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Barcelona blues

The 14th International AIDS Conference held last month was the forum for a number of activists, medical workers, and those closely involved with the epidemic to engage in a dialogue to address the issue. Dr. JAYA SHREEDHAR and SHREEDHAR RAJAN write.

Activists march in Barcelona demanding aid for developing countries in their fight against AIDS.

MORE than two decades into the epidemic, AIDS continues to kill millions and HIV continues to infect millions more. Meanwhile, the virus continues to stymie vaccine researchers — viral mutations and the inability of people to fight one strain of HIV even when they have good resistance to a similar strain are daunting impediments in the development of an effective vaccine. Treatment and care for the majority of the people living with AIDS is still to be realised while access to drugs remains the preserve of the rich.

Understandably, International AIDS Conferences appear to have become the latest arena for radical activism. At the 14th International AIDS Conference in Barcelona, giant inflatable Coke bottles had skulls and crossbones painted on them to protest against the company's policies toward its HIV-positive employees in Africa. The plush floors in the booths of multi national drug companies were littered with "corpses" to protest the prohibitive prices of anti-HIV drugs. The Health and Human Services Secretary, Tommy Thompson, was heckled by protesters as he tried to defend the U.S.'s role in the fight against AIDS. Activists who were outraged by the way visa applications of delegates from poor countries were handled, booed Celia Villalobos, the Spanish minister of health, off the stage. Even before the Conference concluded, she resigned from the government.

Declaring that they were infuriated by the "culture" of inhuman profiteering and apathy that was widening the gap between rich and poor nations in the area of health, the activists felt that "governments and corporations change their policies only when they feel the heat and not because they see the light".

The United Nations estimate that U.S.$ 10 billion a year is needed to mount a global assault on the AIDS epidemic. The current spending is about U.S.$ 2 billion. The shortfall has sent the epidemic spinning out of control, but developed countries are willing to offer less than one-third of this sum. Many however are of the view that in today's globalised world there is no such thing as insulating oneself from the crises of other people. They believe that if entire societies are allowed to collapse, if human miseries are allowed to continue, then those who are in a position to prevent these tragedies, but fail to, will have a hefty price to pay.

Irene Fernandez, a human rights activist from Malaysia, delivering the second Jonathan Mann memorial lecture, said that globalisation was responsible for transforming national health care into a privately controlled commodity in the hands of the drug and insurance industries. This has pushed primary health care beyond the reach of the poor and further fuelled the spread of the HIV, she said. Today, HIV prevention measures cover less than one fifth of those at risk. Of last year's five million new cases, more than half were among the young, aged 15 to 24, the majority in developing countries.

The epidemic is poised to make a comeback among the younger groups of gay men in high-income countries, if the rising incidence of sexually transmitted infections in this population is any indication. Nearly one out of every three new HIV cases in the U.S in 2000 was a woman. Injecting drugs is increasing the incidence of HIV in many Russian and Eastern European countries, Portugal and parts of Asia. In Russia, the number of HIV infected has increased 15-fold in three years. In China, 17 percent of the population has yet to hear of AIDS, even as the disease spreads its tentacles there.

For the West, images of the former Soviet empire wracked by AIDS could present nightmares of refugees streaming into Europe, economic collapse, and outbreak of violence. "The world stood by when AIDS was spreading in Africa," said Peter Piot, the executive director of UNAIDS. "We can't do the same thing now that it is spreading in Eastern Europe and is at the doorstep of the E.U."

With regard to India and China, Africa once again serves as an object lesson of how a disease can change the course of human history. Today, with about a third of the adult population of the southern part of the continent infected with HIV, its institutions are on the brink of collapse.

Noted economist Jeffrey Sachs called upon the WHO and UNAIDS and the GFATM (Global Fund to fight AIDS, Tuberculosis and Malaria) to come up with a plan in 90 days in order to place a clear list of dues before affluent nations, beginning with the U.S.. Former U.S. President Bill Clinton saw merit in comparing the plight of the activist to that of Sisyphus. "Keep pushing the rock up the hill and in time you will reap the benefits", he said. Nelson Mandela declared at the closing ceremony, "Unless we are able to follow what we say by doing something practical, our eloquence is worse than useless." The curtains fell on the Barcelona Conference in the hope that the rich are listening.

A shot in the arm

Union Health Minister Shatrughan Sinha at the International Aids Conference.

JAYA SHREEDHAR: You have repeatedly expressed concern that India accounts for about ten per cent of the world's population living with HIV and AIDS and that we need to talk openly about condoms and responsible sexual behaviour. Do you see yourself doing this?

SHATRUGHAN SINHA: We can ill afford to ignore AIDS and we cannot go on pretending that it does not exist. AIDS and the complex issues surrounding it must be discussed with an open mind. With regard to sexuality we must remind ourselves that as Indians, we are also the inheritors of an ancient and resilient civilisation. Certain aspects of our tradition may be limiting our march into the new millennium. So in the light of the advances in science, we have to convert our limitations into strengths.

How do you propose to translate these ideas into action?

I shall place AIDS high on the political agenda of my government and take steps to ensure that it remains there. I call upon my colleagues heading other ministries to also appreciate the need for a multi-sectoral approach and do everything they can from their respective positions of strength.

How do you propose to go beyond your ministry, party or government to ignite a national response to combat AIDS?

We already have the unreserved support of not only the ruling government but also members of the opposition. Unless the political leadership at the grassroots level takes the issue to their communities, the problem will never be adequately addressed. I appeal to members of the Parliament to talk to their constituencies. A portion of their annual constituency fund of two crores could be spent on AIDS, TB and malaria in their constituencies. They could start a blood bank, a voluntary testing and counselling centre, help upgrade infrastructure of health centres, provide nutritional support to poor TB patients and so on.

Many of the related problems cannot be solved without coming to terms with social, economic and gender inequalities. How do you propose to deal with such complex issues?

We must have a more rigorous assessment of this epidemic. Looking at the examples of Thailand and Brazil, it is clear that multi-sectoral involvement can take us closer to a solution. Unless we address staggering issues like overpopulation in the countries of the subcontinent, we will find it that much more difficult to make any progress in poverty and disease reduction.

The voices of people from Africa are being heard at many of the important sessions here. But Asia seems to lack a sense of urgency although it is believed that the epidemic is gathering momentum here.

The Prime Minister has already declared his commitment to fighting HIV/AIDS. I think the contribution of the Indian pharmaceutical industry in the form of affordable anti-AIDS generic drugs is itself a commendable one from the subcontinent. It has a global impact and prices have dramatically come down. I would like to do all I can to bring the 16th International Conference to India. I hope to work towards bringing together the health ministers of the SAARC region to jointly address issues arising out of AIDS, TB and malaria. We share a common culture and we need to get together, share our experiences and expertise and evolve a concerted response to the epidemic from the subcontinent.

The writer is a Health Communications Expert and works as an Advisor and Consultant with various International Organisations. She has won several awards for her coverage of the HIV/AIDS epidemic.

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