Co-Director’s Interview with Anne-christine d’Adesky and Ann T. Rossetti on the Making of PILLS, PROFITS, PROTEST: CHRONICLE OF THE GLOBAL AIDS MOVEMENT.

Larin Sulivan: What led you to make this film?

ACD: The idea for our film really came out of direct community organizing work that I was doing, having been a journalist for very long now and being involved in the AIDS movement since the mid ‘80s.I began turning my attention to the global epidemic really in 1999, leading up to the 13th International AIDS conference in Durban, South Africa in July 2000. I was at the time Editor in Chief of HIV Plus, a national magazine that is still published. I was the founder and editor of that magazine and I had prepared coverage for the Durban conference. I wanted to see how to provide some treatment information and some of the access to the scientists and activists who were coming to that conference for women who I knew were not going to be able to afford getting into this big international conference – it costs a lot of money. Clearly no women from the local areas who were probably HIV-positive and needing the information were able to go. So I worked with a couple of colleagues in the U.S. and reached out to some women’s organizations in South Africa.

We organized a conference called “Women at Durban” – a week long really wonderful event --for 300 women of the local townships of Durban. We decided to document that conference. Initially we began with the idea that it was important to document the coming together of these women with us. The overall Durban international conference was really the first major protest on African soil by activists around AIDS issues. It was led by the Treatment Action Campaign which has become a very big grassroots movement in South Africa and really in southern Africa. When we were doing the filming and saw these protests, we of course documented the protests at the same time.

I had come there with Ann Rossetti who I knew as a friend and talented filmmaker. We thought maybe this is the seed of a film about women and AIDS and the global movement of activists. It was very loose at that time but we thought at least let’s document this. We interviewed women who were at the conference and really began to document their stories and I realized that we had the kernel of a film. At this time this activism was really taking off and was continuing in the US. I was very involved in going to activities and protests, so we decided that we would document this movement as it was happening and really make sure we were covering the main protests in the US. Out of that we realized that we were witnessing the beginning of the global AIDS movement. It’s about this battle – the access to medicine -- but the greater issue is the rights of these 40-45 million people who are HIV-positive and don’t have access to life-saving medicine and are going to die unless they get it.

A couple of months into that process, we ran into Shanti Avirgan who was working on a film about the AIDS movement in Brazil. We realized that she was working on a subject that was close to our film -- a little different --and so we decided to collaborate on the footage of the film that she was working on. Brazil is one of the countries that is featured in the film, a country that has really taken on providing treatment to people with HIV as part of their human rights as citizens. It has shown that you can do this in a way that is really model for other poor countries around the world. So as we began to work, we decided to make a short list of people who were really speaking to the issue – both activists and community providers. In many cases these were physicians on the front lines. We decided to not only focus on individuals who were emerging as leaders in both the global south and global north, but some of the countries where the issues are easy to demonstrate and where there is a movement of activists and civil societies. The key to it was really activism.

So the film that emerged is a portrait of the years since 2000 to 2003 when the movement for access to affordable HIV treatment really became a prominent issue both globally. It became something that was really discussed at the highest levels; there was a lot of media attention from the moment of Durban on the way through. We covered some key battles. It merged with the activism we’re seeing around the United States on globalization and in some cases it built on the global movement against globalization. We saw it in Seattle. We were able to capture the right to HIV drugs really being the right to healthcare and the right of all citizens to this care. And looking at this: what it’s really all about is a battle for profits. Really looking through that lens at what right do Americans have to essential medicines as well. So it’s a film that started out as a film about the AIDS movement but really became about the story of this larger issue that we’re facing and a lot of countries are facing, which is are we going to have healthcare as an essential human right?

LS: In the film there is a lot of discussion of generic drugs and companies and countries ability to produce them. How does this shake down?

