parliamentarians need to gather first-hand knowledge from people living with HIV and healthcare workers about the challenges faced in implementing treatment programmes. Informed by these perspectives, they can publicly champion improved access. They can highlight the particular challenges faced by women, children and key populations and challenge fears, myths and misconceptions about AIDS. They can insist that responses be based on medical science and evidence, rather than ill-informed prejudices. And they can raise government and community awareness about the impact of intellectual property rights on the cost of treatments and ways to make treatments more affordable.
HIV remains one of the most profound health and development challenges of our time. Thankfully, we now have the tools to bring this global epidemic to an end. Recent advances in the efficacy of HIV treatments and a better understanding of how treatment also contributes to prevention can bring an AIDS-free generation finally within reach. Critical to success, however, will be an acceleration in the expansion of treatment access to all in need – ensuring no one is left behind. Parliamentarians can help make that a reality.