SOURCE: AF-AIDS is the regional forum on HIV/AIDS in Africa, coordinated by the Health & Development Networks Moderation Team (HDN, www.hdnet.org) with technical support from Health Systems Trust (HST) on behalf of the AF-AIDS Steering Committee (HST, HDN & SAfAIDS), with the support of the Government of Ireland. Reproduction welcomed provided source is cited as follows: AF-AIDS eForum 2003: af-aids@healthdev.net Chairperson's hopes for ICASA By HDN Key Correspondent 13th ICASA, Nairobi, Kenya, 22 September 2003 ************************* Interview with Dr. D. M. Owili, Chairman of ICASA HDN: Why do you think that AIDS conferences are useful? Dr Owili: I think conferences can and should have a positive impact on HIV/AIDS. It is a forum where activists, scientists and clinicians meet to discuss and share what is happening around the world. When one person or group comes up with new ideas, then you can compare your weaknesses and strengths. Secondly, there is a lot of research going on in the North, due to their facilities, manpower and financial resources, so there is much to learn from there. The networking you can do at an event like this is incredible. You can exchange ideas and experiences with people you would not otherwise meet. HDN: What do you see as the overall goals for ICASA? Dr Owili: For one thing, we want to sensitise the scientists and African leaders in power to be more aware of the magnitude and impact of HIV/AIDS in Africa. Secondly, we want to bring in the community to be part and parcel of the fight. We want also to look at the HIV/AIDS network in Africa and to identify the key people, so we can talk with one voice; especially with regard to how we can collectively access HIV-related treatments. Treatment does not only mean antiretrovirals; it means various types of treatment and management, given our health and clinical infrastructure. Thirdly, we need to explore some of the challenges and how we tackle them as scientists, as communities, as leaders. Can we cover more ground by tackling them together? We also need to make sure that young people fully participate in the Nairobi ICASA. We know that, in many of our countries, the number of HIV infections may be starting to decline. But if we do not tackle HIV transmission among young people, we may well also see a future increase as new cohorts of young people becoming sexually active. We have to give young people the attention they need and deserve, and involving them directly in the conference is one of the best ways for them to express themselves, and make sure that the future plans are designed with them in mind.The overall goals of the conference are to hopefully take us one step closer to addressing many of these challenges. HDN: You said that the leaders, communities, scientists and doctors need to work more closely together - do you mean in Kenya or in the region as a whole? Take leaders as an example. Dr Owili: Having been the secretary of the Society for AIDS in Africa for some years, I have a broad idea of what is happening in many African countries. Having looked back at what we used to call the Organisation for African Unity - now called the African Union - I have come to realise that most of the African leaders never paid much attention to the epidemic, to research and to the management of people with AIDS-related conditions. It is only more recently - and I have to say this is limited to only a few countries like Uganda, Core d'Ivoire, Senegal and some others - who actually showed more interest and attention to AIDS. Now, we are seeing other countries like Kenya paying greater attention. Kenya actually declared AIDS to be a national disaster. We would like to see more sub-Saharan African countries, and north African countries - which are still largely in denial about the potential of an epidemic there - putting AIDS as a priority. Whenever there is a meeting of African leaders, or ministers of health or of finance, they should always put HIV and AIDS as one of their top agenda items whatever they are discussing - whether about war, economics, or inter-country co-operation. HDN: Can we move from having AIDS on the agenda of high-level meetings like NEPAD to translating that into real actions at the country level? Dr Owili: That is really why we think that the Nairobi ICASA will create something different, because we would not like HIV/AIDS to simply be on the agenda. We would like to push further, and say that it has to be discussed fully and implemented. And we don't expect this to happen unless we sensitise the people who matter - public health ministers and others. When they go to a NEPAD meeting in Addis Ababa, they should be taking an expert on HIV with them. Let's face it, ministers are not necessarily chosen because they are doctors, or researchers, or because they necessarily have experience in respective areas - they are usually political appointments. In every area advice is essential, and HIV/AIDS is no exception. HDN: Could you tell us about the general features of the conference: Dr Owili: When we started to organise the conference, we had a bit of a problem in that the old government was still in power. Once the new government was elected, we more or less had to start the process over again in February this year. The new ministers are very understanding and giving all their support to the conference - particularly the minister responsible for HIV/AIDS in the office of the President. We also know there have been some concerns about terrorism - but we should not think this is simply a threat here in Kenya - it is a global problem in today's world and we have to be vigilant everywhere. We are also working very closely with our minister responsible for security. Of course there must be a fairly standard format for a conference of this kind - otherwise people cannot find there way around such an event. We have some additional features, such as interactive roundtables, where we hope to encourage active discussions among different groups of the issues that most affect them. More participation by people in the audience should really give people a chance to air their views. HDN: Are there any specific African countries, or communities or sectors that you especially hope will bring their experience into ICASA? Dr Owili: The