How did South Africa do it?

Six years ago at the 14^th AIDS conference in Toronto, Stephen Lewis, the then UN special convoy on HIV and Africa accused South Africa of being criminal in dealing with HIV. At that time the president refused to admit that HIV caused AIDS. The minister of health advised people living with HIV to use garlic and olive oil to treat HIV!

This year South Africa is a proud country. The country managed to beak the taboo about HIV and is scaling up prevention and access to testing and treatment. South Africa is on track to have an HIV free generation by stopping mother to child transmission.

So what turned the South African tide? Activism in South Africa goes back to the early days of the epidemic. In 2001, the global access to treatment movement led by South African activists and people living with HIV won a court case against 39 pharmaceutical companies who wanted to use Intellectual Property to boost their profits and thus limiting access to medicines in South Africa.

Then the activists fought their own government and took it to court and won their case so that the government had to start providing services for pregnant women to stop mother to child transmission.

Subsequent government and president learnt the lessons, recognising that hiding their head in the sand would only fuel the epidemic. The government decided to focus on allocating more domestic resources into HIV programmes even if donors pull out.

The moral of the story is clear: you cannot hide AIDS in any country- the only way to end it in any country is a combination of activism and high level political commitment.

Diary of the AIDS 2012 Conference

Sunday 22 July 2012

So the conference has not officially started but sessions were running anyway. Big pharma and a couple of generic and diagnostic producing companies have already sat up their impressive booths in the commercial exhibition centre. Few countries have also done so, notably the US, Germany and the Netherlands. Most NGOs have sat up their interesting booths in the Global Village. Last night it was great to meet old comrades and talk about the latest advocacy plans while they were setting up their tables and flyers. Global village is fun!

First session I attended was about Research and Development (R&D) for medicines: the new WHO report recommending global actions. Clearly the current system of R&D based on Intellectual Property (IP) has failed people in developing countries. Relying on the market to decide R&D priorities means production of medicines that would make high profits. Poor people cannot pay high price and therefore medicines for diseases like sleeping sickness or children HIV are not produced. Suffice to say that the latest diagnostics for TB is 100 years old and the latest medicine is 30 years old!

The WHO report recommends that countries allocate a small % of their GDP for R&D and that part of this money is pooled to pay for R&D for priority diseases. Priorities are set collectively by a coordinating body-the WHO.

Neither rich nations nor pharmaceutical companies are supportive of this model. Perhaps every new idea that commits governments to payment or challenge companies on their “normal” business are not popular.

But we have an opportunity to learn from the tobacco convention and other global initiatives so that the world can collaborate to invest in R&D for diseases that disproportionately affect developing countries. Time to act is now!

The world bank president at AIDS 2012

At the official opening of the AIDS 2012 conference, Jim Kim was the first World Bank president to address an AIDS conference. This is very significant. Given Jim Kim’s background in health and HIV, some were saying that he would not focus on health issues. Therefore it is heartening to see that he still recognises that health (including fighting HIV) is at the heart of poverty reduction and inclusive growth.

In 2005 when Jim Kim was at WHO, he engineered the –then-controversial strategy of treating 3 million people by 2005. Today 8 million people are on treatment. He sees a lot of lessons to be learnt from the response to HIV which can be implemented in education, maternal health and in poverty reduction strategies. He praised HIV advocates who campaigned for access to treatment and got the world to “turn the tide” of AIDS since the epidemic started.

I was pleased to hear him committing the World Bank to work on AIDS and to focus on what it does best: building sustainable health systems.

Jim Kim also talked about the importance of social protection because 150 million people fall into poverty/year due to cost of health care. Yet the bank would do a great job stopping these people falling into poverty by supporting countries to provide free public health care services and encouraging other donors to support similar programmes.

Well, if the Global Fund and PEPFAR are enabled to invest in HIV prevention, treatment and care, pharma joins the patent pool and thus generic companies can produce affordable new medicines, and the World Bank scales up investment in sustainable free public health services, then we really can end AIDS!

Asmaa: A beautiful story of love at the time of AIDS

At last I watched Asmaa. I heard about the film last time I was in Egypt but unfortunately I missed it when it was screened there.

Based on a true story, the film shows the life of an Egyptian woman living with HIV. Asmaa was managing to live with HIV, but she needed an ordinary operation. Being an honest woman, she told the surgeon that she is HIV +Ve. That was enough to get her thrown out of the hospital. No other surgeons would accept to perform the operation.

While in despair, a popular TV programme contacted her, via HIV support group, and offered to help her if she appeared on TV. Asmaa refuses to say how she got infected so that she does not implicate others.

The story portrays the stigma, discrimination and ignorance of Egyptian society especially the medical profession. It is depressing that at the time the world is talking about ending AIDS, ignorance, silence and prejudice in North Africa is similar to the situation in other countries but during the eighties.

Discrimination against HIV +ve people actually uncovers even deeper layers of prejudices in Arab societies.  For example, one of the common ideas among the public there is that “the number of HIV + ve people is so small”. Yet those who hold this view do not seem to see that people have tights (e.g. to respect and treatment) whether belonged to a small of big sector in society. The obsession with knowing how people got infected reflects Arab societies preoccupation with how others practice a “strict moral code” connected only with sex and sexuality especially concerning women.

The film managed to escape directly “educating” society about stigma. Through a simple love story with beautiful traditional village scene, it makes the audience question their own prejudices and unfairness.