Durban World AIDS Conference
July 9-14, Durban, South Africa
REPORT 28
Mbeki defiant about South African
HIV/AIDS strategy: a review of Mbeki's speech at opening ceremony for Durban
Int'l. AIDS Conference: From The July 15 Lancet, A Science Journal
Lancet 2000; 356: 225 - 232
In an uncompromising rebuttal of criticism aimed at South Africa's HIV/AIDS
policy, President Thabo Mbeki called on scientists to have "sufficient
tolerance to respect everbody's point of view". He spoke of the
"desperate and pressing need to wage a war on all fronts" against an
epidemic that affects one in five adults in his country. Mbeki used his opening
address to the XIIIth International AIDS conference in Durban, South Africa, to
compare the campaign against AIDS with the struggle against apartheid.
Mbeki emphasised that "the world's biggest killer and the greatest cause of
ill-health and suffering across the globe, including South Africa, is extreme
poverty". He told a personal story of how he discovered Africa's
"health crisis of enormous proportions", and his conclusion that
"we could not blame everything on a single virus". Despite this
important African dimension to the pandemic, Mbeki assured delegates that
"there is no substance to the allegation that there is any hesitation on
the part of our government to confront the challenge of HIV/AIDS".
During Mbeki's speech people in the audience shouted that such views had
"nothing to do with our lives". And later Jerry Coovadia, the
conference chairman, noted that although poverty "exacerbated"
HIV/AIDS, it was "not the
basic cause".
But the most moving plea for a more vigorous response to HIV/AIDS came from
Justice Edwin Cameron, a South African High Court judge living with AIDS. He
argued that "in my own country, a government that in its commitment to
human rights and democracy has been a shining example to Africa and the world,
has at almost every conceivable turn mismanaged the epidemic".
Cameron spoke of "governmental ineptitude", the "pitiously
little" progress it had made, and Mbeki's "intractably puzzling"
association with AIDS dissidents. "I cannot believe that my President's
speech has done enough to counter these concerns", he added. The South
African Minister of Health Manto Tshabalala-Msimang rejected Cameron's argument.
And she denounced the use of antiretroviral drug treatment as a litmus test for
a strong HIV/AIDS strategy.
In a review of what does constitute an appropriate global HIV/AIDS strategy, Roy
Anderson (Oxford, UK) concluded that "rigour is not the issue of the day,
reality is". Policy makers need to implement fewer measures but be more
effective in what they do, and on a larger scale. "Resource allocation does
not in any way match the scale of the problem", he added. Although noting
that the burden of HIV-AIDS will continue to increase, Anderson saw "the
beginnings of a recovery" in Uganda as "a glimmer of hope".
Irrespective of measures to provide antiretroviral drugs, control sexually
transmissable disease, distribute condoms, and educate young people about risk,
Anderson believes that a vaccine remains "the only hope for the longer
term". However, "the paradigm [of vaccine development] must be
changed". Low efficacy vaccines--as little as 20% in some low prevalence
areas--could have dramatically beneficial effects. The success of any strategy
depends on "strong political leadership". With that remark, Anderson
added his voice to those who were "disappointed" by Mbeki's speech.
Richard Horton
WASHINGTON, July 18 -- The United States plans to offer sub-Saharan African nations $1 billion in loans annually to finance the purchase of American AIDS drugs and medical services, a program that greatly increases the money available to combat the disease in a region that has become its epicenter.
The program, which will be announced by the United States Export-Import Bank on Wednesday, comes after five multinational drug companies agreed in May to cut the prices they charge African nations for drugs to combat AIDS. The loans will help poor nations to buy the drugs that fight the complications and transmission of AIDS, and which are expensive even at discounted prices.
It is estimated that Africa already has 50 million people who carry H.I.V., the virus that causes AIDS, far more than any other region, and doing more to fight the disease there has become a central goal of the Clinton administration and several European nations. Despite the severity of the problem, international health officials estimate that only 5 percent of Africans who carry H.I.V. are aware of the fact.
