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Multi-Class Immune-Based Therap I Es Co Combination Drugs AZ T m- IMMUNE-BASED THERAP o /R) c VIR, A LPV ) MULTI-CLASSA NFV VIR, A S T N (INDIN COMBINATION DRUGSA VIR, REZIST AZ R 754) P A ) AVX C + Inhibitors Protease RTV VIR/RITON ) CRIXIV AB A OM (KIVEXA, COMBIVIR (ZIDOVUDINE + LAMIVUDINE, AZT + 3TC) EMTRIVA Protease754, Inhibitors C VIR, (EMTRICITABINE, FTC) EPIVIR (LAMIVUDINE, 3TC) EPZICOM (KIVEXA, TPV T A PZI HE EPT (NELFIN SPD OVIR DISOPROXIL ABACAVIR + LAMIVUDINE, ABC + 3TC) RETROVIR (ZIDOVUDINE, AZT, E HIBITO F VIR, , LOPIN ZDV) TRIZIVIR (ABACAVIR + ZIDOVUDINE + LAMIVUDINE, ABC + AC A A S IR N IN TRUGGLE FOR AZT + 3TC) TRUVADA (TENOFOVIR DF + EMTRICITABINE, TDF + V ENO A ) T ABINE ( ABINE FTC) VIDEX & VIDEX EC (DIDANOSINE, DDI) VIREAD (TENOFOVIR T TV I THE (ALUVI C DISOPROXIL FUMARATE, TDF) ZERIT (STAVUDINE, D4T) ZIAGEN A (ABACAVIR, ABC) RACIVIR (RCV) AMDOXOVIR (AMDX, DAPD) ORVIR (RITON N PRI VIR, A ) IREAD ( A A V APRICITABINE (SPD754, AVX754)ELVUCITABINE (ACH- TORS ) LETR N ) A I 126,443, BETA-L-FD4C) COMBIVIR (ZIDOVUDINE + FPV A Z I LAMIVUDINE, AZT + 3TC) EMTRIVA (EMTRICITABINE, ) K A ) APTIVUS (TIPR DAPD T VIR, IPTASE IPTASE , A FTC) EPIVIR (LAMIVUDINE, 3TC) EPZICOM (KIVEXA, A PV A SQV CCESS TO ABACAVIR + LAMIVUDINE, ABC + 3TC) RETROVIR R Z ( PIVIR (LAMIVUDINE, 3TC) B A This book documents the struggle that has been faced by those E (ZIDOVUDINE, AZT, ZDV) TRIZIVIR (ABACAVIR + T AMDX VIR, VIR, A A A I STRUGGLEA requiring treatment for HIV/AIDS in India, and those affected ZIDOVUDINE + LAMIVUDINE, ABC + AZT + 3TC) MPREN AVIR + ZIDOVUDINE + LAMIVUDINE, SC EY A C TRUVADA (TENOFOVIR DF + EMTRICITABINE, by HIV/AIDS, since the first recorded incidence of HIV/AIDS in FOR R N ) TDF + FTC) VIDEX & VIDEX EC (DIDANOSINE, QUIN India in 1986. This struggle has been shaped by legal judgments, A T C (DIDANOSINE, DD MPREN A DDI) VIREAD (TENOFOVIR DISOPROXIL E REATMENT FOR REATMENT DRV developments and discussions, which are fully documented in A ABINE, FTC) VI (DELAV INTELENCE (ETRAV MDOXOVIR ( MDOXOVIR FUMARATE, TDF) ZERIT (STAVUDINE, T SE (S I A this book, including the seminal Voluntary Health Association of RA A ) SE ( C ELZIR, FOS ACCESSD4T) ZIAGEN (ABA CTOAVIR, ABC) RATREATMENTCIVIR VIR, V IDEX A T TR M A Punjab case brought in the Indian Supreme Court in 2003, which RI C V (RCV) AMDOXOVIR (AMDX, DAPD) ( T UNE (NEV R A I NVIR ) TRIZIVIR (ABA RD continues today to act as a vehicle through which voices in civil APRICITABINE (SPD754, AVX754) I RUN ) FOR HIV/AIDS A society can shape the Government’s policy on access to HIV/ I NE, ELVUCITABINE (ACH-126,443, EXIV SE ZDV IVIR ( IVIR AGENER IDV L (D C AIDS treatment. IDEX & BETA-L-FD4C) COMBIVIR T, A V R DLV RIVA (EM I R (ZIDOVUDINE + LAMIVUDINE, AZT + RAP T AZ IN INDIA C) M (FUS INH ENTRY 3TC) EMTRIVA (EMTRICITABINE, FTC) I ) HI R E S I I NE, AB EPIVIR (LAMIVUDINE, 3TC) EPZICOM NE, UST V/ (KIVEXA, ABACAVIR + LAMIVUDINE, F + FTC) NVP AIDS RIVA T I VA ( T D ABC + 3TC) RETROVIR (ZIDOVUDINE, AZT, M AVIR, M C C ZDV) TRIZIVIR (ABACAVIR + ZIDOVUDINE + ) E -125) I S RI IN TOCR LAMIVUDINE, ABC + AZT + 3TC) TRUVADA ON INH LP (TENOFOVIR DF + EMTRICITABINE, TDF + I I V ABINE, T NDIA R I T I R I FTC) VIDEX & VIDEX