The setting of this conference in South Africa, a country with more HIV-positive people than anywhere else in the world made it hard for us to ignore its context and merely concentrate on the scientific data. We were certainly not alone, indeed at the closing address; Stefano Vella described the conference as ‘less of a clinical meeting and more of a political one’ and spoke movingly about upholding their decision to hold it in Durban despite some opposition, ‘mainly from those who are not here’.
It was a week of uplifting, eloquent, angry and emotional (and not so great) speechmaking. At the opening address President Mbeki successfully skirted round the practical issues and necessary interventions to combat AIDS and talked at length about poverty.
Undeniably, poverty aids the spread and inadequate treatment of disease, including HIV. Poverty produces conditions which facilitate the spread of the virus and makes currently available antiretrovirals a difficult, if not impossible, option. Prevention campaigns cannot succeed when poverty focuses the mind on the here and now, the next meal. Planning for the future becomes an impossible luxury. Poverty prevents access to treatments through lack of infrastructure, lack of a means to pay for treatments, and the public health and social difficulties which follow limited interventions.
The UNAIDS announcement of free supplies of nevirapine to reduce mother-to-child transmission was welcomed by many. But who will pay and care for the additional hundreds of thousands of babies saved from HIV-infections whose mothers remain untreated and condemned to certain disease and death. Intimacy with the struggles and peculiarities of the African situation allowed Mbeki to hint at the complexities and seemingly insurmountable barriers to alleviating the impact of AIDS in Africa. Complexities often overlooked by those demanding uncompromising access to treatment.
Concentrating on the wider issues has a tendency, however, to paralyse action. Action, which on an individual level can be immensely important. This perhaps is Mbeki and the South African governments dilemma.
Mbeki also neither defended nor refuted his recent interest in dissident theory disappointing many. ‘One bullet, one dissident’ declared one rather unambiguous slogan, displayed at a demonstration prior to the conference demanding more government action. Here it was particularly heartening to see important US treatment activists from TAG and Project Inform reclaiming their grassroots and marching with placards. And, although perhaps with motives that were not entirely spotless (two fingers to the government?), we heard Winnie Mandela’s words much lacking from her compatriot’s speech, ‘HIV causes AIDS’.
In his closing address Nelson Mandela, speaking to a packed auditorium, commented that those infected must ‘wish that the dispute be put on the back burner’, and wisely pleaded for a ‘move from rhetoric to action’ to stop the ‘terrible scourge of AIDS’.