But wealthy nations have only just begun to make money available to match their vocal pledges to address the problem. The United Nations estimated recently that the amount of money devoted to fight the disease in Africa needs to rise 10-fold to $3 billion annually if the nations hardest hit are to make significant progress in education, prevention and care.
"This is at least a first step in showing the world that Africa is important to the United States and that we can make a dent in this terrible problem," said James A. Harmon, president of the Export-Import Bank, which is an independent government agency financed by Congress. "We think that this is the most significant funding commitment by any international institution to date."
Mr. Harmon said he expected that export promotion agencies in Europe and Japan would eventually match the American initiative. He estimated that together wealthy nations could make $3 billion available in annual financing to African governments that want to buy pharmaceuticals, equipment and services.
The loans are not without complications. Several officials said the administration was split about the wisdom of the Export-Import bank's action, with some officials arguing that it does not make sense for the United States to lend African countries billions of dollars in export credits at a time when Congress is being pressed to forgive past loans.
Most of the new loans, which will not require Congressional approval, would be provided at commercial interest rates that now average about 7 percent, though a small percentage might be offered at a lower concessional rate, bank officials said.
Wealthy nations and international lending agencies are seeking to forgive as much as $100 billion in past development loans to the most indebted nations, including many in Africa. Some administration officials had promoted debt relief to a reluctant Republican-led Congress as the best way for the United States to combat AIDS, because it would free up money that African nations would otherwise have to use to service their debts.
The loans are also likely to increase an active debate among groups interested in development over the best way to tackle AIDS. Many of the African nations and private charity groups have argued that AIDS is a huge medical and social crisis that requires more than discounted drugs and new loans.
"I think what the United States is doing is laudable," said Koby Koomson, Ghana's ambassador in Washington, referring to the loans. "But the pharmaceutical companies need to come around and see that the only way to fight this pandemic is to donate whatever is necessary."
The United States loans could help American pharmaceutical companies prevent the spread of generic knock-offs of their profitable AIDS drugs to Africa. Even with heavy discounts of up to 80 or 90 percent -- the companies have not made public the prices they will charge -- some drug makers may still hope to sell their product profitably in Africa.
The United Nations has said it is exploring the possibility of helping African nations buy generic AIDS drugs from Brazil and India for less money that even the discounted prices Western drug companies might charge for the original product. The drug companies consider generic alternatives a violation of their intellectual property.
But it seems unlikely that Brazil, India or other nations that produce such drugs for home consumption would have the export financing available to help African nations buy the goods. The American loans, along with a recent commitment by the World Bank to provide at least $500 million to help African nations set up anti-AIDS initiatives, give added incentive to African nations to treat many of their AIDS cases with Western medicine.
Even at 90 percent discounts, a typical cocktail of AIDS-suppressing drugs might cost $2,000 a year for a single patient in Africa, more than four times the average per capita income in many of the worst-afflicted countries.
Jacob Gayle, a senior technical adviser for the United Nations AIDS Program, which is based in Geneva, called the Export-Import Bank action "a major announcement" that takes a big step toward providing the $3 billion in annual fund commitments that his agency considers necessary to fight the disease in Africa.
But he stressed that the problem is much broader than a lack of AIDS drugs. African nations need to set up education and prevention efforts and develop the medical infrastructure to administer drugs effectively before they can make good use of loans to purchase medicine, he said.
The loan program is the first time the Export-Import Bank has offered financing for drug purchases by any nation, Mr. Harmon said. Moreover, the government bank plans to make the financing available to the 24 eligible sub-Saharan nations for five-year terms, an unusually long term for loans that are considered high risk.
He called the loans a pilot program that could be expanded or scaled back depending on how African nations and drug companies respond.
Teaching Troops About AIDS
UNITED NATIONS, July 18 -- At the urging of the United States, the Security Council has adopted a resolution asking for more attention to education about AIDS to be given to peacekeeping troops, who have been carriers of the disease, especially in Africa. The United Nations has been advising peacekeepers on the dangers of AIDS and promoting the use of condoms, and the resolution reinforces those efforts.
