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By Max Martin
A roundup of the recently concluded 15th International AIDS Conference 2004, held in the Thai capital Bangkok
 The context
“In the course of human history there has never been a greater challenge than HIV/AIDS.” -- Nelson Mandela
The promise
“For the first time there is a real chance that we will get ahead of the disease.” -- Peter Piot, executive director of UNAIDS
The grim statistics
38 million people are living with HIV/AIDS worldwide, including 1.1 million in Asia infected last year. -- ‘2004 Report on the Global AIDS Epidemic’, UNAIDS
Nearer home
In the Asia-Pacific region, where 7.4 million people are living with HIV/AIDS, an estimated 500,000 people died of AIDS-related illnesses. -- UNAIDS statistics
India
India alone has an estimated 5.1 million infected people, making it home to one in seven HIV-positive people in the world, second only to South Africa.
The trend
Since Barcelona 2002, HIV has infected 9.2 million people and killed 5.6 million, notching up the toll to 20 million since AIDS was first diagnosed in 1981. Now, 38 million people are infected says a UNAIDS report released on July 6.
The conference
17,000 delegates; 9,826 paid an entry fee ranging between US$ 800 and US$ 1,000. It blew $ 17 million, explored new treatment possibilities and generated more funds to fight AIDS.
Funds needed
Although global funding for AIDS has increased 15-fold, to about $ 5 billion in 2003, it is less than half of what will be needed by 2005 in developing countries, says UNAIDS.
The pleas
Debt relief for African countries that lose US$ 15 billion in debt servicing annually -- four times the money spent on health and education. -- Peter Piot
Cut drug prices. Promote cheap generics. No restrictive IPR regime. Limit free trade. -- Health activists
The story
The conference was a mix of promise, grim tales and stardust thrown in liberal doses.
Delegates from sub-Saharan Africa, the area worst hit by AIDS, described its dance of death over there. “Some 2,500 young people are dying every week,” said Mary Sandasi, a grandmother from Harare, Zimbabwe, a country where 24.6% of people aged between 15 and 49 are infected with the virus. “We organise meetings at funerals and tell them about ways to fight AIDS.”
The sub-Saharan African region is home to a tenth of the world’s population, and 70% of people living with HIV worldwide. A United Nations Development Programme (UNDP) report ‘The Human Development Report 2004’, released on July 15, says that the AIDS crisis has reduced the average life expectancy in many sub-Saharan countries to 40 years or less.
The theme of the conference, ‘Access for All’, meant access to drugs and treatment without discrimination along the lines of gender, income, nationality and other divisive issues. In this grim context, delegates were forced to redefine ‘access’ to include food and basic human rights along with the more specific meanings.
As for stars, there were Richard Gere, Miss Universe, Shabana Azmi, Nandita Das and several singers and performers from around the world, all chipping in their bit in the fight against AIDS.
The consensus was clear, at least among activists fighting for equal access for all. AIDS is spreading like wildfire, stoked by poverty, conflict, high drug prices, discrimination and stigma and silence about it, as is the case in Asia.
The emerging HIV epidemic in Asia typically started with drug users and gay men, progressed to sex workers and their clients and then to other groups, said epidemiologist Tim Brown of the East West Centre, a Hawaii-based think-tank.
Experts are alarmed at the rapid spread of HIV from high-risk groups to young women and married, monogamous housewives across Asia. Widows in their early 20s form a significant part of HIV support groups. Women now account for half of all those infected. UN secretary general Kofi Annan called it a “terrifying pattern”.
In Asia, the spread is slow and the prevalence rate low. At present, the prevalence rate in India is “very low” -- between 0.4% and 1.3% says UNAIDS. But, 1% in India means millions of people.
Thailand, where the spread was early and rapid, was able to reverse the trend thanks to the aggressive promotion of the use of condoms. By the way, delegates at the conference received free condoms at the airport arrival lounge itself, complete with how-to tips -- some serious, some as graphic as Vatsyayana’s text, and some in jest! “You can put your cellphone in one during the rainy season,” joked Thai senator Mechai Viravaidya, community co-chair at the conference. “Talk about condoms, promote them.”
At Cabbages and Condoms, a downtown restaurant, condoms pad glass tabletops. Ping Pong, a Bangkok sex worker, says that women can now insist their clients wear condoms. “Still, we need respect and empowerment to fight this epidemic.”
Sometimes, girls driven by poverty and farm market failures (partly due to new global trade norms) from up north and across the borders end up in Bangkok’s sex shops, say social scientists.
