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		18 - 24 July 2002 Issue No. 595 International	Current issue Previous issue Site map
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When profits kill
Squeezed between realpolitik and corporate greed, millions of AIDS patients die every year, writes Negar Azimi

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Former South African President Nelson Mandela addresses the International AIDS Conference in Barcelona, Spain
Former American President Bill Clinton and South African leader Nelson Mandela unleashed a large-scale reprimand of the international community last week at the closing session of the 14th International AIDS Conference in Barcelona, urging global leaders to forge a greater commitment to combating an epidemic that has already killed 20 million and left an additional 40 million in precarious imbalance.
The plea came at the end of a week marked by impassioned dialogue surrounding questions of equity in access to HIV/AIDS treatment, prevention outreach and general education. In the end, a strong North-South trajectory marked the conference as realpolitik and corporate greed were resoundingly assailed for providing an insufficient response to the epidemic.
"One hundred million AIDS cases means more terror, more mercenaries, more war, destruction and the failure of fragile democracies," said Clinton -- who serves as co-chair of the International AIDS Trust -- at the close of the conference.
Like countless participants, Clinton espoused a greater financial commitment to combating AIDS from the world's wealthiest nations. Alluding to the United States' lightweight $200 million contribution, he recommended an increase of nearly $2 billion annually -- what amounts to, he noted, "less than two months of the Afghan war, less than three per cent of the requested increase of defence and homeland security budgets."
Former South African President Nelson Mandela, for his part, delivered a rousing speech -- touching on the especially vulnerable position of women within the context of the epidemic, as well as the plight of the more than 13.4 million children who have lost one or both parents to AIDS.
"This is a cause that requires the mobilisation of entire populations," he said about the millions left orphaned. He continued: "We have an obligation to provide proper care and support for these children."
According to a joint USAID, UNAIDS, and UNICEF report released at the conference, the number of AIDS orphans is projected to increase to 25 million by 2010.
During his opening speech, Zachie Achmat, chair of South Africa's Treatment Action Campaign (TAC), called for pharmaceutical companies to waive patent restrictions and open the door to a competitive market that would make room for cheaper, more accessible, generic drugs in treating HIV/AIDS.
"The partial price reductions and insufficient donations by drug companies will not assure access in the long term to deal with the epidemic in a sustainable and effective manner," said Achmat via teleconference. Suffering from a lung infection and too ill to travel to Barcelona, HIV-afflicted Achmat declared in 1998 that he would not take antiviral drugs until the South African government agreed to fund a national pilot project providing free treatment in all nine of the country's provinces.
"Just because we are poor, just because we are black, just because we live in environments and continents that are far from you, does not mean that our lives should be valued any less," he continued.
Two decades into the epidemic, it is unequivocally clear that AIDS attacks the poor, the disenfranchised, the displaced in a disproportionate manner. Ninety- five per cent of those infected with HIV live in the developing world while, according to the World Health Organisation, less than one per cent of AIDS patients worldwide have access to the potent antiviral drugs that have transformed the virus into a largely manageable chronic illness in the North.
For some, Barcelona marked the end of a decade-long debate over the merits of prevention over treatment. While prevention is advocated as cost-effective by health economists, many point to the questionable ethics of denying life-extending drugs to those who cannot afford them.
Daniel Berman of Doctors without Border's Essential Medicines Campaign spoke to the Weekly from Barcelona: "The debate between prevention and treatment was fully put to rest this week."
"People who presented papers on preventive measures were booed out of conference rooms. Here we saw that we have the ability to help those who are already sick, and this can't be ignored," he added.
Others, such as Dr Helen Gayle, head of the HIV/AIDS Programme at the Bill and Melinda Gates Foundation, maintained that prevention constitutes an essential complement to treatment, particularly as countries with little or no health infrastructure may find it difficult to administer drugs. During one session, Gayle noted that simple efforts such as free condom distribution "dramatically slash HIV infections and their soaring attendant costs".
Conference tensions spilled over when, just before the opening ceremony, more than 500 protesters stood outside the main exhibition hall clamouring for a greater commitment from the most industrialised nations to fighting AIDS. A contentious US AIDS policy was perhaps the most vulnerable to attack as Secretary of Health and Human Services Tommy G Thompson, the head of the official US delegation, found out when he was nearly shouted down by protesters while speaking of the American contribution to the global fight against AIDS. Many of those shouting hailed from ACT UP and the Gay Men's Health Crisis (GMHC) -- historically outspoken US AIDS advocacy groups.
In the end, over three dozen protesters from the audience marched onto stage, catching Thompson by surprise and shouting "Shame! Shame!" until they were escorted away by conference security. Nevertheless, the shouting resumed soon after with calls for the US to affirm its commitment to fighting AIDS via increased spending as well as support for needle exchange programmes and advocacy of safe sex measures over abstinence. Thompson, visibly perturbed, later dismissed the protesters as "close-minded".
Likewise, the European Commission's exhibition stand was trashed by activists early in the week. Protesters demanded increased monetary contributions to the fight against AIDS as well as greater commitments to enabling developing countries to access generic drugs despite the obstacles that intellectual property rights pose. Such physical activism has not been seen since the epidemic's early days in the 1990s and has been taken as an indication of the gravity of the current situation.
