29 March 2004

Ambassador Randall Tobias
Global AIDS Coordinator
U.S. Department of State
SA-29, 2nd Floor
2201 C Street, NW
Washington, DC 20522-2920

Re: Generic medicines and U.S.-initiated conference on Fixed-Dose
Combinations

Dear Ambassador Randall Tobias,

We, the undersigned organizations, are writing to express our serious
concerns about efforts by the Bush administration and by your office to
block the use of affordable generic HIV/AIDS medicines in U.S.-financed
programs in poor countries. In order to mount a rapid and successful
response to the growing AIDS pandemic, we call upon you to ensure that
programs use the most affordable medicines available, and accept the current
drug quality standards of World Health Organization¹s drug prequalification
program.

We are particularly concerned about the U.S.-initiated ³Conference on
Fixed-Dose Combination (FDC) Drug Products: Scientific and Technical Issues
related to Safety, Quality, and Effectiveness,² 29-30 March 2004 in
Gaborone, Botswana. This meeting needlessly casts doubt upon the clinically
proven quality of generic AIDS medicines, and disregards the WHO¹s
internationally recognized Drug Prequalification Program. The meeting is
intended to justify the use of expensive, more complex branded treatment
regimens, and will be used by the US as the minimum basis to justify its
efforts to use bilateral assistance programs to lock generics out of
developing countries. Of particular concern is your attempt to discredit the
use of urgently needed fixed- dose combinations (FDCs) of antiretroviral
AIDS medications.



Single-pill combinations promote adherence, decrease the risk of resistance,
and facilitate stock and procurement management, and are widely recognized
as a core element in efforts to scale up ARV treatment in developing
countries. FDCs are strongly preferred over blister packs and other
multi-pill regimens. In addition to ease of use and other advantages, FDCs,
which are taken in the form of one pill twice a day, are also by far the
least expensive option: today, triple FDCs from generic manufacturers are
available for less than $140 per person per year. The same combination from
brand-name companies costs a minimum of $562 per person per year and must be
taken in the form of six pills a day. Forcing people with HIV/AIDS to accept
higher pill burdens, wasting limited taxpayer resources on brand name
products, and, most importantly, using scarce resources to treat one person
when the same amount of money could treat four is unacceptable.



If the ambitious goals of the President¹s Emergency Plan for AIDS Relief
(PEPFAR), and the WHO¹s ³3 by 5² initiative are to be met, triple
combination FDCs pre-qualified by WHO must be made widely available. FDCs
are recommended in WHO treatment guidelines, and several generic FDCs have
been certified by WHO as meeting stringent international standards for drug
quality, safety and efficacy through its Prequalification Project. The WHO¹s
standards for prequalification are supported by UNICEF, the World Bank, the
Global Fund to Fight AIDS. TB, and Malaria, Columbia University¹s MTCT-Plus
program, many national governments in developing countries, international
humanitarian organizations such as Médecins Sans Frontières (MSF), and other
programs with experience treating people living with HIV. Clinicians in
resource poor settings are already using triple combination generics with
tens of thousands of patients, with efficacy and adherence rates
equal-to-or-better than treatment success and adherence rates in the United
States.



Rather than disregarding the drug procurement policies of developing nations
to create expensive new barriers that benefit US drug companies, your office
should accept the WHO¹s internationally recognized drug quality standards
and promote access to affordable medications. We object to any and all
efforts by the Bush Administration and your office to block the use of WHO
prequalified generic medications, and any efforts to discredit the standards
of WHO¹s prequalification project that would impose new barriers to generics
entering the global market.


