AIDS Meeting Evokes New Sense of Urgency
By Jon Jeter and David Brown
DURBAN, South Africa, July 15 –– The mid-afternoon seminar at the 13th International AIDS Conference was wrapping up
when a woman ambled to the microphone with a question for the panelists. What could she do to help their embryonic efforts
to get life-saving antiviral medicines to poor, developing countries that could not afford them?
Lee Wildes, an American with the nonprofit AIDS Empowerment and Treatment International who arranges shipments of
donated medicines, barely allowed the woman to finish. From his chair on the dais, he leaned forward and all but snarled into
his microphone. "You need to do something about Mbeki," he said, referring to South African President Thabo Mbeki. "I can't
even get a vitamin sent into this country."
In tone and substance, the exchange reflected the passions evoked by the week-long conference that ended here Friday, the
first held in a developing country and the first in Africa, home to nearly two-thirds of all people infected with HIV, the virus that
causes AIDS. The conference produced a militancy and sense of urgency unlike anything seen in the world of AIDS activism
since the early days following the discovery of the disease.
With researchers releasing studies this week that strengthen arguments for antiviral therapies that can improve and prolong the lives of HIV-infected patients, the conference culminates a movement in AIDS activism that has been building worldwide for months. Having largely tackled the epidemic in developed countries, how do the rich now help the poor confront an epidemic that is sweeping their countries at a pace that threatens to create the worst public health calamity in modern history?
"We've clearly seen some real movement on the whole debate about access to medicine," said James McIntyre, a senior researcher in the maternity ward at Chris Hani Baragwanath Hospital in Soweto. "That's been one of the real thrusts of this conference. The genie is out of the bottle, and I don't think it's going back."
"I think the process that has been started here will not be stopped," said Stefano Vella, a physician from Rome who is the president of the International AIDS Society, one of the conference's main organizers.
The more than 12,000 researchers, activists and politicians who gathered in this city on South Africa's Indian Ocean coast focused like lasers on the availability of costly antiviral drugs to the poor countries that need them most, and on Mbeki's public questioning of whether the drugs can treat poor Africans infected with the virus as they have affluent Westerners.
For the first time since this country's black majority toppled an oppressive white-minority regime six years ago, the new, widely praised democratic government is facing the kind of scorn and international protests that helped lead to the collapse of the apartheid government.
"This conference is unique for its focus on treatment and barriers to treatment for people living with HIV in Africa and the rest of the developing world," said Mark Heywood, director of the AIDS Law Project in Johannesburg. "There is this anger at the drug companies, and there is this very real anger at Mbeki. We've always expected the worst from the pharmaceuticals, and now we're just getting our act together in figuring out how to challenge their pricing policies, which put drugs out of reach to so many poor people. But this is the first time that, internationally, people have questioned the legitimacy of the new South African government."
With nearly one of every five South African adults infected with HIV, this country of 41 million people has more people living with HIV than any other. But Mbeki has confounded and outraged many AIDS researchers and activists with his public support of dissident scientists who contend that HIV doesn't cause AIDS and with his refusal to provide antiviral medicine even to pregnant women despite evidence that it greatly reduces HIV transmission from mother to child.
Hundreds of activists walked out in protest of Mbeki's opening address last Sunday in which he asserted a need to reexamine the disease because Africa's grinding poverty may yield a different strain of the virus than is commonly seen in more developed countries such as the United States. Five thousand scientists signed the "Durban declaration"--essentially a catechism about
HIV infection and how to prevent it--that was designed to counter any credibility that Mbeki's public scrutiny may have provided dissident scientists who contend that poverty, not HIV, causes AIDS. And angry protesters took to the streets here with placards that read "one bullet, one dissident," a revision of the popular anti-apartheid theme in which activists threatened the violent overthrow of the white-minority government with signs reading "one settler, one bullet."
How much concrete action surfaces from the conference is, of course, impossible to calibrate, but many here said they believe that the AIDS debate has reached a new mark from which there is no return. Few forums, either research- or policy-related, failed to mention either the pharmaceutical companies' pricing policies or South Africa's anti-AIDS policies. Activists here announced plans to protest, lobby and sue both drug companies and the government to provide the poor with access to antiviral drugs, which, when used in combinations of three, can improve and prolong the lives of patients infected with HIV but can cost as much as $12,000 annually. That exceeds the annual income of more than three-quarters of South African households.
Asteria Evard, a 35-year-old nurse who is the AIDS coordinator for the Kunene region of Namibia, said that research persuaded her to propose using antivirals if the drugs are made affordable. "I really support that. But we are not doing it now because the drugs cost too much."
Activists say that momentum to address drug pricing policies began two years ago at the international AIDS conference in
Geneva and reached a boiling point only this week. Conversely, Mbeki's stance on AIDS has generated an almost spontaneous combustion.
Jennifer Ann Geel, a South African physician who treats AIDS patients at a Cape Town clinic, was among those who walked out on Mbeki's address.
"I'm glad they're walking out," she said, as she sized up the droves of people heading for the exits at the cricket field. "This is the kind of mass action we used to see during apartheid. People are fed up with this kind of irresponsibility."
"People who are not from South Africa have really been openly critical of President Mbeki at the conference," said Sandra Thurman, director of the White House Office of National AIDS Policy. "But the flip side is that the attention of the world is now focused on the whole issue of how we get drugs to people who really need them. This debate has really elevated the visibility of this issue. Everybody is paying attention."
"I think everyone is leaving here and going home with a real fire in their belly."
© 2000 The Washington Post Company