The debate around the Global Fund for AIDS, tuberculosis and malaria topped the bill. The $200 million that the US donates remains the lowest contribution-to- GDP ratio among First World nations. Sweden has contributed seven times more than its GDP. Rwanda beats both, its contribution weighing in at a hefty ten times more as a share of GDP.
"The US cannot run around claiming to be a global leader in the fight against AIDS and then offer relatively minuscule contributions," said Joanne Csete, director of Human Rights Watch's HIV/AIDS and Human Rights Programme in an interview with the Weekly. She continued: "The US track record is appalling and the activists are right to call Tommy Thompson and others to task."
United Nations Secretary- General Kofi Annan made last year an appeal for a global AIDS fund of $7 to $10 billion. Thus far, a mere $2.8 billion has been collected, while a group of prominent personalities including Annan, renowned Columbia University development economist Jeffrey Sachs, Mandela and Clinton among others have urged the US to give more.
In the realm of research on the epidemic, it was a week during which scientists delivered triumphant news surrounding accomplishments in treatment even while announcing pessimistic forecasts that indicate the fight is far from over.
Just one day before the start of the conference, Thai and American scientists announced that the first comprehensive nationwide programme in a developing country to prevent mother-to-child transmission of HIV has proven a success in Thailand. Early indications from the pilot programme have yielded reductions in infection rates of over 50 per cent.
Dr Salim Abdool Karim, former head of the HIV/AIDS Research Division at the Medical Research Council of South Africa and Scientific Programme chair at the last international AIDS conference, told the Weekly: "The 2002 conference has taken the issue of drug access to the next step with this (Thai findings) and several other papers showing that implementation of ARV (antiretroviral) drugs in the South is eminently possible."
The findings have had particularly great resonance in South Africa where TAC and Doctors Without Borders among other activist groups have been waging an all-out war against a president and health ministry that have shown themselves reluctant to instate a nationwide mother to child transmission programme -- an initiative that would save an estimated 5,000 lives per year.
But just as the Thai study raised hopes about the prospects of treatment, a study released on the same day by a team at the University of California at San Francisco reported that a rising number of people are getting infected with strains of HIV that are resistant to conventional treatment.
Days later, researchers from the US Centres for Disease Control and Prevention in Atlanta released the results of a study that served as further indication of how far the North -- often lapsing into an overmedicalised apathy -- is from conquering the epidemic. The study, conducted amidst 5,719 gay and bisexual men in Baltimore, Dallas, Los Angeles, Miami, New York City and Seattle, found that 573 had HIV. Among those, 440 -- or 77 per cent -- had not known.
The findings were particularly worrisome for men from racial minorities. Ninety per cent of African Americans and 70 per cent of Hispanics reported that they did not know they were infected, indicating that they were likely to have been transmitting the virus all along.
For many, the study signals that America's gay community, the first to raise consciousness and effectively combat the disease in its initial years has lapsed into apathy. In an interview with Al- Ahram Weekly, Martin Algaze of New York City's Gay Men's Health Crisis commented on the perception, held by today's youth, that they are relatively safe from the AIDS threat: "The younger women and men did not see an entire generation of people getting ill and dying of AIDS in the 1980s and early 1990s."
He continued: "There is a feeling among young people that if they become infected with HIV they can take HIV prescription medications and they will not die. Of course, they do not understand that the side-effects of these drugs can be severe, that they are extremely expensive and that they will have to take them for the rest of their lives."
Indeed, Laurie Garrett, a Pulitzer-prize winning journalist and author of The Coming Plague, wrote in 2001, "Most Americans are now significantly less concerned about the AIDS epidemic than they were a few years ago, but their increasing comfort stands in sharp contrast to reality."
The picture for Africa is even more grim. The epidemic has spawned a development crisis without precedent. Today, of the 40 million persons living with HIV and AIDS, 28.5 million reside in sub-Saharan Africa. Seven sub-Saharan nations already have life expectancies of under 40, while Botswana has gone as far as to experience a negative population growth due to the epidemic's devastating impact. By 2010, life- expectancy in the small, once- prosperous southern African nation will be a mere 27 years.
But nor is the rest of the world without its taste of such devastation. China, with one fifth of the world's population, has experienced a 67 per cent increase in HIV infections in the first six months of 2001. Russia is also at the forefront of the epidemic. New cases have almost doubled annually for the past few years. The Middle East, despite being a step behind much of the world in its exposure to HIV/AIDS, is experiencing a definite surge in infections; at the end of 2001, 500,000 adults and children were living with HIV/AIDS in the region while an estimated 80,000 became infected in 2001 alone. In India, an estimated 3.97 million people are living with the virus -- more than any other country in the world save South Africa. It seems that few are left immune to AIDS and its ravages.
Last week's Barcelona conference went a long way in consolidating the gains registered at the last international AIDS conference, held in July of 2000 in Durban, South Africa. Indeed, Durban was perhaps revolutionary in that, for the first time, access was identified as the central factor in determining people's experiences with the disease. Pharmaceutical companies were universally lambasted, assailed for putting profits before lives and choosing to ignore the opportunity to save thousands, if not millions by eliminating socio-economic obstacles to drug access.
"Durban was a breakthrough in helping to crystallise the growing global movement for AIDS treatment access. Barcelona has continued that important trend," said Csete.

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