Experts point out that migrant workers like fishermen from Burma, who provided a steady supply of seafood to the conference’s food courts, are not entitled to free treatment for HIV infection as are Thai citizens.
T he International Labour Organisation (ILO) estimates that, globally, as many as 36.5 million people engaged in some form of productive activity -- most between the ages of 15 and 49 -- are HIV-positive.
By 2005, more than two million infected people will be unable to work. “(It) is a direct threat to goals for poverty eradication and sustainable development,” said an ILO report released at the conference.
Time To Act, HIV/AIDS in Asia , a 2003 ActionAid International publication, listed the factors that fuel the spread of AIDS: poverty, illiteracy, forced migration, trafficking, war and conflict, distress, violence against women, alcoholism, drug use, low status of women and girls, social disintegration…According to the report, AIDS spreads along conflict zones, migration routes and pockets of poverty, often first hitting people who are the most discriminated against.
“The current understanding of AIDS is based on epidemiology. But as a science it has failed to explain factors of vulnerability,” said Joe Thomas, an AIDS expert and former advisor to the East Timor government. “To fight it we need a ‘new public health’ initiative, recognising health as a human right.” As Amnesty International secretary general Irene Khan said in the context of discrimination against positive people: “HIV/AIDS is a human rights crisis.”
“Increasing inequalities and anti-poor policies drive people to risk behaviour and contribute to the epidemic,” said Dr Delen de La Paz, who teaches public health in the Philippines. “Further, free trade agreements and intellectual property rights regimes pushed by rich countries make drugs inaccessible for poor people,” she said.
“There is increasing recognition of the fact that lack of food security, basic health services and access to affordable medicines contribute to the AIDS spread,” said Dr Prem Chandran John, a spokesperson for People’s Health Movement (PHM), an international grassroots group of health workers and professionals.
UN agencies say AIDS is fuelled by poverty and it causes poverty. Annan called AIDS a development issue. UNAIDS director Peter Piot urged the cutting of red tape and recognising people’s rights.
“We urgently need a multi-pronged strategy to fight AIDS. We need to cross organisational boundaries and overcome organisational limitations to ensure synergy,” said John Samuel, Asia director of ActionAid International based in Bangkok.
ActionAid International and People’s Health Movement are key partners in an emerging Asian alliance of health groups, trade unions, voluntary groups, social workers and human rights activists that addresses AIDS as a rights issue.
Positive moves
“In the course of human history there has never been a greater challenge than HIV/AIDS,” said Nelson Mandela amid a standing ovation. “History will surely judge us harshly if we do not respond with all the energy and resources that we can bring…”
The conference did witness some positive developments.
While the European Union pledged an extra $ 52 million, the Bill and Melinda Gates Foundation pledged US$ 50 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria . But Piot, a scientist-turned-administrator, called for full funding and accelerated investments for “desperately needed vaccines and microbicides, as well as better treatments”.
Although global spending on AIDS has increased 15-fold, from $ 300 million in 1996 to just under $ 5 billion in 2003, it is less than half of what will be needed by 2005 in developing countries.
“Let us be honest with ourselves: treatment access today has consequences for the future. It means that increasing numbers of people will be on treatment for life, and that the more expensive second-generation therapies will need to be made accessible globally.”
Those who block these objectives, including the US and European countries that lag behind on their money allocations to the global fund, and multinational drug companies that impose process patents in developing countries (thus hiking drug prices), came in for stringent criticism from NGOs. “Place people above profits,” said the People’s Charter on HIV and AIDS, launched by the PHM.
Activists smeared red poster colour on pictures of Bush and Blair and yelled ‘Guilty’. They heckled US AIDS coordinator Randall Tobias, a French minister and a representative of the pharma giant Pfizer. ‘ Bush lies, people die. Generic AIDS drugs now’ urged activists. Pfizer’s chief executive Hank McKinnell for his part argued that patents drove innovation by ensuring profits on inventions.
There was growing recognition at the conference that AIDS is biased against certain groups. Young women, for instance, are 1.6 times more vulnerable than young men. Annan called for men to be considerate, shun macho stereotypes and refrain from proving their teenage virility on sex workers.
Even as the conference promised ‘Access for All’, including men who have sex with men and intravenous drug users, a spokesman of the Thai Drug Users Network accused the government of crackdowns and extra-judicial killings of drug users. At the opening, the group displayed protest posters during the Thai prime minister’s applause-winning speech promising free generic drugs to people living with the virus in his and neighbouring countries.
Throughout the conference, leaders and activists were reminded that mere words and promises were not enough.
(Max Martin is a freelance writer based in Bangalore)
InfoChange News & Features, July 2004
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