DURBAN, South Africa: Nelson Mandela, the former president of South Africa, electrified the closing session of the XIII International Conference on AIDS with his mere presence. He entered to a sustained standing ovation, complete with cries in Zulu and other dialects of the region, and chants from the struggle to end apartheid.
He looked frail but his ringing voice belied his 82 years and offered a capstone of hope that the attendees had been seeking. "If 27 years in prison have done anything to us, it was to use the silence of solitude to make us understand how precious words are and how real speech is in its impact upon the way people live or die," said Mandela on the Conference theme of "Break the Silence."
He did not directly mention the controversy surrounding President Thambo Mbecki's embrace of AIDS denialists or the substance of those issues, that had dominated discussion and news coverage of the Conference. Mandela called them a distraction "from the real life and death issues." He praised Mbecki several times during the course of his speech.
Mandela called upon the tradition of collective leadership in Africa. "In the face of the grave threat posed by HIV/AIDS, we have to rise above our differences and combine our efforts to save our people. History will judge us harshly if we fail to do so now, and right now."
Mandela outlined the need for programs that work to "banish stigma and discrimination," prevent new infections, offer treatment, and support the survivors. He specifically supported "measures to reduce mother-to-child transmission," an action resisted by the South African government.
"Others will not save us if we do not primarily commit ourselves," said Mandela, but that did not negate the need for support and alliances both within societies and from without.
"You cannot imagine how your speech is music to our ears," said Conference chair "Jerry" Coodavia. "It has answered so many unspoken and spoken questions on our lips. It has filled the torment in our hearts." He pledged, on behalf of scientists, that they would do their part.
Justice Edwin Cameron, a member of South Africa's highest court, is openly gay and one of the most prominent people in South Africa who is open about living with AIDS.
"I exist as a living embodiment of the iniquity of drug availability and access in Africa," said Cameron. "On a continent in which 290 million Africans survive on less than one U.S. dollar a day, I can afford monthly medication costs of about US$400 per month." He lambasted international agencies, national governments, and the pharmaceutical industry that "have failed us in the quest for accessible treatment."
He compared the moral issues to those of Nazi Germany and apartheid South Africa when he said, millions will die "because available treatments are denied to those who need them for the sake of aggregating corporate wealth for shareholders who by African standards are already unimaginably affluent." Refusal to act at this point is "genocide."
ASSESSMENT
"I've been coming to this meeting since 1988 and this is by far the best International AIDS Conference that I've ever been to," said David Barr, an AIDS advocate from New York. "It is the first time that a whole new set of issues have been raised concerning how health care is provided." That includes the roles of industry, government, and "what things cost."
Pulitzer Prize-winning AIDS journalist Laurie Garrett called the Conference "a huge turning point" in dealing with "access to care, inequity in North-South relations, the agenda of how can HAART get to everybody."
"There is clear evidence of a major political shift," said Bill Arnold, with the ADAP Working Group in Washington, D.C. "Clearly industry has gone through a whole bunch of behind closed doors type decisions" about how they are going to meet the call for access to therapy for the poorer nations.
"It was tremendously important to come here and see the face of AIDS as it affects most of the world," said David Scondras, a Boston activist who also was appointed by President Mbecki and serves on the South African AIDS Commission.
"When we chose South Africa, many, many expressed their concerns, particularly those who are not with us today," said Stefano Vella, incoming president of the International AIDS Society which organized the Conference. "But this conference proved that they were wrong."
AMONG THE MISSING
New York activist Mark Harrington singled out some of the missing for special criticism. "There is a real 'Mafia' that controls not only the ACTG [ US AIDS Clinical Trails Group ] but they control the retrovirus conference [ which meets in January in the U.S. ] . And guess what, they're not here," he said. He works with the Treatment Action Group and is recipient of a five-year MacArthur Foundation "genius" grant for his work in AIDS advocacy.
"Chip Schooley didn't come and neither did Connie Benson, or Doug Richmond," said Harrington, naming three of the leading researcher/ administrators. "I think that is a little bit of a 'fuck you' to the rest of the world, particularly to the developing world," he continued. "They have the largest clinical trials infrastructure in the world and they didn't even bother coming to see. I think that is a little rude."
Cornelius Baker took a different tact, "The reality is that there is no one not here that we couldn't live without.
The people who are here are the people who are very much committed to the future of this epidemic, which means really ending it in every corner of the world."
"If 90 percent of the people have either no access to the drugs or the drugs are not useful to them in their part of the world, then we are producing useless science," Baker continued. The former executive director of NAPWA and current head of the Whitman-Walker Clinic in Washington, one of the largest AIDS services organizations in the U.S., said, "The world that mattered was here."
The IAS also announced that they would begin sponsoring a Conference on HIV Pathogenesis and Treatment to be held on alternate years. Unlike the Durban Conference, which included social sciences and community leaders, it will focus only on science. The first will be next July in Buenos Aires.
New Treatment
Guidelines for
Poor Nations
New treatment guidelines were unveiled by the World Health Organization ( WHO ) which include a section for "resource limited settings."
"There is only one standard of treatment, which is the use of a combination of drugs aimed at maximum suppression of viral replication," read the document.
But that seemed to be undercut by an ensuing statement that a dual nucleoside regimen "may be suitable for use in resource limited settings," even though "they cannot achieve or sustain suppression of HIV replication to the same extent as the three-drug regimen."
So what you are saying, asked one reporter, is that "there is one standard of care, unless you can't meet that standard."
The organization representatives squirmed in silence for a few seconds before the WHO's Eric Van Praag responded, "We want to make sure that the reality is the best possible clinical outcome."