Signed,


International organizations

International Association of Physicians in AIDS Care (IAPAC), Int¹l

Partners In Health, Int¹l

Oxfam International

International Council of AIDS Service Organizations (ICASO), Int¹l

International Planned Parenthood Federation, Western Hemisphere Region,
Int¹l

CAFOD International ­ Catholic Agency for Overseas Development, Int¹l

AIDSETI - AIDS empowerment & Treatment International, Int¹l

Ecumenical HIV Initiative in Africa, World Council of Churches, Int¹l

European AIDS Treatment Group (EATG), Int¹l

Health Action International, Int¹l

Health Alliance International, Int¹l

ILGA - International Lesbian and Gay Association, Int¹l

International Community of Women (ICW) living with HIV/AIDS, Int¹l

People's Health Movement Global Secretariat, Int¹l

Red Centroamericana de Personas que Viven con VIH/SIDA (REDCA+), Int¹l

Third World Network, Int¹l - Malaysia

African Jesuit AIDS Network, Int¹l

Artists for a New South Africa, Int¹l/USA-CA

Asociación para la Salud Integral y Ciudadanía de América Latina (ASICAL),
Int¹l

COLEGA, La Federación Española COLEGAS de Lesbianas, Gays, Bisexuales y
Transexuales, Int¹l

Comite Latinoamericano y del Caribe para Defensa de los Derechos de la Mujer
(CLADEM), Int¹l

International Health and Development Associates, Int¹l

International Peoples Health Council, Int¹l

INTERSECT Worldwide, Int¹l

JACANA Real World Development, Int¹l

Joint Mongolian-German Reproductive Health Project, Deutsche Gesellschaft
für Technische Zusammenarbeit (GTZ), Int¹l

Kenya AIDS Intervention Prevention Project Group (KAIPPG) Int¹l

Latin American and Caribbean Women¹s Health Network, (LACWHN), Int¹l

Movimiento Latinoamericano y del Caribe de Mujeres Positivas (MLCM+), Int¹l

Pastoral de la Esperanza Iglesia Catolica CentroAmericana, Int¹l

People¹s Health Movement East Africa, Int¹l

Red de Salud de las Mujeres Latinoamericanas y del Caribe (RSMLAC), Int¹l

The River Fund, Int¹l

Ukimwi Orphans Assistance, Int¹l

Voluntary Services Overseas (VSO), Int¹l

WE-ACT - Women's Equity in Access to Care & Treatment, Int¹l


US National Organizations

Episcopal Church USA

Presbyterian Church, USA

Unitarian Universalist Association of Congregations, USA

Amnesty International, USA

American Foundation for AIDS Research (AmFAR), USA

National Gay and Lesbian Task Force, USA

ActionAid International USA

Africa Action, USA

AIDS Treatment News, USA

AIDS Vaccine Advocacy Coalition (AVAC), USA

American Jewish World Service, USA

American Medical Students Association (AMSA), USA

Center for Health and Gender Equity (CHANGE), USA

CHAMP, USA

Church Women United, USA

Commission on Social Action of Reform Judaism, USA

Consumer Project on Technology, USA

Essential Action, USA

Gay Men's Health Crisis (GMHC), USA

Global AIDS Alliance, USA

Global Exchange, USA

Health GAP (Global Access Project), USA

Jubilee USA Network, USA

Maryknoll Office for Global Concerns, USA

National Minority AIDS Council (NMAC), USA

Our Bodies Ourselves, USA

Physicians for Human Rights, USA

POZ Magazine, USA

Project INFORM, USA

Reformed Church in America Mission Services program in Africa, USA

Student Global AIDS Campaign, USA

TII CANN - Title II Community AIDS National Network, USA

Treatment Action Group, USA

Washington Office on Africa, USA

Women's International League for Peace and Freedom, United States Section

50 Years Is Enough: U.S. Network for Global Economic Justice, USA

Adrian Dominican Sisters, USA

Africa Faith and Justice Network, USA

AIDS Treatment Data Network, USA

The Praxis Project, USA

AIDS.ORG, USA

Corporate Responsibility Program, Province of St. Joseph of the Capuchin
Order, USA

