Despite access to antiretroviral medicines, this still means that

Despite
that UNAIDS achieved their goal, that by 2015 15 million people within
vulnerable populations will gain access to antiretroviral medicines, this still
means that 1 in 5 people will still will be without treatment (Juxtamagazine,
2014).

            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).  

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            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.

            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). 

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