Adherence to the bottom line, adherence to drug regimens

With AIDS medicines still so out of reach for so many who need them, it's worrying—although predictable--to note the lack of responsibility taken by the pharmaceutical company Roche for the tens of thousands of people depending on their anti-retroviral drug, nelfinavir (Viracept). In June, Roche quietly recalled this common ART drug because of contamination, leaving many HIV positive people with the choice of giving up their life-saving medicines or taking potentially poisonous pills. (See the NYTimes report here)

After being pressed for more information by activists, Roche finally admitted that contamination with a cancer-causing byproduct has been common since the drug was first produced in 1998, and that the contaminated drug has been distributed all over the world.

Roche needs to act more aggressively to make alternative and affordable treatments available. In a climate where some people still fear that lifesaving ART medicines are toxic, only fully responsive, ethical steps taken by manufacturers will undercut the damage a recall like this can do--not just to the treatment plans of specific patients taking the medicine involved, but also to the entire effort to use antiretroviral medicines fight HIV effectively.

It's also interesting to consider this as a case of structural interference with drug adherence (more commonly thought of only as costs of treatment, distance to health facilities, etc.). More than any other factor, we tend to hold people with HIV themselves accountable for good adherence to their drug regimen. We charge them with the job of faithfully taking their medicines every day, and we often act as if the primary barriers to adherence are their attitudes or behavior, and the fault if they slip is theirs. Clearly this is not so in this case.

A pharmaceutical company should not simply be able to walk away, due to a flawed product, from people who rely on daily doses of one of its products to hold off a fatal disease. Those with the most power to act should be held the most accountable – especially when they are so handsomely paid and protected from competition. If we really want to support good drug adherence in people taking ART medicines --and thus make ART the most effective tool against the epidemic that it can be-- we need to find ways to create and enforce structural supports to good adherence, as are many of the advocacy organizations found here. Providing pill boxes and calendars is not enough.

Repression of the Right to Water Movements: El Salvador and Mexico

Like all struggles for rights and justice, the struggle for water rights and water justice has drawn repressive responses from governments more interested in corporate profit than human needs. Violent actions against popular movements this month in both El Salvador and Mexico demonstrate the urgency governments and corporate interests feel about preventing the right to water from becoming –and remaining-- an accepted human right.

In El Salvador, a peaceful demonstration against the decentralization of the water system (seen as a first step toward water privatization) was brutally repressed on July 2. Police and military units attacked protestors with rubber bullets and tear gas, and captured four movement leaders in a vehicle kilometers away from the protest. 14 people have been arrested, many claiming mistreatment and torture at the hands of the police. Dozens of protestors were injured by rubber bullets, tear gas poisoning, and beatings; at least 2 people were hospitalized.

"Those arrested include activists from the community organizations of the resettled refugees and ex-combatants of El Salvador's civil war who are the majority of the people living in the Suchitoto area." They are being held under El Salvador’s new anti-terrorism law – a repressive law enacted last fall with the clear objective of attacking and discouraging social movements.

The government’s actions have been strongly criticized. Over 60 social movement organizations in El Salvador signed a powerful statement; Amnesty International has condemned the illegal application of the anti-terrorism law; and Tutela Legal, the legal aid office of the Archbishop of San Salvador, has demanded the release of the activists and an investigation of the repression. Click here for more information and an opportunity to send letters of solidarity.

Two days later in Central Mexico, on July 4th in San Luis Mextepec, in the municipality of Zinacantepec, the lawyer Santiago Pérez Alvarado was arrested and charged with a kidnapping that occurred nine years previously. According to witnesses, four men dressed as civilians smashed his car window, held a gun to his head and hit him with a tire iron. He was first accused of violent robbery; as the statute of limitation had expired, the judge dropped the charges. Hours later he was detained again and accused of kidnapping.

Santiago Pérez Alvarado is well-known as a promoter of human rights and defender of natural resources. He has worked with farmers in the Toluca Valley and in southeast Mexico to resist the large-scale removal of their water for use in Mexico City. He has also collaborated with the indigenous Frente Mazahua por la Defensa de los Recursos Naturales, to help them redress damages to their communities caused by the construction and operation of the Cutzamala system, which diverts water from their lands to Mexico City. The false arrest of Santiago Pérez Alvarado is a strike against people struggling to maintain the ecological, cultural, social and economic integrity of their region.