Health Professional Student AIDS Advocacy Network, USA

Institute for Agriculture and Trade Policy, USA

Keep A Child Alive, USA

Maryknoll AIDS Task Force, USA

Medical Mission Sisters' Alliance for Justice, USA

Missionary Oblates, Justice/Peace & Integrity of Creation, USA

National Association for Victims of Transfusion-Acquired AIDS (NAVTA), USA

Operation USA

Share International USA

South Africa Development Fund, USA

Universities Allied for Essential Medicines, USA

Foreign Country Organizations

Act Up-Paris, France

Agua Buena Human Rights Association, Costa Rica

AIDES, France

Bread for the World, Germany

Deutsche AIDS-Hilfe, Germany

Grupo de Incentivo à Vida, Brazil

Médecins Sans Frontières, Project of Access to ARV therapy, Kenya

Médecins Sans Frontières, Spain

Médecins Sans Frontières, Benin

Royal Tropical Institute, Holland

Treatment Action Movement, Nigeria

Action for Southern Africa (ACTSA), UK

Advancement of Rural People And Nature (ARPAN), India

African Research Institute, LaTrobe University, Australia

African Services Committee, Ethiopia

Agency for Cooperation and Research in Development (ACORD), UK

AGIHAS PLWHA Support group, Latvia

AIDS ACCESS Foundation, Thailand

AIDS Access Foundation, Thailand

AIDS Council of New South Wales (ACON), Australia

AIDS Law Unit, Legal Assistance Centre, Namibia

AIDS Task Force (HIV/AIDS Division of Africa Japan Forum), Japan

AKINA MAMA, Sweden

Alnæmissamtökin á Íslandi, The AIDS Organization of Iceland, Iceland

AMAS/AFAS, Mali

APPRENDE, Peru

Asian-Pacific Resource & Research Centre for Women (ARROW), Malaysia

Asoc. Gente Positiva (GP), Guatemala

Asociación ACCRAD, Argentina

Association is sid'accueil 14, France

Asociacion Amigos de Ayacucho, Spain

Asociación Atlacatl Vivo Positivo, El Salvador

Asociacion Comunitaria Anti SIDA, Spain

Asociación Coordinadora de Sectores de Lucha Contra el SIDA  (ACSLCS),
Guatemala

Asociación Costarricense De Personas Viviendo Con VIH/SIDA, Costa Rica

Asociación de Mujeres Contra la Violencia Intrafamiliar, México

Asociación por la Vida (ASOVIDA), Venezuela

Associação Brasileira Interdisciplinar de AIDS (ABIA), Brazil

Associação de apoio a pessoas com VIH/SIDA (ABRAÇO), Portugal

Associação Justiça, Paz e Democracia (AJPD), Angola

Association Bondeko, France

Association de Lutte Contre le SIDA (ACLS), Morocco

Association Kénédougou Solidarité, Mali

ATTAC Japan, Japan

Australasian Society for HIV Medicine, Int¹l/Australia

Australian Federation of AIDS Organisations, Australia

Australian People for Health, Education and Development Abroad
(international humanitarian agency of the Australian Council of Trade
Unions), Australia

Australian Red Cross, (Lao PDR Office), Australia

AVERT - Averting HIV and AIDS Worldwide, UK

Begin (learning & living with HIV), UK

BolivaGAY.com, Bolivia

British Columbia Persons With AIDS Society (BCPWA), Canada

Campagne pour les Droits de l'Homme au Congo (CDHC), Congo

Campaign for Improved Access to Treatment for AIDS in resource poor
countries (ImpAcTAIDS), Scotland

Canadian African Partnership on AIDS (CAP-AIDS), Canada

Canadian HIV/AIDS Legal Network, Canada

Canadian Union of Public Employees (CUPE), Canada

CARE Raks Thai Foundation, Thailand

Casa del Paso del Peregrino, Argentina

CASI - Comité d'Action Sociale et Internationale of the Université de
Montréal, Canada

Catholics for AIDS Prevention & Support (CAPS), UK

Center for Health and Gender Equity (CHANGE), Peru

Center for Information and Advisory Services in Health, Nicaragua

Centers of Excellence- Substance Abuse & HIV/AIDS, India

Centre for International Health (CIH) of the Macfarlane Burnet institute for
Medical Research and Public Health, Australia