conference is aimed at involving all African countries. We know that some countries are much further ahead than others in terms of the response, research and of prevention efforts. There are others who are just really beginning and moving very fast, such as in Botswana. Yet others are ignoring AIDS to a large extent and still are in denial. We want is to sensitise the whole spectrum of countries -AIDS is a threat to our whole region, and we must all be alert. Being alert means knowing what is happening, and that can only happen during this type of forum. We are expecting most of the African researchers, doctors and people living with HIV. The problem we face, of course, is that many people simply cannot afford to come to a conference of this kind. It is unlike meetings in Europe, for example. This is the main problem with who can take part. Let's not forget that this was why we decided in 1987 to hold the ICASAs in Africa. When they started, they were in Europe of course; first in Belgium, then Italy and then in France. It was in Marseille when all of the African participants met and said that this is an African conference, we must move it to Africa. We moved to Arusha in 1988. Finally, every country in Africa has a strength - it might be the research base in Kenya; success with tackling stigma in Uganda; early efforts to expand access to treatment in Senegal - every one has something to bring. This year one country may be setting the pace and next year it will be another. If we continue to learn from one another, and from the front-runners in particular, we can make the most of all of these strengths in order to solidify our human, financial, and infrastructure resources, political will, knowledge and understanding. The goal of ICASA is to bring these strengths together to be discussed and shared. HDN: What was the best AIDS conference you have attended? Dr Owili: Well, I have attended nearly all of the important AIDS conferences. I only missed the one International AIDS Conference held in Japan. I found that the South African AIDS Conference in 2000 was really good. It was where the epidemic was happening, for a start. But also, nobody really thought that such a big conference could be successful in Africa. Even despite the attitude of the South African President at the time, it went along very nicely. It was a chance for most of the African scientists, sociologists and other specialist to come together. It was a great conference. HDN: Finally, what would you say to the many people from around Africa who cannot come to ICASA in person? Dr Owili: For the first time, we are focusing on providing information from the conference to as many people as we can - whether they will be there in person or not. We have to make sure as many people and communities as possible benefit from the discussions.If you cannot come to ICASA yourself, it doesn't mean you can't benefit through the internet, the media and the conference report. You have not been forgotten! ON THE KENYAN RESPONSE TO HIV/AIDS HDN: What stage in the response to AIDS in Kenya at today? Dr Owili: Our thinking has changed, and Kenya's response to AIDS has recently changed. The new government is so concerned about democracy, about openness - you can even criticise the President. You must understand this is completely different to what we were used to before, despite AIDS being declared a national disaster around two years ago. The President talks about HIV at almost every opportunity. He was the Minister of Health before he became President, at that makes a big difference. Initially it was so difficult to work on HIV/AIDS in our country. In Kenya today, the incidence of new HIV infections are beginning to fall. People feel more free to talk about issues and problems that they face, and it means we can talk about HIV transmission and about sexual behaviour too. Like many other countries in the region, we may have given HIV/AIDS the appropriate level of attention later than we could have - like many countries still, we needed information and knowledge in order to be sensitised to the problem. HDN: What is the greatest success of the response to HIV/AIDS in Kenya? Dr Owili: Well, I think we have to thank WHO for its Global Programme on AIDS - they and other bilateral donors helped us by providing the resources and guidance to set up the National AIDS Programme in Kenya. At the time, most people did not want to get involved with HIV/AIDS - there were even doubts about the modes of transmission. But once our people started to see their brothers, their friends, their children dying of AIDS-related conditions, then they began to realise this was real, and the national programme we put in place a long time ago can achieve a great deal. We cannot talk about increasing awareness of HIV among Kenyans, without recognising that even now, however, HIV-related stigma is still one of our biggest problems - and that includes in the clinical setting. If someone dies of an HIV-related condition, it is not uncommon for their death certificate to read that they died of a given complication - respiratory failure, for example - rather than mentioning HIV/AIDS specifically. You have to read between the lines of the obituary columns in The Nation in order to find an indirect reference to HIV. This prevents indirect stigmatisation of surviving relatives. If we could remove AIDS-related stigma, our people and our national AIDS programmes would be free to achieve much more. HDN: Kenya is perceived to have a very strong AIDS research base and academic record - would you agree with that? Dr Owili: I am a Kenyan but I would have to say yes. We have a strong base because we have institutions like the Kenyan Medical Research Institute which has been funded by MRC (UK), JICA and other donors for many years. We have many researchers who are doing meaningful work. Researchers from many other African countries have visited Nairobi in planning their own work. Many of the well-known international figures working in the HIV/AIDS field had their first glimpse of the epidemic and basic research here. There are still many foreign researchers involved in projects here. **************** HDN Key Correspondent Team To contact the HDN KC team during ICASA or to comment on the Conference coverage: info@hdnet.org