EC (DIDANOSINE, DDI) ESCR Dipika Jain & Rachel Stephens N, EFAV ROVIR (ZIDOVUDINE, I C NE ( T + 3TC) T IAGEN (ABA IAGEN VIREAD (TENOFOVIR DISOPROXIL FUMARATE, RI E Z T AZ R TDF) ZERIT (STAVUDINE, D4T) ZIAGEN (ABACAVIR, I T PTOR ABC) RACIVIR (RCV) AMDOXOVIR (AMDX, DAPD) M I RENZ, APRICITABINE (SPD754, AVX754)ELVUCITABINE (ACH- C -278) I I F + EM 126,443, BETA-L-FD4C) COMBIVIR (ZIDOVUDINE + B D I C + 3TC) LAMIVUDINE, AZT + 3TC) EMTRIVA (EMTRICITABINE, FTC) ES EFV B EPIVIR (LAMIVUDINE, 3TC) EPZICOM (KIVEXA, ABACAVIR I AB TORS TORS AVUDINE, D4T) AVUDINE, ) OVIR T + LAMIVUDINE, ABC + 3TC) RETROVIR (ZIDOVUDINE, AZT, I HUMAN RIGHTS LAW NETWORK F TORS) A division of Socio Legal Information Centre (S ZDV) TRIZIVIR (ABACAVIR + ZIDOVUDINE + LAMIVUDINE, ABC T 576, Masjid Road, Jangpura ENO + AZT + 3TC) TRUVADA (TENOFOVIR DF + EMTRICITABINE, TDF T ERI New Delhi – 110014, India Z + FTC) VIDEX & VIDEX EC (DIDANOSINE, DDI) VIREAD (TENOFOVIR Phone: +91-11-24379855/56 F) DISOPROXIL FUMARATE, TDF) ZERIT (STAVUDINE, D4T) ZIAGEN AZT, ZDV) TRIZIVIR (ABACAVIR + E-mail: [email protected] D (ABACAVIR, ABC) RACIVIR (RCV) AMDOXOVIR (AMDX, DAPD) ZIDOVUDINE + LAMIVUDINE, ABC + E, T E, AZT + 3TC) TRUVADA (TENOFOVIR www.hrln.org INTEGRASE INH APRICITABINE (SPD754, AVX754)ELVUCITABINE (ACH-126,443, T BETA-L-FD4C) COMBIVIR (ZIDOVUDINE + LAMIVUDINE, AZT + 3TC) DF + EMTRICITABINE, TDF + FTC) AVIR + LAMIVUDINE, EMTRIVA (EMTRICITABINE, FTC) EPIVIR (LAMIVUDINE, 3TC) EPZICOM VIDEX & VIDEX EC (DIDANOSINE, DDI) C (KIVEXA, ABACAVIR + LAMIVUDINE, ABC + 3TC) RETROVIR (ZIDOVUDINE, VIREAD (TENOFOVIR DISOPROXIL UMARA COMBIVIR (ZIDOVUDINE + LAMIVUDINE, ABA + 3TC) TRUVADA ( F retrovirtrizivirFUMARATE, TDF) ZERIT (STAVUDINE, D4T) ZIAGEN (ABACAVIR, ABC) RACIVIR (RCV) AMDOXOVIR (AMDX, NUCLEOSIDE/NUCLEOTIDE REVE DAPD) APRICITABINE (SPD754, AVX754)ELVUCITABINE (ACH- 126,443, BETA-L-FD4C) COMBIVIR (ZIDOVUDINE + LAMIVUDINE, AZT + Human Rights Law Network Vision To protect fundamental human rights, increase access to basic resources for the marginalised communities, and eliminate discrimination. To create a justice delivery system that is accessible, accountable, transparent, efficient and affordable, and works for the underprivileged. To raise the level of pro bono legal expertise for the poor to make the work uniformly competent as well as compassionate. To professionally train a new generation of public interest lawyers and paralegals who are comfortable in the world of law as well as in social movements, and who learn from social movements to refine legal concepts and strategies. The Struggle for Access to Treatment for HIV/AIDS in India © Socio Legal Information Centre* ISBN 81-89479-48-2 December 2008 Text: Dipika Jain and Rachel Stephens Editor: Laya Medhini Cover Design: Pavitra D Tuladhar Layout: Birendra Kr Gupta Printed at: Print Graphics, 196-J, Ramesh Market, East of Kailash, New Delhi Published by the Human Rights Law Network (HRLN) A division of Socio Legal Information Centre 576 Masjid Road, Jangpura New Delhi - 110014, India Ph: +91-11-24379855-56 E-mail: [email protected] Disclaimer The views and opinions expressed in this publication are not necessarily views of the HRLN. Every effort has been made to avoid errors, omissions, and