Letters of solidarity with Santiago Pérez Alvarado should be sent to: Gobernador del Estado de México, Lic. Enrique Peña Nieto, Lerdo poniente numero 300, primer piso, puerta 216, Palacio del Poder Ejecutivo, Colonia Centro, Código Postal 50000, Toluca, MX. Emails to: gob@gem.gob.mx, and phone calls and faxes to: Tel.- 0052 (01 722) 276 00 50/Fax: 0052 (01 722) 276 00 46.

If Another World is Possible, Another US is Necessary: First US Social Forum Meets in Atlanta

Imagine a country built on peace and social justice, on racial and gender equity, on ecological and economic security for everyone. Imagine transforming a culture from one where two million people are imprisoned, where migrant workers die everyday for lack of services, where 85 million people lack health coverage, and where billions of dollars are taken from schools, hospitals, and public housing to fund war and occupation, into a culture that excludes no one, marginalizes no one, imprisons no one, and leaves no one behind. Imagine another world…a better world…a world made of many worlds…Imagine a country called hope.

For those who were able to attend the first US Social Forum (USSF) this June in Atlanta, Georgia, a glimpse of this country appeared on the horizon. Spun off from the World Social Forums that began in Brazil in 2001, the USSF brought together over 10,000 people to dream, plan, strategize, and act toward a just society. The gathering took place in Atlanta, birthplace of Martin Luther King, Jr. because, in the words of W.E.B. Dubois, “As the South goes, so goes the Nation.” Katrina turned from a natural disaster caused by climate chaos into a social disaster caused by the government’s failure to respond to the needs of tens of thousands of mostly poor, African American refugees. Many activists see the South as highlighting some of our nation’s most urgent needs for change.

Years in the making, the USSF brought together over 10,000 people to dream, plan, strategize, and act on the notion that if you want peace, you must work for justice. By coming together to strengthen their movements – in the words of Kai Barrows, an organizer with Critical Resistance, “to turn many movements into one Movement that really moves” – participants in the USSF hope to bring about long-term, radical social change.

Over 900 workshops, cultural events, and lectures took place over 5 days, touching on issues from immigrant rights to environmental sustainability to abolishing prisons. The overwhelming majority of presenters and participants were young people of color, affirming what 21-year-old Julián Moya, a representative of New Mexico’s Southwest Organizing Project said: “As youth, we are not the future, we are the present.”

The People’s Health Movement participated in the Social Forum by organizing over a dozen workshops and panel discussions throughout the week, as well as a full 4-day session of the International People’s Health University (IPHU). Designed to stimulate critical thinking in the health and healthcare sector (see previous post here) and to encourage action around the social determinants of health (see previous post here) IPHU is an effort to direct attention at the ways in which access to health is denied by structural inequalities, both in the US and around the world. Participants in the IPHU looked at the health impacts of global warming, militarism, the pharmaceutical industry, water privatization, and other issues, and brainstormed about campaign strategies to bring about health equity. Meanwhile, groups involved with PHM, such as Doctors for Global Health, the Poor People’s Economic Human Rights Campaign, Partners in Health, and Hesperian, held workshops on liberation medicine, environmental justice, food sovereignty, and other crucial topics.

We know that many who attended the USSF and especially those who attended the IPHU and other PHM workshops, will return revitalized with new knowledge, a stronger analysis of the problems we face, and energized by the awareness that they are part of a worldwide movement for positive change.

Keep  an eye out for regional social forums happening across the country until the next U.S. Social Forum in 2010.

Other articles about the forum:

http://www.ipsnews.net/news.asp?idnews=38397

http://rabble.ca/news_full_story.shtml?sh_itm=679f516f9630455d845939e77f95e3a9&rXn=1

http://www.zmag.org/content/showarticle.cfm?ItemID=13078

http://ipsnews.net/news.asp?idnews=38397

http://www.southernstudies.org/facingsouth/2007/06/us-social-forum-another-politics-is.asp