ACD: In 2000 when the Durban conference was happening, it began to emerge that some of the Indian companies had begun to manufacture generic AIDS drugs legally. They were doing it for Brazil. Here in the US, the cost of AIDS drugs is 10,000 a year for one person – clearly out of the range of most people who don’t have healthcare. And there are waiting lists here in the US for access to these drugs. Around the world it’s impossible for most people to get access and for most governments to afford that. So one Indian company – CIPLA – began to make these drugs. They were allowed to do it because India has a constitutional law that allows them to make these drugs and it can’t sell those drugs in the United States where there are patents, but it can sell to other countries where those patents have not been put in place. India was producing these drugs for $500 a year.
So you can imagine the revelation that you can actually make drugs for a fraction of the money -- it really exposed the profits that were being made in the AIDS field. And as people really began to look into it –journalists began to investigate and activists began to make a lot of noise – it really showed that it wasn’t just AIDS but most medicines.

The pharmaceutical industry is making enormous profits. It is growing at twice the rate of the American economy. It’s the leading sector in terms of profit, perhaps just ahead of the gold and mining industry in some areas, but it really is the major profit industry in US.

What was particularly egregious is that many of the AIDS drugs had been developed with taxpayer money in the big universities. And then those researchers had sold them to big pharma companies to get them approved through clinical trials so they could be marketed. That costs a lot of money. But they didn’tinvent the drugs. And they were claiming that they were charging so much for these drugs because they had put so much into researching and developing (R&D) them -- and that simply wasn’t true. Lawyers and the Consumer Project on Technology, led by Jamie Love, who is featured in the film, did this great work of informing people, particularly in the Congress, that the profits being made in AIDS were really astronomical and that the drug companies were really using patents as a way to prevent access to affordable medicine around the world.

The issue began to capture the attention of world governments and Kofi Annan was instrumental in pushing for a new fund that was called the Global Fund for Aids, Malaria and Tuberculosis. The monies in that fund were used by some governments to begin buying generic drugs. The problem was that some countries could afford it, but most could not. This issue has been debated in an economic sphere that is under the control of the World Trade Organization (WTO). The WTO is a global body that many governments have signed onto and it demands that countries uphold patents. So within the WTO there were very fierce debates. African countries, and Brazil and India formed a block to say “No! We have to make an exception for AIDS drugs. There’s too many people and lives at stake.” Legally they could do that by invoking the argument that in the case of a national emergency, governments do have the right to do two things – one being issue a compulsory license, and two, issuing a parallel license so they can import the drugs and sell them for the price of generic medicine. In other words – if big Pharma companies are not willing to make the drug available at affordable price then these governments can issue this emergency law.

This created a big pressure so that the prices of the Big Pharma drugs began to fall and fall and fall. Not to the point where they were equivalent with generic drugs, but people began to see that the pricing was an arbitrary pricing scheme in the first place and they were just using the patents to hold onto the profit. What has happened in the period of time since we began our film this issue really came to the forefront. So we were able to capture the arguments and debates and show that this is really about profit and despite the fact that you had 42 million lives at stake, Big Pharma companies were going to use this patent to protect their interests.

It really went beyond generic drugs. They’re terribly afraid the American people are going to learn that it only costs pennies to make drugs and that they are being charged an arm and a leg for medicine. Our system in the US allows insurance companies to pay for this medicine and it’s all done through employer schemes. Sometimes we don’t feel it. But many Americans don’t have health insurance because we can’t afford it because the premiums are so high -- because the cost of drugs is so high. We are bearing the brunt of all of this. We have begun to see the federal and different state governments saying “We can’t afford the cost of generic drugs.” Here in the US. There’s s a huge debate going on where several governors say they are going to begin to import generic drugs from Canada – not just AIDS drugs but all kinds of medicines – because they cannot afford the name brand drugs as they are priced by these major pharmaceutical companies. They’re really robbing us blind.

LS: Didn’t President Bush block the generics from Canada plan?

ACD: Bush has done everything he can to block generics, particularly from abroad. His administration has taken a cynical move to protect the patent system in a larger sense. These Big Pharma companies have given so much money to the Bush administration; they’re really working hand–in-hand. It’s really a fear of generics opening the doors for any .generic product. They began a major PR campaign to discredit the quality of the Indian produced drugs, claiming their production facilities are not up to snuff compared them to the drugs approved by the FDA. Even when they were approved by the World Health Organization, which has an independent quality review system that is top notch.

