Access to ARV treatment: Aid, trade and governance in Uganda

Access to antiretroviral medicines (ARVs) for AIDS treatment creates a field binding local and global governance. Local modalities of AIDS treatment are governed by the context of global trade through the implementation of patents on medicines in the World Trade Organisation (WTO), and within the context of global aid through development assistance. While industrialized countries, on the one hand, set aside donations to fight AIDS in developing countries, on the other hand, the same countries use the WTO to prevent developing countries from accessing cheap medicines. Uganda’s success in reducing HIV prevalence is unique among African states, and it is considered the most promising candidate for effectively “scaling up” ARV treatment on the basis of its history of dealing with the pandemic. Yet, despite the many interventions addressing HIV/AIDS and dramatic price reductions of ARVs, only a minority of the infected population is currently receiving treatment, and promises of universal coverage for all who need it seem unrealistic. Our paper examines how the disconnect between international and national priorities on the one hand, and between aid and trade on the other, are currently affecting access to ARVs in Uganda. In spite of the political discourse of equality in treatment, the realities of funding suggest the difficult choices will be made from the level of policy to that of individual. Thus, global governance of trade and of aid will both shape and rely on individuals in charge of “implementation” which must be examined outside the sanitizing context of development discourse. We introduce our use of governance in this paper, and then discuss the global governance of aid to AIDS and global governance of trade and AIDS. The second half of the paper examines the Ugandan case study beginning with a political background and examination of aids policy, followed by the history of ARV provision and advocacy for ARVs, a discussion of the national health system and then aid initiatives and trade of ARVs in Uganda. Finally, we draw preliminary conclusions from our case on the conflicts between global and local governance of trade and aid to AIDS.