Treatment access and community responses: online webcasts and debates

9 September 2006. Related: Conference reports, Treatment access, World AIDS 16 Toronto 2006.

Many of the important sessions relating to healthcare policy and treatment access are available as webcasts, podcasts and transcriptions from kaisernetwork.org.

The selected edited quotes below give an indication of the speeches and wider discussions, and are all available online:

http://www.kaisernetwork.org/aids2006

Loon Gangte

“Let me hear the voice of people living with HIV/AIDS. Universal access and health is a human right. It’s immoral, unacceptable, unjust and outright genocide, when the rich people can buy life, while poor people are condemned to unnecessary, untimely and unjust death. We demand universal and free access to all essential medicine. People before trade! To all the government officials here, please remember that when you sign for free trade, our lives are at stake.”

Loon Gangte, Delhi Network of People Living with HIV

Closing session – ‘one-minute’ address

Friday 18 August, 2006

Gregg Gonsalves

“Peter Piot told the New York Times earlier this year that „“2005 was the least bad year in the history of the AIDS epidemic.” But I am telling you today that we are losing the struggle against this disease. 5 million new infections last year, and 3 million dead, among them half a million children gone. It was the worst year yet for those we’ve lost.

I shan’t offer attempt a comprehensive analysis of 25 years of HIV/AIDS in seven minutes and thus I will make three brief points hopefully to start a conversation rather than end one. The first is about the often misdirected energies and efforts, and the paralysing effects, of the international AIDS bureaucracy; the second is the familiar but indispensable point that AIDS is both a consequence and a symptom of wide and deep global injustice; the third is to take issue with some dear colleagues, and others I respect, about the push to ‘re-medicalise’ AIDS and why we must be careful in this regard not to cast AIDS as yet another intractable social ill, drain it of political significance and give up the fight when we really need to be taking the struggle to the next level.

…We need to reinscribe the fight against AIDS as part of a larger movement for social and economic justice. Our heroes knew and know this. It’s no surprise that where we find HIV/AIDS, we often find other infectious and chronic diseases, including TB, diabetes, obesity, heart disease, asthma, mental illness and social epidemics of crime, violence and poverty. Unless we start looking at the factors, the root causes that drive health disparities – in other words, why some of us get sick and some of us don’t – broadly within our communities, we will be always treating one illness, while the ‘patient’ dies of another. It’s also no coincidence that these multiple epidemics exist among marginalised communities across the globe, among the poor, women, drug users, sex workers, gay men, prisoners, migrants – the social, economic and political policies that create this marginalisation in the first place also push us into the path of oncoming epidemics. Yet, we continue to place our hopes in prevention programs that narrowly construct risk around individual behavior or in some new technology that will save us….

…We are at a terrible anti-political moment right now, where the powers-that-be have taken our rhetoric and told us that everything is fine-we’re on your side-you can demobilise and leave the epidemic to us. That is the pernicious message of this conference. Don’t believe a word they say.”

Gregg Gonsalves, AIDS and Rights Alliance for Southern Africa

Session: 25 Years of AIDS ˆ Reflecting Back and Looking Forward

Wednesday, 16 August 2006, 12:45 – 13:45

Stephen Lewis

“…we must continue to roll out treatment. Treatment is keeping people alive; treatment is bringing hope; treatment is stimulating prevention; treatment is meshing more and more frequently with community-based care; we cannot let the process slow.

While I am on the issue of treatment, I am bound to raise South Africa. South Africa is the unkindest cut of all. It is the only country in Africa … whose government is still obtuse, dilatory and negligent about rolling out treatment. It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state. Between 600-800 people a day die of AIDS in South Africa. The government has a lot to atone for. I’m of the opinion that they can never achieve redemption.

There are those who will say I have no right, as a United Nations official, to say such things of a member state. I was appointed as Envoy on AIDS in Africa. I see my job as advocating for those who are living with the virus, those who are dying of the virus … all of those, in and out of civil society, who are fighting the good fight to achieve social justice. It is not my job to be silenced by a government when I know that what it is doing is wrong, immoral, indefensible.

…Unbeknownst to many, we are on the cusp of a huge financial crisis in response to the pandemic. I think we have been lulled into a damaging false security by the fact that we jumped from roughly $300 million a year from all sources in the late 1990’s, to $8.3 billion in 2005. And indeed it sounds impressive. But, we need $15 billion this year, and $18 billion next year, and $22 billion in 2008. Any straight line projection will take us to $30 billion in 2010 … the moment of universal access to treatment, prevention and care. We’re billions and billions short of those targets. If these circumstances continue, universal access is doomed. All governments, as they continue to expand their treatment and prevention initiatives, are spooked by worries of financial sustainability. They’re right to be spooked. The financial promises made at the G8 Summit in Gleneagles one year ago, are already unraveling. We will never accumulate the extra $25 billion for Africa by 2010 as was committed.

PEPFAR has not yet announced its extension beyond 2008; when it does (as it surely will), the annual contribution, given the other demands on the US Treasury, will probably remain at $3 billion a year. That large amount was a very significant percentage of the total expenditure on AIDS back in 2003/2004. But as a percentage of what is needed for global AIDS programmes in 2008 – $22 billion – $3 billion seems pretty paltry from the world’s superpower.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is still half a billion short this year and more than a billion short next year. At the moment, there is no obvious way to close the shortfall. It is almost inconceivable that the extravagant promises of Gleneagles are revealed as so fatuous that the Global Fund is now compromised. No one is asking for any more than that which was promised. But the Pavlovian betrayal of the South has already begun. Everything in the battle against AIDS is put at risk by the behaviour of the G8. Yesterday, Dr. Julio Montaner characterized that behaviour as genocide. I remember back in 2001, in an op-ed for the Globe and Mail, I used the phrase mass murder. It’s hard, in the face of the annihilating human toll, not to be driven to linguistic extremes. This issue of resources makes or breaks the response to the pandemic. It is imperative that the delegates here assembled never let the G8 countries off the hook.”

Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa,

Closing session, Friday 18 August 2006

Mark Wainberg

“…I also want to remind you all that this conference cannot be deemed a success unless we collectively realise our theme of Time to Deliver. Indeed, we will have failed unless we dramatically and rapidly expand by millions the numbers of people around the world with access to antiretroviral drugs. Clearly, progress cannot be achieved if more people continue to become infected by HIV each year than the numbers that are able to access treatment.

In this context, we also recognise the problem that is sadly posed by HIV denialists. And it is correct that we ask how many additional millions of HIV cases are attributable to the failure of certain world leaders to directly and honestly address issues of HIV/AIDS with their people.

In South Africa, as an example, which has more cases of HIV than any country in the world, it is unconscionable that government leaders still do not speak openly about HIV and instead talk about lemon juice as a key prevention strategy. We all know that such talk about lemon juice as a mode of HIV prevention is scientific nonsense. Why don’t the government leaders who need to impart critical messages to the vulnerable people of their country also understand this basic fact?”

Mark Wainberg, President IAS, Conference Co-chair

Closing session, Friday 18 August 2006