The first drug in South Africa made by Aspencare has been approved by the FDA so there’s one generic drug. It’s been licensed as a subsidiary of two big pharma companies who therefore get a cut of their money. The consumer in South Africa is paying a generic price. But it’s frozen out these Indian companies and others who would have made the drug available in a very different way. So they’re upholding the patent system and they’re cutting down the competition. Here we are 2005 and you have probably 3 million who died last year because they couldn’t get hold of life saving medicines. You had some cases where drugs were sitting in the Indian warehouses and Indians themselves couldn’t get a hold of them because of the fight that was taking place at the highest levels of government between corporations and civil societies that were trying to get their hands on these affordable medicines.

LS: I’m surprised this situation didn’t incite riots – were there troops protecting these drugs?

ACD: Not at all. The Indian governments wouldn’t make these drugs available because it was afraid to opt for generic drugs because the United States would impose a penalty in some other arena. The government which tried to go ahead and offer access to generics elsewhere were directly threatened by representatives of the Bush administration: “If you try to access generic aids drugs, we won’t give you a deal on whatever it is, some other import.” We kept hearing about these kinds of cases or threats. In some cases they were very clear” “You have to respect the WTO laws or you’re going to suffer.” Different parts of the Indian government were fighting over this. Economists were saying, “Of course we want to help our citizens with AIDS, but it’s going to hurt us if we can’t sell our soybeans or our corn or other products.” You really have the health sector and economic sector fighting with each other about which way to go. Ultimately – the people who are suffering are going to be the poor. And those are the people who make up the bulk of people with HIV – whether it’s here in the United States or any other country. It’s really terrible.

Right now you have a very dramatic situation in India. India just had to agree to go by the WTO rules that are being imposed as of 2005. What it means is that India is no longer going to be able to manufacture more generics. They can use the ones they have already produced but they are going to have to sell drugs that are locally patented – basically the losers are Indians. There is an incredible epidemic raging in India. The idea that Indians are not going to have access to generic drugs made by their own companies -- it’s just… it’s just… I don’t know how to describe it… It’s a crime of high proportions. It’s not just big pharmaceutical companies that are responsible; it’s also people within these governments who are going along with it. They have not defended the rights of their own people to have access to healthcare.

LS: How, in your opinion, could they more effectively defend their people against the epidemic? Is it going as badly in Brazil, South Africa, Uganda?

ACD: Brazil is supposed to be going along with the WTO laws in 2005 too, and so people are on pins and needles to know what is going to happen. AIDS activists have continued to show real muscle. The Brazilian government is in a much better position, they have better control over their epidemic; it’s a smaller epidemic too. Because they moved towards generic production and have effective prevention policies in place, they’re put in a whole infrastructure and done a great job. They have a lot of generic drugs now available that they can continue using. Whether they’re going to be able to afford the next generation of drugs that they need or going to have to import is a big debate. It used to be that the bulk of their health budget for AIDS was used up by having to import just a few drugs. If they have to do that again, they’ll be in real trouble.

LS: What’s the impact of the drugs on individuals?

ACD: Here in the United States you really saw the dramatic drop in deaths, almost overnight. Someone who is at death’s door, who has a really depleted immune system, who has been living with HIV for a number of year and has severe illness… if they get hold of these drugs before they are absolutely dying, they are going to be able to come back and regain their health in a very short time, become productive and live happy lives. The agony people go through if they’re not able to get drugs is just unbelievable. It can cause dementia -- you can go mad. It causes blindness. It ravages your entire body. The kind of pain and agony is the part that people don’t hear about and they should hear about.

This is why I call the lack of access to aids drugs a crime against humanity. We know that we have the means to treat, bring back to life and health. We have 3million people who will die in 2005 if they don’t get access to these drugs. We have managed get 1 million people onto drugs in the last year and half and that’s fantastic. But we know we have 6 million people who need treatment now. We have to scale up much faster. Putting up roadblocks has really been a death sentence to people who should have had the right to live. We’re all responsible in the sense that we didn’t make these drugs available. I think the people who are most responsible are the heads and CEOs of these companies and the governments who cow to them, who didn’t make the drugs available. They say, “We’re going to sacrifice these people to protect the greater development of our countries. But look -- South Africa has rates of 70% HIV among some communities of young girls. HIV rates are up 50% in the army in most of southern Africa like Zambia, Lesotho, etcetera. I

LS: How does treatment relate to the eradication of AIDS?

