Bill Clinton and Nelson Mandela promise to lead peer education among political leaders as world looks for $10 billion a year to fight HIV/AIDS

Graham McKerrow, HIV i-Base

On the Thursday evening of the conference former US president Bill Clinton was asked at a “town hall meeting” to act as a peer educator to make other world leaders respond to the AIDS crisis. The next day he told perhaps 10,000 delegates at the closing ceremony: “I pledge that in every speech I make and in every meeting I have I will raise this and I ask you both to hold me accountable to that pledge and to tell me what more I can do.”

Speaking from the same platform as former South African president Nelson Mandela, Clinton added: “President Mandela and I have agreed to work together to launch the World Leaders AIDS Network … to raise the global commitment to end AIDS.”

The first 12 International AIDS Conferences were focused on the scientific work to develop treatments, and the 13th conference, two years ago in Durban, directed attention towards the need for political leadership to confront the AIDS crisis in developing countries. The 14th conference, held in Barcelona, Spain, in July, highlighted the need for world leaders to make sure there were sufficient resources to respond to the epidemic.

Most estimates put this at $10 billion a year. Some people said it was more like $25 billion.

Political leaders stayed away from the Durban conference as poor countries ignored their own problems, and the host, President Thabo Mbeki, was booed for questioning the link between HIV and AIDS.

This year countless presidents, prime ministers, former presidents and former prime ministers and ministers of health attended the conference. A list of just some of them appears at the foot of this article.
During the conference, Dr Denzil Douglas, the prime minister of St Kitts and Nevis, announced that he had signed an agreement on behalf of 14 Caribbean nations for the cut-price purchase of antiretroviral drugs from six pharmaceutical companies. For some of the supplies, the companies promised to match the lowest prices in the world.

Many debates included speeches from the platform or from the floor by serving ministers of health such as Sam Ongeri, the Kenyan minister of public health, and Assana Sangare, the AIDS minister for the Cote d’Ivoire.

But it was not only poor countries that were represented. Tommy Thompson, the US secretary of health, gave a speech, although it was made inaudible by shouts and whistles from protestors. A copy of his speech distributed afterwards said that America was doing more than any other country to combat HIV/AIDS, but he made no new promises.

The lobbying group Health GAP (Global Access Project) criticised the US for paying a smaller percentage of its GDP to the Global Fund for AIDS, TB and Malaria than were poorer nations like Uganda.

Health GAP led much of the protest at the conference and focused on companies like Anglo American, the largest mining company in South Africa, and Coca-Cola, demanding that they do more to provide access to treatments for staff in poor countries.

ACT-UP protesters trashed pharmaceutical company marketing stands in a routine manner that attracts less attention at each passing conference.

Several hundred people attended a rally and march on the eve of the conference, at which a ‘Barcelona Declaration’ was unveiled demanding donations of $10 billion a year for fighting AIDS around the world, antiretroviral (ARV) treatment for two million people in the developing world by the time of the International AIDS Conference 2004 in Bangkok, lower ARV drug prices in the developed world and universal access to drugs in the developing world by 2004.

One speaker at the end of the Durban conference said it had seen “activists become scientists and scientists become activists.” The Barcelona conference saw the political baton seized by an even more appropriate group: politicians.

Nelson Mandela walked onto the stage at the Palau St Jordi for the closing ceremony, supported by a walking stick in one hand and holding Clinton’s arm with the other.

Mandela said: “AIDS is killing more people than all the wars in history and natural disasters. AIDS is a war against humanity. This is a war that requires the organisation of entire populations.”And he said that there was a growing number of children being orphaned by AIDS, and added: “I ask all leaders of the world: is it acceptable? We know that there are treatments available to stop TB and help AIDS sufferers for several years at least but these parents had no access to treatments. Is this acceptable? The answer is no. We have to make this treatment available to everyone who needs it, regardless of their ability to pay.”

Mandela outlined three challenges for the world. The first was for all institutions, public and private, to make real and rapid progress on achieving access to treatment for all people who need it regardless of their ability to pay.

His second challenge was that testing should be available to all: “If HIV testing is not available free of charge you must demand it. It is your right to know.” He also said businesses should not humiliate people by testing them openly.

Mandela added: “My final challenge is to leadership. When leadership starts at the top it is more effective.” But he made clear this was not only a call to political leaders, but also to business leaders, trade union leaders, religious leaders and the leaders of NGOs.

He said: “I am calling on all leaders in the world today to ask themselves what they have done to limit the AIDS pandemic, and whatever they have done or not done, they must do more.”

At the end of his speech he spoke directly to political activists – as someone who has been an activist all his life. He said – “You have my greatest admiration. Keep on fighting and you will overcome.”

Clinton told an audience of 1,000 at the town hall meeting that the rich countries simply had to foot the bill for fighting the pandemic. He seemed to suggest a regional response would be appropriate when he said that the US and Canada should provide the money to enable the Caribbean to respond to the crisis, “to bridge the gap between the cost of treatment and what the countries can afford.” He said: “You should come to us and we should pay.”

And he urged countries to negotiate lower prices with the drug companies and said that if the deals offered by the companies were unsatisfactory they should buy from generic manufacturers in Thailand or India.

Clinton told the closing ceremony: “Developing countries have to work out how much they can pay and send the rest of us the bill for the difference.

“Leaders everywhere must move aggressively to remove stigma and denial. There are still people who think people living with HIV/AIDS are people who are different. Yes, they are sex workers, and poor and often gay men … but they are also our friends.”

Other politicians who addressed the conference included: Kim Campbell, former prime minister of Canada; IK Gujral, former prime minister of India; Paul Kagame, president of Rwanda; Pascoal Mocumbi, prime minister of Mozambique; Ali Hassan Mwinyi, former president of Tanzania; Jorge Sampaio, president of Portugal; Meechai Viravaidya, senator from Thailand and UN AIDS ambassador; Marcus Bethel, minister of health of the Bahamas; Henri Claude Voltaire, minister of health of Haiti; Jerome Walcott, minister of health for Barbados; Mrs Graca Machel, Southern African activist; Barbara Lee, US Congresswoman and Crispus Kiyonga, former minister of health for Uganda and now chair of the Global Fund to Fight AIDS, TB and Malaria. Another speaker was The Most Reverend Njongonkulu Ndungane, archbishop of Cape Town and metropolitan of the Church of Southern Africa.

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