Durban 2016: Oh, how things have changed!

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The contrast could not be more stark, writes Nicola Jenvey for MedicalBrief, who in 2000 covered the 13th International Aids Conference in Durban. The failure then of former President Thabo Mbeki to abandon his government’s Aids denialism cast a grim shadow over the entire proceedings. In contrast, Aids 2016 at the same venue has been a week of hope, albeit a looming black cloud over  the HIV/Aids progress made, not least in South Africa, being diseases like tuberculosis and malaria.

In July 2000, the mood was sombre as the conference tackled the theme “breaking the silence” on an urgent need for equal access to treatment and care; improved and ongoing prevention of HIV transmissions; governmental and private sector support of HIV/Aids education and resources; human rights; access of appropriate and meaningful information to all sectors and ensuring a supportive environment for people living with HIV/Aids.

When Mbeki officially opened the conference, the 14,000 delegates, international media and scientists had waited with bated breath hoping he would recant his denialism views – but the wait had been in vain. Aids deaths were escalating towards their 2005 peak of 2.3 million annually and anti-retroviral (ARV) drugs were beyond the reach most of those infected. SA had the greatest number of people living with HIV in the world and life expectancy had fallen rapidly to historical levels.

The Aids 2000 conference  saw the battle lines drawn between the political and scientific communities on the fringes of the main event and it was the arena at which former World Health Organisation (WHO) commission on macroeconomics and health chairman Prof Jeffrey D. Sachs first called for a global fund to fight HIV/Aids. This recommendation was picked up the following year with the founding of the Global Fund to Fight Aids, TB (tuberculosis) and Malaria and shortly thereafter by the US President’s Emergency Plan for Aids Relief (PEPFAR).

Throughout his presidency, Mbeki continued his sympathies for HIV/Aids denialism and instituted policies denying ARVs to Aids patients, an approach particularly devastating to HIV-positive women who subsequently passed on the virus to their unborn children. The cost of these policies was the preventable deaths of between 343,000 and 365,000 people.

How things have changed. Aids 2016 has been fully supported by the present SA government, with Deputy President Cyril Ramaphosa and a host of supporting cabinet ministers, heavily involved in panels, discussions, and events at the conference.

The new International Aids Society (IAS) president-elect and Desmond Tutu HIV Foundation chief operating officer, together with the foundation’s chief executive director Prof Robin Wood, writes in Health-e News that with a supportive national health department leading the way, HIV is largely an outpatient disease, and is managed throughout the country at district level with the help of community structures.

“With almost four million South Africans having initiated ART, declines of life expectancy in the country have been reversed… We also now have better-tolerated regimens that cost substantially less with once-a day dosing. Tuberculosis is inextricably linked to HIV and improving TB-case finding in HIV programmes has improved TB survival … Additionally, we now have prevention options for every mode of HIV transmission such that client-tailored packages can be offered that go far beyond the mainstay of abstinence, monogamy and consistent condom use,” Bekker and Woods write.

In an earlier interview with MedicalBrief‘s Stephen Coan, Bekker said she was  “chuffed” at the South African  government support in the fight against HIV/Aids. “Our current health minister Aaron Motsoaledi doesn’t want South Africa to be behind the curve; he wants to be ahead of the World Health Organisation guidelines.”

“And I must give kudos to the present administration who, from 2008, have been determined to own the problem. They realise we are a middle-income country and we should be able to handle this on our own. But the needs here are more than any other country in the world and that behoves government to be circumspect as to where and how they place their priorities.”

She pointed out that HIV/Aids is not a stand-alone disease; other diseases, such as tuberculosis, as well as other factors are part of the HIV/Aids scenario, including global warming which has seen a resurgence of malaria. “The three illnesses are an unholy triad,” said Bekker. “They coexist, causing increased morbidity and fatalities.” Eradicating them involves far more than treatment. “Social and economic issues also have to be addressed.”

Such issues account for the theme of this year’s conference – “Access equity rights now”.

There are 37 million HIV/Aids infected people worldwide; 16 million are currently receiving treatment. Which means 21 million people do not. “We need to find these people and move them to the top of the tree,” says Bekker. “We’ve got to plug the gaps.

The IAS belief is that ‘no one must be left behind’ – whether it be someone in the Ukraine or a gay man in a village in Kenya – they must have access to prevention and treatment. Unless we get to these people we can’t talk about ending an epidemic.”

As incoming IAS president Bekker believes “it is urgent to reaffirm the passion around this epidemic. We are at a crucial moment, the glass is half-full, we mustn’t let it dribble away in apathy and non-commitment.”

Full MedicalBrief interview with Prof Linda-Gail Bekker


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