The all-pervasive neoliberal culture of the past decades has affected women even more than men. Women have not only continued to earn less than men, to have less access to paid work and to carry the burden of unpaid domestic and agricultural labour, but, in their responsibilities for the young, the sick and the aged,  have also suffered most from drastic cuts in social services. However, neoliberal policies have been countered by the growth of anti-global social movements, many led by grassroots women.  

The myriad varieties of globally connected social protests that have emerged since the late 1990s suggest that many people can still envision “the commons” as a public right even as, in much of the world, this public right is under assault. Nowhere has this been more evident than in the struggles for treatment access for AIDS. This history was clearly outlined in Ellen 't Hoen's UNITAID presentation "A Proposal for Change: Managing Patents for Access to AIDS Medicines for All" at the Conference plenary today. 

In 1994, at the creation of the World Trade Organization, Trade Related Intellectual Property Regulations ( TRIPS ) were introduced as part of the shift to global governance and the extension of the reach of global corporate influence. Although many countries of the global South have historically been relaxed in the enforcement of copyright and other such laws, nations that refused to go along with the new stipulation were now threatened with sanctions through loss of investment and the inability to export goods. In the finding and patenting of new drugs, the new intellectual property laws allow corporations to turn common goods into private commodities. TRIPS then protect corporate profits in the subsequent sale of the medications by preventing local manufacture.

Patents, newly enforced on an international level, allowed corporations to prevent the manufacture of generic drugs and deprive needy people of life-saving medications. With respect to HIV and AIDS, as well as many other diseases, global protesters began to question the right of pharmaceutical corporations to use the new international patent laws to remove their research findings from the public realm. As a measure of the success of these struggles, many corporations negotiated lower prices for specific medications for poor countries. Meanwhile, they continued to expand the global reach of patent regulation to ensure their profits for the long term.

Hoen mentioned the International AIDS Conferences in Vancouver 1996 and Durban 2000 as key moments for treatment action demands. However, public health activism for access began to percolate in 1998 - following the major anti-global demonstrations in Geneva. In May 1998, at the Conference in Geneva, health activists met - including Alan Berkman, the late visionary activist who helped to form HealthGap - the nascent South African Treatment Campaign, ACT-UP and other groups, to fight to make AIDS drugs available to all in the global South. Although  Hoen pointed to TRIPS negotiations, she did not delineate the interrelations between demands from the global South.  

One of the major issues that has emerged on the “anti-global” stage has been the question of fair trade and agricultural subsidies. A central controversy concerns how much farmers in poor countries are paid for their produce. Agricultural tariffs set by wealthy Western governments combined with the subsidizing of Western agriculture, in general, force down the prices for farmers in poorer countries.  

TRIPS, which, limit poor people’s access to both indigenous herbal remedies and HIV drugs, have featured as a central bargaining chip in global policy decisions. With respect to agriculture, as it has been with many other issues, negotiations about TRIPS and life-saving pharmaceuticals have been juggled with the need to reform agrarian tariffs. In some instances, poor countries have had to choose one or the other. At Doha, after the 9/11/2001 attack on the World Trade Center in New York City heightened fears of terrorism, an emergency demand for vaccinations and medications on the part of Western nations led the WTO to negotiate with respect to pharmaceutical patents while refusing to discuss agricultural subsidies.

 In contrast, in October 2004, India was forced to abide by WTO patent regulations in exchange for agricultural trade agreements. Since India is a major world supplier of generic HIV drugs, this decision contributed to higher prices.  Hoen has shown us the way in which public health demands have not only rewritten the history of TRIPS and drug availability over the past two decades, but they have paved the way for new civil society institutions such as the Global Fund and cooperation around health emergencies.  Now in 2010, Hoen clearly demonstrated that we still need to do battle to fight the narrowing opportunities for the production of generic AIDS and other drugs, as India is conforming to new patent laws, more people are contracting HIV -  particularly more young women – and, as their bodies build up resistance to earlier drugs, second and third wave drugs are becoming crucial to people's survival.