Pharmaceutical the policies on access to medication and the

Pharmaceutical
companies receive great and increasing sums of power, due to global realisation
that to reduce the burden of the HIV/AIDS epidemic, public access to medication
is key (Juxtamagazine, 2014). It could be argued by pharmaceutical companies
that these official policies are providing an invaluable service due to the
legitimization of these products, which gives control to the pharmaceutical
companies and ensures HIV affected countries are dependant. Contemporary
neo-colonialism is represented through this dependence (Juxtamagazine, 2014).
The neo-colonial agenda of pharmaceutical companies have underwritten to the
huge inequality between the policies on access to medication and the actual sum
of individuals receiving the treatment (Juxtamagazine, 2014). In 1987,
zidovudine was released in the United States as the first medication available
to treat HIV. 5 years later, 800,000 people worldwide were receiving
antiretroviral medicines. However, in low-income countries, where 95% of global
HIV infections are accounted for (WHO, 2002), less than 40% of the population
were on this treatment. In contrast, in the developed world antiretroviral
medication is widely accessibly (HIVclinic.ca, 2012).  

            The production of antiretroviral
medicines within developing countries has been ensured to remain dependant, a
decision decided through the cooperation of international intellectual property
laws and pharmaceutical companies (Juxtamagazine, 2014). The agreement on Trade-Related
Aspects of Intellectual Property Rights (TRIPS) was passed by the World Trade
Organisation (WTO) in 1995 (Elliot et al., 2003). Productions of pharmaceuticals
within each country is require to grant patents, for 20 years without judgement
to accessibility. Profits are often made by the companies holding the patents,
as exaggeratedly high prices are charged for the drugs (Juxtamagazine, 2014). A
potential alternative to branded pharmaceuticals was also introduced as generic
drugs. However, various regulations were introduced to pharmaceutical companies
through the TRIPS agreement, which resulted in a discouragement of the
production of generic medication. The Doha Declaration was introduced and
signed by the WTO in 2001, which allowed members to protect the public health
of their citizens by granting domestic compulsory licenses (Juxtamagazine,
2014). Nevertheless, huge pressure from pharmaceutical companies and foreign
governments were faced by countries attempting to obtain these licenses. A
neo-colonial approach is adopted by pharmaceutical companies by authorising the
patents, which has prioritised market dominance over access to drugs and public
health.

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            However, in a contrasting perspective,
the frequent application of neoliberal policies applied in low-income
countries, recent research has identified a potential link with the HIV/AIDS
epidemic (Lester, 2017). Various global organisations have been criticised in
their response to the disease in an attempt to understand the potential link.
Associations such as; health, commercial sex, poverty, labour migration etc.
have been explored and identified as primary issues that are influencing the
epidemic (Lester, 2017). Affecting the majority of countries, neoliberalism is
considered a philosophy equally as it is an economic structure. Anderson (2000)
describes neoliberalism as “the most successful ideology in world history”,
which allows the examination of healthcare, taxation, macroeconomic policy etc.
Despite the general acceptance that neoliberalism has become a vital part of
the global context, there is also an increasing amount of criticism (Campbell
& Pederson, 2001) and this theory is yet to present strengths in regards to
HIV/AIDS (Lester, 2017). The theory of neoliberalism aims to enhance the
availability of control within the public sector in comparison to private. A
common neoliberal policy is the structural adjustment program, which has been
commonly used to improve the economic structure of a population by the World
Bank and IMF (Lester, 2017). A common theme identified throughout HIV/AIDS
prevention research in low-come research is lack of financial support for
medicine, health care workers and doctors. Research blames the cuts in national
budgets on policies formed by neoliberalism.

            Particularly in Africa, the World
Bank and IMF have made substantial additions to neoliberal policies, by promoting
free trade and taxation policies. Such institutions were firstly formed by
governments, with a primary aim to support global economy and balance growth.
Over time, authority has been gained through shareholders allowing the
institutions to become independent (Lester, 2017). The withdrawal of funding
from the health sector for example has been a mutual debated issue, as often
the sectors generate no direct economic benefits, and treatment and preventions
suffer and as a result disease prevalence increases. Woods (2006) suggested
that this particular failure within the World Bank and the IMF is primarily
reliant on the governmental influencing roles which controls agenda and the
actions of institutions. Therefore, with this in mind, the overall verdicts
decided are based on what the powerful actors can gain rather than with the needs
of the vulnerable in mind (Lester, 2017).

The World Bank also plays an important
role as one of the leading development organisations for international health
and for the global response to HIV/AIDS. The organisation is a unique global
corporation which consists of 189 countries, offices in over 130 areas and
staff from over 170 countries (World Bank, 2018). The World Bank aims decrease
poverty prevalence by promotion economic development in low-income countries by
forming sustainable solutions (World Bank, 2018). Various structural adjustment
programs introduced in the early 1990’s encouraged by the World Bank and the
International Monetary Fund were disapproved by critics due to the recurrent
negative consequences (Parker, 2002). In response to this, the World Bank World
Development Report (1993) stated that attention was focused on issues relating
to health; increasing the availability of resources and new lending schemes, in
hope this introduces new projects concentrating on common developing word
issues (Parker, 2002). The organisation has also been visibly committed to
responding to the HIV/AIDS pandemic (World Bank, 1997). The international
financial institution provided a total of $1.7 billion in loans to developing
countries available for HIV/AIDS related work by the start of 2001, which by
that time was a vital financial resource in order to globally attempt to fight
against the epidemic (Parker, 2002).