Closing Ceremonies Durban World AIDS Conference 2000
Thursday, July 14
Durban, South Africa
Reported by Jules Levin

Report 19

Nelson Mandela Speaks

Breastfeeding Reduces Effectiveness of Treatment To Prevent Mother To Child Transmission

BREAK THE SILENCE What does this mean? It means we should talk about the problem of AIDS facing developing countries such as Africa and India.

Nelson Mandela said:

"the world will be judged harshly if we fail to do the right thing now"
"people with HIV/AIDS don't want stigma, they want love"

I just came from the closing ceremony. Nelson Mandela gave a beautiful and wonderful talk. He called for the introduction of measures to prevent mother to child transmission. He called for peace with Preseident Mbeki. He said Mbeki is well intentioned and dedicated to addressing AIDS. It appeared he was saying treatment works and should be brought to South Africa. He said he would work with Mbeki on this issue. More of Mandela's comments are below.

The closing ceremony included talks by Nelson Mandela, Jose Gatel (chair of the next Intl. Conference in Barcelona. Also speaking were Stafeno Vella, incoming chair of the IAS, and Mark Wainberg, the outgoing chair of the IAS. Wainberg, the IAS and his colleagues deserve much credit for selecting Durban for holding this conference and to sticking to their guns when faced with criticism about that choice and faced with people saying they were boycotting this conference. For well intentioned reasons, they didn't want to attend this meeting because of the climate created by the South African government & President Mbeki in refusing to recognize and support treatment access for his suffering people. Holding this conference in South Africa was a wonderful and very smart decision. It has truly focused world attention, as best as possible, on this crisis. Not to have held the conference here, would not have accomplished this. In his closing remarks today, Hoosen "Jerry" Coorvadia (conference organizing committee), said that 12,000 people attended this conference and 4,500 were African. He thanked everyone for coming despite the boycott. I want to encourage all of you to take an interest in the suffering in the developing world. Nelson Mandela said 1 in 2 young people in South Africa will die but this suffering can be prevented. Mandela called for the world community to unite and be "our brother's keepers".

Mandela told a story about a young boy who was suffering from a disease where if he was touched more than lightly a bone would fracture somewhere in his body. This boy of 16 was very undersized and asked Mandela what he thought of people like him. Mandela struggled with how to answer him but said you are alive, you have loved ones, and the important thing is to bring glory to yourself when you die. Mandela was referring to people with HIV. And also to people who are dedicated to working in this field. He said his heroes are people who do this type of work. He also quoted famous words--"a coward dies a thousand deaths but a bold man dies only one death".

In his talk, Stefano Vella said we have not broken the silence yet but we have started to do this. We need a continued full commitment from governments from both the South & the North. He committed the IAS to bringing this conference here again. He also said we will not, should not and could not forget this conference.

Nelson Mandela Speaks

In anticipation of Mandela's talk police in and out of uniform are all over and secirity is very tight. When Nelson Mandela entered the room, it was quite an amazing spectacle. Jerry Coovadia called him an icon of the century, the greatest man of our times. He welcomed Germans despite the FIFA decision. The FIFA decision was to award the next Soccer World Cup to Germany instead of South Africa, but I heard on CNN yesterday that this decision is being reconsidered. Mandela said it was an honor to be chosen to address this audience. He seemed fragile as he had difficulty climbing the few stairs to the stage. He said, this is not an academic conference but it's a gathering of humans wanting to turn around one the greatest problems in humankind, and the greatest since the wars have ended. And he said he doesn't use words lightly. He supported Mbeki by saying it was a small distraction-- the argument surrounding him on the fringes of this conference. In all disputes a point is arrived at where no one is totally right or wrong. And this debate has reached this point. Wise words. He praised Mbeki and his commitment. And he praised the scientific & medical AIDS community in South Africa. He suggested lets politics behind us and proceed too deal with the suffering. We have overcome much in South Africa, we have to rise above our differences and combine our efforts to save the suffering. We will be judged harshly if we fail to do so and right now. Lets not equivocate and avoid an unprecedented tragedy. AIDS in Africa is claiming more than all wars, malaris, depleting resources, robbing schools of teachers, business is suffering.. AIDS is having devastating impact on families, economy, and children.  Death will double in the worst affected communities in Africa.

Something must be done as the matter of certainty. We know what works--HIV infection can be preventing by investing in information, promoting abstinence, safe sex, condoms. Preventing STDs, confidential testing & counselling, introducing measures to reducing mother to child transmission are essential, must address stigma of discrimination by providing safe environments for people with HIV/AIDS. Experience in Thailand, Uganda, Senegal show that commitment & investment makes a real difference. Stigma and new infections can be stopped. Life with HIV can be enhanced. Mandela said that Mbeki continues to place this issue on the top of his agenda, he has done much, and he will proceed with resolve & dedication & Mandela will work with him. The challenge is to move from talk to action. We must focus on what we know works. And to show total inconclusiveness in the fight against AIDS. People infected DON'T WANT STIGMA THEY WANT LOVE. We need bold new initiatives to prevent mother to child transmission and to help children & to search for appropriate vaccines.

There are 1,500 journalists here from all the leading news organizations CNN, ABC, CBS, Wall St Journal, Bloomberg, BBC, everyone is here. Many key US & European researchers are here-David Cooper, Joep Lange, David Ho, Marty Markowitz, Anthony Fauci and many others.

World discussion must continue after going home. This meeting will hopefully create a sea change regarding the WORLD AIDS epidemic. I think there is an unconscious sense among attendees that there is special thing happening here and we are part of this. Its been very special for me to be here and to observe see all that ocurred here.

Community involvement at this conference has been dominated by community from Africa and developing countries, and I think this is a very good thing. Developing country community need to feel empowered and take control of a problem that is theirs and its different than ours in the developing world.

In order to adequately address this world scourge, it will be necessary for government, the drug companies, researchers, and the community to work together in a well meaning concerted effort to identify appropriate goals, and to follow through with commitment. This effort should include improving infrastructure to deliver needed medical and other services, and when appropriate adequate treatment access.

Breast feeding & Preventing Mother To Child Transmission

One of the key treatment issues emerging here is how breastfeeding appears to dramatically reduce the benefit of treatment intervention to prevent mother to child transmission. The PETRA study was presented as an oral late breaker. It reported that transmission was 9.2% at 6 weeks in a treatment arm receiving AZT/3TC, and 19.2% in the placebo arm. However, after 18 months trnamission was 26.6% in the placebo arm, and increased to 20.7% in the AZT/3TC arm referred to above. Other studies reported here showed a reduction in transmission prevention due to breatfeeding but not as much as in this study. I spoke with Jerry Coovadia about this and he said that this was an ITT analysis, and there were a good number of deaths that may have affected the outcome (30% I think he said). Also, it appears as though exclusive breastfeeding for the first 6 months may not severely reduce treatment benefit. Women often mix breastfeeding with other methods that may not be healthy. It appears that for cultural reasons women must breast feed. Analysis of the timing of breatfeeding is ongoing, and PETRA study analysis is ongoing. This will allow for a better understanding  of HIV-1 transmission through breast feeding and hopefully lead to feasible strategies to address this problem.