On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.99 n.9 Cape Town Sep. 2009
G8 failure on AIDS funding 'obscene'
The failure of the G8 countries to renew their 2005 commitment to universal access to antiretroviral treatment and their cynical use of the global financial crisis to threaten cutbacks to AIDS funding was 'obscene' and hypocritical.
This was said by Stephen Lewis, Co-Director of AIDS-Free World, who delivered a stinging opening address at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town on 19 July.
His scathing, no-holds barred attack on the 'divide and conquer' tactics of the treasuries of western nations and the politicians who ran them was a clarion call for scientific activism.
Outlining how 'scholarly activism' had jolted politicians into recognising that scientists were 'mobilised, watching and keeping the world informed', the United Nations special envoy for HIV/AIDS in Africa singled out two powerful petitions by scientists.
The latest was just before this year's G8 summit and signed by 25 of the most renowned climatologists and earth scientists a full-page advertisement in the influential Financial Times , headlined 'Scientists call on world leaders to take action on climate change'.
The other was signed by 81 acclaimed medical clinicians and researchers just after the 2006 Toronto AIDS conference, calling for the resignation of then South African Minister of Health, Dr Manto Tshabalala-Msimang.
'No-one should underestimate the power of science when it decides to take a stand and never has the exercise of power and influence been more imperative than at this moment in the fight against the AIDS pandemic,' Lewis added.
With the Global Fund to Fight AIDS, TB and Malaria facing a shortfall of several billion dollars, it was time scientific authority was used to remind political leaders how they used precious public money to bail out banks.
'(This) so that Goldman Sachs could make a profit of $3.4 billion in the second quarter of 2009, JP Morgan Chase could make a profit of $2.7 billion in the same period, and with obscene contempt for the human condition, pay bonuses, yet again, beyond the dreams of hyperactive wealth,' he said. 'You spend every day of your working lives to make life possible, and the power brokers devalue your work with the fraudulent plea of destitution. Don't let them get away with it,' he added.
AIDS 'exceptionalism' rampant
When there was a backlash against funding for AIDS, with 'mindless charges against AIDS exceptionalism, you should find a way, collectively, to shoot down the pinched bureaucrats and publicity-seeking academics who advocate exchanging the health of some for the health of others, who propose robbing Peter to pay Paul'.
The argument should be made, in principled fashion, that money must be found for 'every imperative, including maternal and child health, and sexual and reproductive health, and environmental health as well as all the resources required to turn the tide of the AIDS pandemic,' he said.
'We're talking about human lives, for God's sake, not about the phony parsing of balance sheets,' the former Deputy Executive Director of the United Nations Children's Fund (UNICEF)(1995 - 1999), and former Canadian Ambassador to the United Nations, added.
Lewis urged conference delegates, 'your whole life is in the world of AIDS. You know the legitimate resource requirements. You just can't permit an intellectual contrivance an argument in favour of accepting the size of the pie and slicing it differently, rather than demanding a larger pie you can't allow that to be used to justify a terrible reversal in public policy.'
The arithmetic argument alleging that AIDS was getting too much money at the expense of other health imperatives was simply 'naked academic and bureaucratic envy'.
'I know I'm not supposed to say that, but it's got to be said,' he added.
Lewis singled out laws criminalising homosexuality (citing the Caribbean), saying they helped create 'an ugly homophobic culture that inevitably serves to spread the virus', domestic violence, and prevention of mother-to-child transmission (PMTCT), as critical areas needing urgent attention. He said PMTCT should have been the easiest intervention of all. 'Instead we've had a panorama of unnecessary death for both the mothers and their children. So-called PMTCT has been a colossal failure, subjected to twisted linguistics, lousy science, governmental chicanery, and astonishing delinquency on the part of United Nations agencies.'
A dreadful double standard prevailed: in the industrial world full HAART was used, in the developing world 'we still use, in the majority, single-dose nevirapine. You're scientists: you know what that means in terms of unnecessary infant infection and death.' Lewis said mothers were being abandoned.
In 2007, only 12% of pregnant women living with HIV identified during antenatal care were assessed for their eligibility to receive ARV treatment. 'That's an unconscionable neglect of women that smacks of vestigial misogyny,' Lewis argued. He said the WHO/UNICEF/UNAIDS guidelines on breastfeeding and the use of breastmilk substitutes were widely ignored. 'To this day, the value of exclusive breastfeeding for 6 months in stemming HIV infection and providing the infant with the strongest possible immunity to other diseases is still caught between conjecture and disavowal,' he added.
Lewis said every minister of health should attend a 'mandatory course' by internationally respected paediatrician, Dr Hoosen 'Jerry' Coovadia, Director of the Nelson Mandela School of Medicine's Centre for HIV/AIDS Networking (HIVAN) and International Vice-Chair of the Paediatric AIDS Clinical Trials Group.
The epidemic of domestic sexual violence that 'lacerates the soul of South Africa' was mirrored in the pattern of 'grotesque raping' in areas of conflict from Darfur to the Democratic Republic of the Congo and in areas of contested electoral turbulence from Kenya to Zimbabwe. Inevitably an unknown percentage of the rapes transmitted the virus, subjecting women to 'the most dreadful double jeopardy'.
Lewis described the discrimination against and oppression of women as 'the world's most poisonous curse' and said nowhere was it felt with greater catastrophic force than in the AIDS pandemic. Bringing an end to sexual violence was a vital component of bringing an end to AIDS.
Lewis' attack on the G8 at the IAS conference was echoed by another top delegate, Professor Julio Montaner, chairperson of AIDS research at the University of British Columbia, who issued a dire warning against the cost-induced paucity of first-line treatment options in southern nations. Montaner said first-line treatment options were typically selected based on cost rather than safety and efficacy.
While historically acceptable as a means to jump-start ART roll-outs, current short-term savings considerations would 'come back to haunt us' in the form of toxicities and tolerability challenges, ultimately compromising adherence and in turn effectiveness.
Describing HIV/AIDS as 'the elephant in the room' at the G8 summit, he said HIV scale-up was a model for health systems strengthening, with health a 'fundamental pre-requisite for economic development'.