E-drug: Act Up: Aids is War
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This article was released in Le Monde January 29, 2000
(distributed as fair use. HH)
AIDS in Africa: Exactly Which War Is That ?
On last January 10, one of our oldest slogans became the very official
watchword of a special meeting of the UN Security Council
concerning the devastation caused by the epidemic in Africa. There it
was, finally: "AIDS IS WAR"
That day, everyone contributed their own metaphore. For Peter Piot,
chairman of UNAIDS - the United Nations' AIDS agency - , "conflicts
and AIDS are linked like evil twins". And thus Kofi Annan, UN
Secretary-General, urges the Security Council - because the Council is
in charge of preserving peace - to make the international fight against
AIDS an "immediate priority".
James Wolfensohn, chairman of the World Bank, also gives in to the
rapture of the new rhetoric: "in AIDS we face a war more debilitating
than war itself because in so many countries it is seldom spoken of,
because it does not catch the headlines, because the voices of its
victims do not reach the corridors of power". Probably moved, Al
Gore, the US Vice-President and chair of the session, announced
exceptional aid from the United States: $100 million. The amount is
insufficient, everybody knows it and Mr Wolfensohn even mentions it:
"Every war needs a war chest, but that provided by the international
community is woefully empty". But there can be no doubt left in our
minds: in the future, fundraising is to mean army-raising... an army of
dollars.
And a strange conversion it is. When the keepers of world peace
assert that "AIDS IS A WAR", one should undoubtedly hear an appeal
to mobilization, which is closely akin to ours: AIDS kills, just as (and
more than) armed conflicts do. But above all one should hear, very
literally, a strategic concern which has very little to do with the
essence of our demands. AIDS, they explain, destabilizes economies,
causes indigence, and favours war; conversely, war, its violent acts
and disturbances, further the propagation of the epidemic. The
preservation of peace thus becomes a parameter of the fight against
AIDS, but it is the reverse which particularly concerns the UN: Mr Al
Gore says, "no one can doubt that the havoc wreaked and the toll
exacted by HIV/AIDS do threaten our security". In the opinion of the
Western nations, AIDS in Africa is only a war in so far as it threatens
the stability of the world - their world.
On last January 10, AIDS became a military staff hypothesis. We, Act
Up-Paris, are thinking of another, less abstract war. Its horizon is not
the "security" of worried nations, but the very basic, very dogged and
very precarious survival of people with HIV. They treat us now to the
geopolitics of HIV; geopolitics which are close, doubtlessly, to the
vital interests of countries, and therefore capable of unlocking safes,
but very far from the realities behind the disease. There lies the whole
issue: the stake of this "war" of the Security Council, is the epidemic,
not the dying sick and the persons still living with HIV. They seem to
only appear in relation to statistics, as virus carriers or potential
contamination vectors. It seems that the millions of people with HIV in
Africa are only good for the role of bugbears of the world contagion.
What observers have presented as a step forward may very well turn
out to be, on the contrary, a step backward: the return to a strictly
epidemiological view of the disease, the resurgence of official
suspicion toward persons with HIV, the relegation of care far behind
prevention. By making it subject to "the work for peace and security",
ie in the bureaucratic lingua, to "the politics of conflict prevention",
the United Nations, far from reorienting the world fight against AIDS,
are sinking it even deeper into the "prevention-only" disaster. For that
matter, James Wolfensohn has made no mistake about it. If he goes
as far as lecturing sponsors for being too niggardly, it's only to use
this new geopolitical emergency to refresh old World Bank creeds:
"We must put prevention at the center. We estimate that the cost of
prevention is between $1.5 and $3.5 per capita per year -- compared
to over $7 per capita per year needed for basic treatment -- and, of
course, the cost of treatment per patient is astronomically higher".
You can't get any clearer than that: to protect from the virus those
who have not yet been contaminated, who will assure tomorrow the
repayment of Debt as well as the stability of countries, even if it
means to sacrifice those already sick, who are considered too
expensive and forever lost as labour; even if it means to give greater
importance to prevention over access to treatments: to the epidemic,
over people with HIV.
Beyond the moral reserves aroused by this type of speech, this is first
of all miscalculation. " Prevention-only " programs have already
proved limited when it comes to prevention ! There is not one single
African country where " prevention-only " has permitted to curb the
propagation of the epidemic. Just because no prevention program can
be efficient nor credible without health care of the people affected: no
one can hope, in a context of extreme social rejection of people living
with AIDS - a rejection nurtured by the fact that these people are
provided with no care that PWAs will submit to the requirements of
prevention; especially when they know nothing of their serological
status and impose the use of condoms ( making themselves out
clearly as virus carriers). As long as the disease will remain a fate,
with no scope but death, nobody will ask for testing that would mean
anything to lose and nothing to gain. AIDS will remain a taboo
because you can cope with problems when you have the means that
for. But the United Nations are reasoning to high to be aware of what
is obvious. Many of us considered AIDS as health problem; we were
wrong. AIDS can't be confined to health and social fields any longer,
Mr Wolfensohn says.
Once again, it is crystal clear and totally wrong: AIDS has never been
considered in Africa as a question of public health. It has always
remained a question of prevention, that is, of security. Before being
apprehended as a disease, it has been dreaded as a danger from
which the Africans turn away because they are helpless before it. But
the chairman of the World Bank hammers it in: " we can estimate the
total amount necessary for prevention in Africa as high as $1 to $2.3
billion, and at the moment, Africa only gets $160 million official aid
against AIDS. " What about the necessary sums for testing,
prevention and opportunistic diseases treatment ? How much does it
cost to give AIDS a human face, to get to the end of the denial, in
Africa and inside the U.N. as well ? James Wolfensohn says nothing
about it. He takes up in full the UNAIDS chairmans speech at Lusaka's
Conference, who had said nothing more about it. So does Al Gore
whose aim is exactly the same as the others': prevention only. And if
they remain silent, that's because they refuse to get out of the denial
they intend to fight in Africa. If they spoke, they would be unable to
conceal the obscenely low sums invested to provide people affected
with health care. Actually, the " prevention-only " option is only taken
for strategic reasons totally disconnected with any efficiency's sake.
The January 10 event must thus be reinterpreted. The special meeting
of the Security Council doesn't reveal any awareness. It is not the
sign of a change from passivity to fight, not even of the gap between
the emergency and the parsimony. It marks the apotheosis of
overhanging geopolitics the PWAs have no part to, and the triumph of
blind macroeconomics where investments are linked to their
profitability for the sponsors, not to their efficiency on the health of
people. The real front of the fight against AIDS in the South is the one
opposing the supporters of " prevention-only " policies, which are
motivated by self-interest and anyway, lead nowhere and those who
claim for access to treatments by all means: compelling the
pharmaceutical industry to lower its drug prices, pushing the Northern
countries to grant funds to buy the drugs, and demanding that the
international rules allow the local production of generic drugs. AIDS is
a war; which side are you on ?
Act Up-Paris
Marie de Cenival
Planet Africa
Commission Nord/Sud
Act Up-Paris
BP287 - 75525 Paris Cedex 11
tel : 01 49 29 44 75
fax : 01 48 06 16 74
e mail : planetafrica@asso.globenet.org
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