As 15,000 scientists, policy-makers, advocates and People Living with HIV/AIDS gathered in Bangkok for the 15th International AIDS Conference, a rising chorus of critics were challenging the strategy of President Bush’s Emergency Plan for AIDS Relief (PEPFAR). Randall Tobias, US Global AIDS Coordinator, and other US officials in Bangkok faced daily protests in Bangkok on issues ranging from the purchase of generic drugs through the President’s AIDS Plan to its highly controversial focus on abstinence-based prevention programs. "The international community has come to Bangkok under the banner of ‘Access for All’, but all too often the Administration’s AIDS plan is undermining this critical goal," said Salih Booker, Executive Director of Africa Action.
Equity and HIV/AIDS
"We, economists, public health experts and policy makers involved in the fight against AIDS are committed to scaling up access to health care including ARVs for HIV positive people. We consider it a rational economic decision and an absolute priority. The goal set by WHO is to have 3 million people on treatment by the end of 2005. What it will cost, who will do it and how it will be done is still being debated and we have much to learn. There are, of course, major concerns around the scaling up of access to treatment; how can these programs improve the uptake? How can they reach the most vulnerable and poor populations? How can they achieve a high level of adherence to ARV treatments in order to avoid the spread of resistance? This declaration sets out a principle we all should subscribe to and apply: the principle of a comprehensive minimum package of treatment provided for free to all the people living with HIV / AIDS."
AIDS drugs can dramatically increase survival for patients in poor countries but further drug price cuts are needed for patients who develop a resistance to the initial therapy, Medecins Sans Frontieres says. The independent humanitarian relief organization treats 13,000 patients in 25 countries. It says patients receiving antiretroviral (ARV) drugs have an 85 percent chance of being alive two years later.
"Malawi, Mozambique, Swaziland, and South Africa have some of the highest HIV/AIDS burdens in the world. All four countries have ambitious plans for scaling-up antiretroviral treatment for the millions of HIV-positive people in the region. In January 2004, we visited these countries with the intention of directly observing the effect of AIDS, especially on health systems, to talk with policy makers and field workers about their concerns and perspectives regarding the epidemic, and to investigate the main issues related to scaling up antiretroviral treatment. We found that financial resources are not regarded as the main immediate constraint anymore, but that the lack of human resources for health is deplored as the single most serious obstacle for implementing the national treatment plans."
In late 2003, largely as a result of pressure exerted by TAC, the government formally committed itself to rolling out HIV treatment. This policy shift has posed several questions related to TAC’s interim and long term political future, given the reality of the roll-out. Will the ‘centre fail to hold’ as factions emerged in the politically ‘broad umbrella’ social movement that is TAC? Will it simply become a service-delivery focused NGO working for the Department of Health? Will the government’s commitment to HIV treatment policy reform lead to TAC’s co-option? Will it render itself obsolete through its own success lobbying for wider HIV treatment access?
"Yesterday, July 11th, at the opening of the Conference, UN Secretary-General, Kofi Annan, used the words "a terrifying pattern" to describe the toll that the pandemic has taken on the women of the world, and the women of Africa in particular. He was both scathing and unsparing in his characterization of male behaviour which has led to the carnage. In the process of his remarks, he talked particularly of the vulnerability of young women and girls in Africa, the 15-24 year-old age group, and then noted that on a world-wide basis, the numbers of women and girls in that age group represented nearly two-thirds of the total infected."
Ongoing coverage of the International AIDS Conference in Bangkok is bewildering to those who are familiar with the current political battles in the HIV/AIDS arena, and no doubt disheartening or annoying to those reading from a distance. The AIDS industry is in full swing: government forces delivering glittering generalities; actors and ex-presidents discussing their "outrage" while eating five-course dinners in Bangkok hotel penthouses.
Multivitamins costing $15 per person per year significantly reduced the risk of HIV disease progression and death in HIV-positive pregnant women in Tanzania, according to a study published in the July 1st edition of the New England Journal of Medicine. The investigators conclude that multivitamins would be a cheap, simple, and effective means of delaying the need for antiretroviral therapy in HIV-positive pregnant women in resource limited settings. An accompanying editorial praises the rigour of the investigators study, and although it calls for further studies into the benefits of multivitamins involving large populations it says that treatment programmes and doctors would be justified in offering multivitamins.
"The introduction of antiretroviral drugs will bring with it new challenges because this treatment is different from that for opportunistic infections, palliative care, home based care and cotrimoxasol prophylaxis which we have been providing and will continue to provide. It is different in the sense that these drugs are delicate, have a variety of side effects and have to be taken regularly and correctly for life. However, I am confident that Uganda will succeed to roll out this treatment to our people."
The GAIN Issues Brief is being launched in response to a perceived gap in current news analysis on the issues of HIV/AIDS, its implications for democracy and governance in Africa, and the challenges of ensuring that the response to HIV/AIDS is consonant with democratic principles. This Issues Brief is a product of the African Civil Society Governance and AIDS Initiative (GAIN), launched in October 2003. The aim of this Issues Brief is to provide civil society activists, journalists and policymakers with a concise analytical digest of developments in the field of HIV/AIDS, governance and democracy.