Centro Regional de Farmacovigilancia, Argentina

Cheshire Homes, South Africa

ChildrenFIRST, South Africa

Children's Rights Centre, South Africa

Christian Health Association of Nigeria (CHAN), Nigeria

Christian Medical Association of India

CICOP Argentina

CIIEMAD/ National Poytechnic Institute, Mexico

Citizen¹s Health Initiative, Malaysia

Coalicion ONGSIDA y de la Licda, Dominican Republic

Comité Ciudadano Anti-Sida de Castilla-La Mancha, Spain

Comité Ciudadano Anti-Sida de Burgos (CCASB), Spain

Comite Dominicano de los Derechos Humanos CDH, Dominican Republic

Comité Orgullo México

Committee of Arab and African Families United to Survive AIDS, France

Community Health Cell, India

Consultants for Health and Development, The Netherlands

Consumer Education Trust (CONSENT), Uganda

Coordinadora de Animación Socio Cultural (CASCO), Dominican Republic

COPROMOR, Burundi

Dame Una Mano, Chile

Departamento Acceso a Tratamiento Via Medidas Cautelares (DATVMC), Dominican
Republic

Department of Pharmacology, School of Medicine, National University of La
Plata, Argentina

Difaem - German Institute for Medical Mission. Germany

Discipline of Clinical Pharmacology, Faculty of Health, University of
Newcastle, Australia

d'Unis-Cité, France

Ecumenical Pharmaceutical Network, Kenya

EDU-PRO Foundation, Albania

Egyptian Initiative for Personal Rights, Egypt

Family Aids Caring Trust, Zimbabwe

Farmacéuticos Mundi (ONL), Spain

Farmacia Siglo XXI Foundation, Spain

Farmamundi Extremadura, Spain

Five Loaves of Bread Christian Community for Homosexuals, Hungary

Foundation For Social Concerns Inc., West Indies

Foundation for Studies and Research on Women (FEIM), Argentina

Freedom Foundation, India

Fundación CIPRESS (Centro de Investigación y Promoción de la Salud y la
Sexualidad), Chile

Fundación Henry Ardila, Colombia

Fundación Nimehuatzin, Nicaragua

Fundación para el Desarrollo Humano y Social de la Región del Pueblo Mam
(FUNDAMAM), Guatemala

Fundacion para la Prevencion del VIH/SIDA (PRESIDA), Nicaragua

Fundacion PRESIDA, Nicaragua

Fundación Proyecto Gente, Columbia

Fundacion Schorer, The Netherlands

Génesis Panama+

Ghana AIDS Treatment Access Group (GATAG), Ghana

Gram Bharati Samiti, India

Green Scenery, Sierra Leone

Groupe de Recherche sur les Femmes et les Lois, Senegal

Grupo Argentino Uso Racional de Medicamentos (GAPURMED), Argentina

Grupo de apoyo de personas viviendo con VIH-SIDA (FUNDASIDA), El Salvador

Grupo De Mujeres De La Argentina

Grupo Desde el pié, Argentina

Grupo Desida Por La Vida, Argentina

Grupo Português de Activistas sobre Tratamentos de VIH/SIDA (GAT), Portugal

GTP+ grupo de Trabalhos em Prevenção Posithivo, Brazil

Health Education and Research Association (HERA), Macedonia.

Health Issues Centre, Australia

Helpless Rehabilitation Society (HRS), Nepal

HIV i-Base, UK

Human Genome Analysis, Wellcome Trust Sanger Institute, UK

Imbiza Intersect Coalition, South Africa

Interact Worldwide, Int¹l ­ UK

Interchurch Organisation for Development Cooperation (ICCO), The Netherlands

International Cooperation Area, Foundation Institut Catala de Farmacologia,
Spain

