Mbeki vs. the AIDS Establishment... (16)
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DURBAN
We have to thank President Mbeki for asking questions, not about HIV,
but about everything else.
Thanks to his attitude, for the first time in ten years there were
actual DEBATES in an international AIDS conference: debates on ge-
neric vs. brand, for or against parallel imports and compulsory li-
censing, debates on attempts to provide full ART care to AIDS pa-
tients/vs. building up infrastructure and decreasing other diseases
first, and many other crucial policy topics, everyday of the confer-
ence.
All the participants I interviewed in the hallways agreed with me: it
was the best conference ever, people from the North felt touched by
the proximity of the epidemic, by the poignancy of the policy debate,
by raising obvious issues: AIDS is not just a health problem, it is a
development problem (and Piot said it better than anyone on Thursday
night in a moving speech), the solutions cannot be said to be just
"scientific", they entail a demand for rethinking international and
national economic policy.
It was unlike Geneva, Berlin or Vancouver, interesting conferences
but further away from the actual fight against the epidemic, and
WITHOUT DEBATES, asserting there was a near cure, that the AIDS prob-
lems was over, "an obscenity" said Phil Wilson, President of the Af-
rican American AIDS Institute.
Contrary to what the some media portrays at times, there was no de-
bate whatsoever on the cause of AIDS being HIV.
In reality the real debate has been:
A. Should the high rates of HIV/AIDS in South Africa and SADC coun-
tries generally be blamed on excess promiscuity and government fail-
ure to promote condoms?
B. Should the high rates of HIV/AIDS be blamed on existing diseases
as co-factors and on poverty?
Why are the governments of Senegal and Ouganda portraied as "exem-
plary" in the fight against AIDS? Do AIDS patients get efficient tri-
therapies? No. There has been one clinical trial on dual therapy in
the context of the UNAIDS program, and it is a failure like the one
in the Ivory Coast. Is there systematic treatment for MTCT? No, there
has been one good clinical trial, so far.
The fact that their statistics look "good" means just that: good
looking statistics. Both societies have had extremely different
socio-political conditions from those of South Africa, which has
lived through a revolution and the break down of apartheid, leading
to increased mobility of the population. South Africa has also a much
better, and much more scientific epidemiological surveillance of HIV
through the monitoring of anti-natal clinics than any other African
nation. The problem faced by South Africa is that the economic system
of apartheid still exists de facto and, so far, the government has
not been able to resorbe extremely high unemployment. The Black
masses are poor, desperately poor. There is a lot of tuberculosis and
a lot of malaria, and they are CO-FACTORS FOR AIDS. Meeting Anthony
Fauci in the hallways, I told him: "In the context of the debate ini-
tiated by Mbeki, it would have been good to hear you speak on the is-
sue in the plenary". He replied: "you mean the study of Goletti? I
don't think it is necessary; EVERYBODY KNOWS THAT TUBERCULOSIS AND
MALARIA INFECTIONS ACT IN SYNERGY WITH HIV". This just means that
people infected with TB or syphilis (AFRO-NETS's Sunday posting) or
malaria, if they get sexually infected with HIV, will tend to have
high viral load which will make them much more likely to transmit HIV
through sexual or blood contact. Everyone knows the risk of contract-
ing HIV through one sexual contact depends on viral load, the risk
can be less than 1/1000 or can be a hundred, a thousand times
higher...It makes the epidemic travel much faster.
When South Africa joined the World Trade Organization in 1996, it
adopted a rather austere economic policy, called the Gear program.
Furthermore, the financial crisis hit the economy very hard. Mbeki
followed the precepts of the international economic thinkers, but did
not get the billions he expected in investments.
If the AIDS problem appear so immense today, it is not for lack of
"good behavior" on the part of the authorities who toned down the
militant stand of earlier years to bring itself in agreement with in-
ternational expectations on economic policy. The only "resistance"
has been on the issue of compulsory licensing and parallel imports.
The other "weird" statement is that which pretend that the only thing
in the way of successfully fighting the epidemic is government's bad
will. It is not easy to envision chronic disease highly expensive
treatment for upwards of 25% of its young adult population. Realisti-
cally, it is momentous. I do feel that MTCT prevention with nevirap-
ine should be implemented as rapidly as possible. But we also should
think about orphan care now; perhaps Alan Whiteside's call for gov-
ernment funded "foster parents" would be a solution. It seems to me
the debate should be what economic policy would allow for governments
to best fight AIDS? I am totally allergic to Duisberg's theories, but
I did not see anybody wasting time on this question during this great
conference; and Mandela made everybody cry at the conclusion.
G. Upham
Journalist
France
mailto:g_upham@club-internet.fr
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