ACD: You have to be able to be able to treat to lower the infections in these people so they live to survive. You’re dealing with rates of orphans –generations. This goes beyond some abstract figures. This is the challenge of our time. If we don’t do it, these countries are not going to survive. If they don’t survive we don’t survive. We are interdependent. It’s a struggle that goes far beyond AIDS drugs.

I hope our film shows this and the good news of it. It is possible to change the world with small groups of people, working with governments. You must combine activism, law and a focus on human rights – that’s the way to go. I think it’s an inspiring portrait of a movement which should inspire other social movements. Fundamentally the issue access to AIDS medicine is a social justice and human rights issue. The good news is we can do it! We can turn this around and succeed. But we have an enormous battle politically ahead of us.

LS: How did you finance the film? How have you told people about it?

ACD: We worked with a lot of limits in making this film. It was made on the backs of a book project, “Moving Mountains.” The Race to Treat Global AIDS.” [Verso, July 2004] I’ve tried to use the book’s publicity to make the film known. I began reporting on this issue as part of my journalism work as a print journalist. I invited Anne and later Shanti to come along to some of the countries where I was reporting for a print journal on a series of articles for a newsletter for the American Foundation of Aids Research (AmFar) I had to contend with the fact that I was working on a book and the film came as a second project. The book was published in July, 2004. We made it with out any money from anyone. We basically put in our volunteer time and money. We had one small donor who helped us get to Haiti but it’s been an entirely volunteer effort.

LS: What has the audience response been to the film?

ACD: We showed a rough cut of the film at Barcelona 2002 and took feedback and then showed the finished work at the Bangkok AIDS conference in 2003. The word got out. We initially made it available to selected activists as an information and organizing tool – particularly two groups who are active here in US and globally -- Global AIDS Alliance and the Student Global AIDS Campaign. And the film has been shown on American campuses. The response is that people are very inspired and the issue and message of the film is really current and relevant over these years – access to affordable medicine is a broader issue worldwide.

LS: How was filmmaking as a first-time director?

ACD: I had worked in documentary films many years ago. I worked on a film about Haiti with a filmmaker named Harriet Hirshorn - a good friend. So I was familiar. I also took film classes in college. But I feel like print and writing is my medium. The difference is that I’m so content oriented -- I know what I want to say. I think there’s a big difference in making something that translates visually and that’s where Ann is so brilliant. She’s able to tell a story visually. And this was a portrait of a lot of voices and people.

We were limited by bi-coastalism and our other work. We really had an east coast-west coast collaboration that was made in different times. It was really challenging to work under those circumstances. Also we had Shanti who came in with her footage from Brazil. It was a meshing of styles. We worked very, very quickly together and trusted one another with such an urgency to get this story out. We also have enough footage for two more films – one being the access to generic aids medicines and the other being something which I think Ann and I will work on together, which we hope to get the funding for, which is about women and AIDS.

LS: Why did you start making a film now after so many years in print?

ACD: They target different audiences. And the impact of seeing AIDS in countries and seeing the activists, hearing their voice…I think it inspires people and gets the information across more powerfully than reading about it. It was really important for us to portray the lives and experiences of people with HIV and activists around the world – to give visibility to those who are making social change and leading these movements. For them to say in their own words why they are doing what they are doing and what it means. It’s very inspiring.

Plus, many of the people around the world who are both the subjects and the protagonists in this story are not people who can read and write or read and write in English. So for us to show people in action around the world was very important for the audiences we felt we are reaching. We are targeting a global audience and American viewers. And many of these people have not had the opportunity to go around the world and see what the epidemic looks like in Haiti, India or Brazil, or Africa. They often they have images of these countries that are very disempowered. They don’t realize that you’ve got incredibly sharp activists there, that people are capable of taking this issue on and being role models -- even for us here.

I’m always shocked by one series of images we showed of these factories that produce generic medicines in India. So many people who have seen the film said, “Oh my God, I had no idea that these companies were so technologically sophisticated; it looks like American companies and the highest standards of American manufacturing.” I realized anew that people have limited perspectives and views of life in other countries, particularly the poorest countries in the world.