International Family Health, UK

International Gender Equality Network (IGEN), Hungary

Ipas Mexico A.C., Mexico

Irish Missionary Union, Ireland

Jamaica-Japan Network, Japan

Jana Arogya Andolana (PHM - Karnataka), India

Kenya AIDS Intervention Prevention Project Group (KAIPPG), Kenya

Kenya Treatment Access Movement, Kenya

KwaZulu Natal Intersect Coalition, South Africa

l'Association des Femmes Avocates au Congo ( AFEAC), Congo

LGBT Organization of Venezuela

Liga Colombiana De Lucha Contra el SIDA, Columbia

Living Hope Organization, Nigeria

LOCOST (Low Cost Standard Therapeutics), India

Massive Effort Campaign, Switzerland

McGill International Health Initiative, Canada

MCS-Consult, Utrecht, The Netherlands

MICHOACANOS POR LA SALUD Y CONTRA EL SIDA, Mexico

Misiones Diocesanas Vascas, Spain

Mulher e Saúde - Centro de Referência de Educação em Saúde da Mulher, Brazil

Myanmar Buddhist Association of South Africa (MBASA), South Africa

National Association of People Living With HIV/AIDS (NAPWA), Australia

National Forum of People Living with HIV/AIDS Networks and Organisations,
Uganda

Nazareth Hospital-Holy Family Center, Kenya

Network Earth Village Japan, Japan

Network of People Living with HIV/AIDS in Nigeria (NEPWHAN), Nigeria

Network of Sex Work Projects, Int¹l - Brazil

Organización de Apoyo a una Sexualidad Integral frente al SIDA (OASIS),
Guatemala

Organization for Social Development of Unemployed, Bangladesh

Pan-African Organisation in Sweden

People Living With HIV/AIDS New South Wales, Australia

People and Planet, UK

People's Health Coalition for Equitable Society, South Korea

Point of View, India

Positive Life Association of Nigeria (PLAN), Nigeria

Positive Living, Malaysia

Positive Movement, Belarus

Positive Women Victoria, inc., Australia

Prodemur significa Promoción de la Mujer Rural, Argentina

Programa de Prevención y Atención a las personas afectadas por ell VIH-SIDA
en Asturias (PAVSA), Spain

Programa de Soporte a la Autoayuda de Personas Viviendo con VIH ( PROSA),
Peru

Progressive Organization of Gays in the Philippines (PROGAY), Philippines

Proyecto de Vacunaciòn y Desarrollo Comunal de Nicaragua (PROVADENIC),
Nicaragua

Public Personalities Against Aids Trust, Zimbabwe

Radio Rhino International Africa, Germany

Reach Out Mbuya HIV/AIDS Initiative, Uganda

Red Argentina de Género, Ciencia y Tecnología (RAGCyT), Argentina

Red Colombiana de Mujeres por los Derechos Sexualers y Reproductivos,
Colombia

Red Hispana de Derechos Humanos en vih - sida y minorías sexuales, Columbia

Red Nacional de Educación Salud Sexual y Desarollo para Jóvenes, Peru

REDBOL, Bolivia

REDVIHDA, Bolivia

Regional AIDS Initiative of Southern Africa (RAISA) initiative of VSO,
Zimbabwe

Regional Committee for the Promotion of Community Health, Nicaragua

Reproductive Health Matters, UK

Reseau des associations des PVVIH, Togo

Réseau du Burundi des PVVIH (RBP+), Burundi

RESULTS, Canada

RNP+ Núcleo RJ, Brazil

Salud Integral para la Mujer, A.C. (SIPAM), Mexico

SAPES Trust, Zimbabwe

Sección Sindical de la Confederación General del Trabajo del Ministerio de
Fomento, Spain

Sida Info Service, France

SIDACTION - Ensemble Contre le SIDA, France

Social Welfare Association for Men (SWAM), India

Sociedad Wills Wilde, Venezuela

Society for Women and AIDS in Africa - Cameroun (SWAA), Cameroon

Solidarité Sida, France

Southern African AIDS Information Dissemination (SAfAIDS), Zimbabwe

Spanish National Community Advisory Board (CACSIDA), Spain

Spiritia Foundation (Indonesian Peer Support Network for PLHAs), Indonesia

St. Joseph's Matale Youth Organization, Uganda

Synthesis, Greece

Tanzania Network Of Organization Of People Living With HIV/AIDS (TANOPHA),
Tanzania