inaccuracies. However, for inadvertent errors or discrepancies that may remain nonetheless, the HRLN takes the sole responsibility. *Any section of this volume may be reproduced without prior permission of the Human Rights Law Network for public interest purposes with appropriate acknowledgement. HRLN acknowledges the involvement of and collaboration with members of the following Positive Networks, Groups and civil society organisations, many of whom have provided crucial and very valuable inputs in the whole process, from 2003. ActionAid India Agra Network for Positive People [AGNP, Agra] AHF Azamgarh Network for Positive People [AZNP+] Bengal Network of Positive People [BNP+, West Bengal] Bihar Network of Positive People Darpan Foundation Delhi Network of Positive People [DNP+] Delhi State Women Forum Etah Network of Positive People [UPNP, Uttar Pradesh] Gujarat State Network of People [GSNP+] India HIV/AIDS Alliance Indian Network of Positive People [INP+] Kalinga Network for Positive People [KNP+] Love Life Society Madhya Pradesh Network for Positive People [MPNP+] Maharashtra Positive Women Network [NWP+] Malappuram District Network of Positive People [MDNP+, Kerala] Manipur Network of Positive People [MNP+] Modi Care Nagpur Network of Positive People [NNP+] Network of Indian People with Alternate Sexual Identities Living with HIV/ AIDS [NIPASHA+] Positive Lives Foundation, Goa [PLF] Positive Women Network [PWN+] Punjab Voluntary Health Association [PVHA, Chandigarh] Rajasthan Network of Positive People [RNP+] Rajasthan Positive Women Network [RPWN+] SAMIKSHA Social Awareness Services Organisation, Imphal, Manipur [SASO] Soudamini Network of Positive Women and Children, Maharashtra Tamil Nadu Network of Positive People [TNNP+] Telugu Network of Positive People, TNP+, Andhra Pradesh UDAAN Trust, Mumbai Uttar Pradesh Network of Positive People [UPNP+] Voluntary Health Association of Punjab [VHAP] World Vision Contents Acknowledgements vi Foreword vii Glossary ix Chapter 1: Introduction 1 Chapter 2: The science of antiretroviral treatment 5 The Virus and Viral Load 5 Types of ARV Drugs 7 Complexities of ART and Strict Adherence Requirement 8 Different lines of ARV drugs 10 Chapter 3: HIV/AIDS Trends in India Since 1986 13 Epidemic Trends in India since 1986 13 HIV Treatment and Policy in India 18 Funding and Mainstreaming 24 Lack of Public-Private Partnership in HIV/AIDS Treatment Programme 25 Discrimination 27 Chapter 4: Universal Access to HIV/AIDS Treatment: A Fundamental Right 31 International Treaties 31 International Jurisprudence 32 Indian Law on Access to Treatment 35 Indian Supreme Court Decisions Interpreting the Right to Life 36 Practical Arguments in Favour of Universal Access as a Right 39 Chapter 5: Important PILs in India on HIV/AIDS treatment 43 Voluntary Health Association of Punjab v Union of India 43 Love Life Society v Union of India & Ors 68 Mr. Wahengbam Joykumar v Union of India & Ors 70 Delhi Network of Positive People & Love Life Society v Union of India & Ors 72 Chapter 6: The True Condition of the National ART Programme in India 75 First National Consultation 75 Second National Consultation 84 Third National Consultation
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