Missed opportunities

World AIDS conferences always provide an opportunity for rich countries, aid agencies and international agencies to announce new funding initiatives to fight HIV/AIDS and gain maximum public relations exposure.

A range of developing countries ‘€“ from the Caribbean to sub-Saharan Africa ‘€“ have taken advantage of the favourable climate in Barcelona to conclude agreements for cheaper anti-retroviral drugs and funds for HIV prevention and treatment programmes.

But for South Africa, Barcelona has once again been a missed opportunity. Little seems to have changed the world’€™s perception that our government lacks commitment to fighting HIV/AIDS and government has yet to realise that it needs to go the extra mile to prove itself to a sceptical international audience.

Health minister Dr Manto Tshabalala-Msimang left Barcelona after two days, leaving a public servant without political authority, HIV/AIDS Directorate head Dr Nono Simelela in charge of the South African delegation. However, before she left Tshabalala-Msimang caused controversy by apparently telling an American journalist that nevirapine was “poisonous”.

No one from government was on hand to explain why central government is delaying a $72-million grant from the Global Fund to fight HIV/AIDS, TB and Malaria to KwaZulu-Natal.

Instead, global fund executive director Dr Richard Feachem alluded to Pretoria as being a problem and said the delay was a cause for concern.

“It is incredibly important that states, provinces and local governments can seek funds from the Global Fund,” said Feachem. “But in South Africa this has proved difficult.”

Although Feachem spoke with characteristically British diplomacy, he indicated that if the impasse could not be resolved “in favour of KwaZulu-Natal”, the Fund would intervene and “enter into negotiations with Pretoria to see what we can do to unblock the blockages”.

Government is concerned with protocol as the KZN application did not go through the SA National AIDS Council. But what this says to the international community is that our government is more concerned with process than the lives of 36% of adults in KZN infected with HIV. What this says is that giving aid for AIDS to South Africa is difficult.

Amir Attaran of Harvard University was blunt. Addressing a conference session on barriers to anti-retroviral (ARV) treatment, he said: “The biggest hurdle to HIV treatment in South Africa is Thabo Mbeki.”

While Cabinet has reversed its opposition to anti-retroviral treatment by resolving in April to offer the drugs to rape survivors, this message has not got to the world still gob-smacked by our president’€™s flirtation with scientists who dispute the very existence of the HI virus.

We have the biggest population of HIV positive people in the world. The Department of Health puts the figure at around 4.5 million people. Others say it’€™s closer to six million. With no anti-retroviral treatment, most of these people will die. By 2014, we will have two million AIDS orphans, say actuaries, but with ARVs in public health, this number could be reduced to one million.

But we need all the help we can get as the drugs are expensive.

In an inspiring address, Dr Paul Farmer told the conference how he had tried for years to bring ARVs to poor people in rural Haiti, initially relying on drug donations from HIV positive patients in the US. His persistance and commitment has paid off and his programme was recently awarded a massive grant from the Global Fund.

“The impact of the drugs of people’€™s survival has been profound,” said Farmer, who has 2000 people on his treatment progamme.

‘€˜This is Samuel the day he started treatment,” said Farmer, showing a slide of a painfully thin, bed-ridden man. “This is him two months later,” he added, indicating a healthy man of moderate weight. “Samuel asked me to show you his picture and tell you how his children are no longer ashamed to be seen with him on the street.”

Brazilian health minister Dr Julio Frenk said ARV drug prices had largely been driven down by the “relative negotiating power of the purchaser”. In Brazil, the threat posed by generic ARV producers has seen a massive drop in brand-name drug prices.

“If lack of purchaser negotiating power is the problem, one solution may be joint purchasing. It makes sense for Africa and could be one of the first goals of the new African Union,” said Frenk.

We need international assistance to ensure that the gains so painfully won are not all lost and to ensure that the New Plan for Africa’€™s Development (Nepad) is not rendered meaningless by millions of AIDS deaths. To get access to this assistance, government needs to sell itself as a caring nation committed to doing whatever it takes to fight AIDS. So far it has utterly failed to do so.


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