LS: It was moving to see these really strong powerful women in the film. Can you talk more generally about how AIDS is seen and reacted to by the American mainstream media? And audiences here? How has activism in America changed?

ACD: Right now is a very important moment – there’s a whole new movement afoot. Domestic AIDS has been eclipsed by the international issue because the American media realized themselves they’ve been so far behind on the global story. The domestic epidemic has really fallen off the radar. I think it’s partly because quite honestly the American media tends to focus on stories which are put forward by groups and causes which can get access to the media. In many ways AIDS is really an epidemic that affects primarily African-Americans and Latinos -- communities of color, poor communities and disenfranchised communities. It still affects gay white men but not to the same degree and proportion as it did in the early days. We really have an epidemic that affects poor people of color, women, drug users -- these entities and groups that don’t have access to the mainstream media the way that other groups might. There is a degree of racism here. Politically these groups aren’t putting this in the face of American media because they politically don’t have as much power.

I think that’s really changing now. As a result of the resurgence of global activism, you see a refocus on the epidemic here in America. Recently in Washington there were a number of activists who came together in the wake of Bush’s re-election to say, “We have a huge problem. There are huge cuts and there’s a conservative agenda that is driving prevention. The Bush admin is pushing abstinence both globally and domestically. All these agencies in different states don’t have the money for their programs. There are waiting lists to receive the drugs. AIDS drug assistance program. It’s a crisis moment.”

So there is an exciting campaign started by AIDS activists who were very involved in the early days and who are now the heads of institutions that are driving the response in this country. The Campaign to End AIDS is based on the 1968 poor people’s campaign led by Martin Luther King Jr. It’s going to involve lobbying in Washington and national caravans that go by key states where there are really important legislative battles around AIDS. There is a globalizing and rejuvenating of the AIDS movement at the very grassroots level. And it’s a cross-issue movement reaching to faith-based organizations, the labor movement, the social justice movement, the women’s health movement saying we need to make common cause. The AIDS movement is part of the issues of public health and the welfare battle affecting poor people of color. These are the people who need our assistance now. This is our movement and we need to really come together and put some pressure on Washington as well as local and state levels.

Housing Works is organizing a march from New York City to Washington, DC – 20 miles a day – camping in the basements of churches. It really is based on the civil rights model -- lots of African American leaders involved. They’re following the civil rights routes from Memphis to Washington. The strategy is to go after local media and make the national media pay attention as we move from state to state en route to Washington.

That is starting now. May 5-8 Washington lobby. Caravans in September. They’re hoping for an encampment of 2,000 people for a month in Washington. We’ll see what happens -- it’s a very ambitious campaign [with] The energy of the early days of ACT UP and the energy of people who have been despairing and beaten down by the Bush re-election but are turning around and saying its time to take our gloves off and really focus on where we need to go during and after Bush… and put in place a movement now which is energized, focused, talented and strategic and that makes something happen. So we can hold the line now and fight against all these budget cuts but really put forward an agenda which demands money for condoms, and programs which really reach the needs of women and people of color. It’s gonna be a fight which people are up for. It’s good to see this generation of activists who have really been dispirited in the past year rallying.

It’s certainly a result of this last election. People put out a great deal of energy out to get someone other than Bush elected, and failing was a great wake-up call for everyone to get serious, to take things to the next level and to build coalitions, for example .

I’m working on integrating women’s issues into the [C2EA] platform. And I think it’s critical to document this campaign on film -- it’s the successive campaign to our film of the international movement. It would be the twin of PILLS PROFITS PROTEST. I haven’t talked to Ann Rossetti yet but I know that it will happen - whether we do it or someone else does -- there will be a film that documents this.

Our film ended on the note that there is a challenge – there is all this international movement, but we need a resurging domestically. And now we’re beginning to see the result of this call happening in us. Really history in the making. It’s exciting to document something that as you’re reflecting on it you’re contributing to people’s understanding and it’s going to continue to inspire new people.

LS: It’s so great that it’s happening and the content is definitely there. It’s interesting from a filmmaking perspective that you’re basically planning a movement that will be the substance of your next film. You’re so driven and focused and always reached out to individuals and doggedly pursued change.

Copyright Action = Life & Larin Sullivan, 2005.