Targeted AIDS Interventions, South Africa

Tertulia Feminist Magazine, Guatemala

Thandanani Childrens Foundation, South Africa

The Ark Foundation, Ghana

TREE, Training & Resources in Early Education, South Africa

Trócaire, Ireland

Tuyakula Group, Namibia

Uganda Coalition for Access to Essential Medicines, Uganda

UK Coalition of People Living with HIV and AIDS (UKC), UK

Unión Afirmativa de Venezuela

United Nations Association Of Uganda

University of Manitoba Medical Students' AIDS Outreach, Canada

University of Toronto International Health Program, Canada

Vanguardia Mexicana de Personas Afectadas por el VIH/SIDA (VANMPAVIH),
Mexico

Vida Positiva Quilpue, Chile

VIH/SIDA de la Iglesia Catolica de Honduras

Waverley Care Trust, Scotland

Wemos Foundation, The Netherlands

Western Cape Intersect Coalition, South Africa

Wits Pediatric HIV Working Group, South Africa

Women on Waves, The Netherlands

Women's Dignity Project, Tanzania

WTO Watch Qld, Australia

Xtending Hope Partnership, St. Francis Xavier University, Canada

Youth (OSDUY), Bangladesh

YWCA of Albania



US Local and Regional Organizations:

ACT UP Cleveland, OH

ACT UP East Bay, CA

ACT UP New York, NY

ACT UP Philadelphia, PA

ActionAIDS Philadelphia, PA

Africa Bridge, OR

African Services Committee, NY

AIDS Action Baltimore, MD

AIDS Foundation of Chicago, IL

AIDS Policy Project, PA

AIDS Survival Project, GA

Balm in Gilead, NY

Blood:Water Mission, TN

Brown University Center for AIDS Research, RI

Catholic Mission Office, Diocese of St. Cloud, MN

Citizens for Consumer Justice, PA

COLOURS Organization, PA

Concerned Medical and Health Care Professionals, MD

Drexel University (Public Health Interest Group) PHIG, PA

George Washington University Student Global AIDS Campaign. DC

God¹s Love We Deliver, NY

HIV Law Project, Inc, NY

Housing Works, NY

International AIDS Empowerment, TX

Liberty Research Group, NY

Loyola AIDS Awareness Coalition, MD

Lutheran Campus Ministry at the University of Arizona, AZ

Migration & Refugee Services, Diocese of Trenton, NJ

NCATA (NW Coalition for AIDS Treatment in Africa), WA

New Mexico POZ Coalition, NM

New York AIDS Coalition, NY

Office of Religion, Catholic Diocese of Scranton, PA

PA Civil Rights Initiative, PA

Pacientes de SIDA pro Politica Sana, PR

Pediatric HIV/AIDS program at The Children's Hospital of Philadelphia, PA

Pennsylvania Lesbian and Gay Task Force (PLGTF), PA

Philadelphia College of Medicine Public Health Club, PA

Philadelphia International Action Center, PA

Philadelphia NORML, PA

Planet Poz, NM

Positive Health Clinic, PA

Prevention Point Philadelphia, PA

Princeton Student Global AIDS Campaign, NJ

Priority Africa Network (PAN), CA

Queers For Racial & Economic Justice, NY

Rescue Childhood, PA

RESULTS Seattle, WA

Rochester Area Task Force on AIDS, NY

Rochester Global AIDS Project, NY

Sisters Mobilized for AIDS Research and Treatment  (SMART University), NY

Sisters of St. Joseph of Carondelet, St. Louis Province, MO

Starfish Project, New York Presbyterian Hospital, NY

Survive AIDS, CA

The Washington State Africa Network, WA

Universities Allied for Essential Medicines, University of Minnesota, MN

Village Care of New York AIDS Day Treatment Program, NY

Vukani Mawethu Choir, CA

Washington Biotechnology Action Council, WA

Women's Environment and Development Organization (WEDO),NY

Yale AIDS Network, CT

Youth-Health Empowerment Project (Y-HEP), PA