In the vote on Monday, however, the American delegation failed to win a stronger resolution. It would have asked for a data base to be kept on peacekeepers to track national efforts to monitor the rate of infection with AIDS and test troops.
Countries supplying troops objected to that
proposal as an infringement of their control over military policies.
LOS ANGELES, July 18, PRNewswire --
The Global Initiative on AIDS in Africa will hold an emergency "Celebrity
Roundtable on AIDS in Africa" from July 27 -- July 29, 2000 at the Wyndham
Bel Age Hotel in West Hollywood, California.
"We must break the deadly silence, unite and engage the world in this war,
otherwise, we may very well lose an entire continent. Africa is dying, the
children are suffering and the world must respond immediately," says Bonnie
Marshall, founder and CEO of the Initiative. "Government should not
be expected to bear responsibility alone. Each and every one of us has a
responsibility to respond to what's happening in Africa. If not, then who
are we, what have we become?"
Dignitaries participating in the roundtable include Congresswoman Juanita
Millender-McDonald; Ambassador Mary Kanya from the Kingdom of Swaziland; Dr.
Eugene McCray, Director of Global AIDS Activity for the Center for Disease
Control; Minister Johnson Ougnyemi, Embassy of Nigeria; Papa Ndiame Sene,
Depute'du Assemblee/President of Foreign Affairs, Senegal.
During the conference, celebrities will plan and develop strategies to assist in
confronting the Africa AIDS crises, and help create and launch a global media
campaign to raise awareness, support and funding for the people of Africa.
"It will take the powerful voices of the celebrity community to break the
silence and enlist the world to help Africa," says Marshall.
The Global Initiative on AIDS in Africa's has over 800 beneficiary foundations
based in Africa. Its mission is to unite, support and empower
African-American and African based grassroots and HIV/AIDS organizations by
providing the resources that they need to fight HIV/AIDS on the ground.
"The war can not be defeated from the top down. It must be waged on
the ground, in the cities and urban slums, in townships and remote villages.
>From South Africa, Congo, West Africa, Central Africa and Ethiopia to Egypt,
we must empower the people of Africa so that they can help themselves,"
says Marshall, who adds that "Celebrity participation is an immeasurable
weapon in the battle against HIV/AIDS, particularly among people of African
descent."
Celebrity Roundtable on AIDS in Africa is being co-sponsored by the Center for
Disease Control (CDC), the National Legacy Foundation, and the Shell Oil
Corporation, and is open to media, entertainment professionals and executives,
and invited guests only.
Celebrities, agents, managers and entertainment executives are encouraged to
attend and may call 407-312-3010 to register or for additional information.
An international press conference is scheduled for Friday, July 28th at 11:00
a.m. in Salon II at the Wyndham Bel Age Hotel.
More information on The Global Initiative on AIDS in Africa can be found at www.aidsinafrica.com.
SOURCE The Global Initiative on AIDS in Africa
S.Africa welcomes U.S. loan offer
for AIDS drugs
JOHANNESBURG, July 19 (Reuters) - South Africa on Wednesday welcomed a U.S.
offer to lend sub-Saharan African countries $1 billion a year to help them buy
anti-AIDS drugs but said lack of infrastructure to dispense the drugs remained a
key issue.
``It's much more than the availability of drugs. There should be infrastructure,
laboratory facilities. It's the issue of us being able to monitor those drugs.
It's a whole variety of issues which we have to address,'' South African
Television quoted Health Minister Manto Tshabalala-Msimang as saying.
The U.S. offer builds on an announcement by major drug companies in May that
they would provide drugs to combat HIV, the virus that causes AIDS, at major
discounts to countries that cannot afford commercial prices.
Sub-Saharan countries -- where more than 13 million people have died from AIDS
and almost 24 million people have either HIV or AIDS -- have not yet taken up
the drug firms' offer, arguing it is not satisfactory or does not address the
lack of infrastructure to effectively deliver the drugs.
Last week, 10 African health ministers including Tshabalala-Msimang met in
Durban, South Africa before the 13th international AIDS conference and expressed
anger at what they said were mere public relations exercises by drug firms
offering limited donations of AIDS drugs to governments.