TURNING THE TIDE TOGETHER

XIX International AIDS Conference

With over 20,000 other participants, Marjorie, Chrisie and Ida gathered in Washington at the XIX International AIDS Conference, for a series of meetings, speeches and other sessions which told of the challenges and successes, the questions and responses in both the lab and in the field. We should be proud that the Church of Scotland, as part of its Mission, has a programme that focuses on HIV prevention, that is working to end discrimination against HIV patients, and that advocates research and investment to make treatment available to all those who need it.

Sunday 22 & Monday 23 July 2012

The M&E Session before the opening was useful in showcasing a solar powered laptop, used for collecting and processing data in remote rural areas.

At the opening, we learned that Zambia’s infection rate has decreased and that more people are able to access ARVs than previously. These are new infections being treated and we are not just treating those waiting in the queue. Proper adherence should ensure people living with HIV can enjoy a more normal, fulfilling and longer quality of life.

Treatment is a form of prevention. This is especially true in the case of PMTCT. If all HIV+ mothers receive ARVs, then the risk of transmission to the child is minimal. Malawi has already gone down this road with good results (Option B+). Zambia is being encouraged by WHO to follow suit. In doing this, the 2015 goal mentioned at the faith-based conference should be reached.

Related to this, is the necessity to upscale our outreach to youth. Too many do not know their status, this is not helped by their exclusion from adult programmes. That is why, at Mwandi, our provision of a Youth-Friendly Corner (and the appointment of a Youth Co-ordinator) has been so important. It will continue to provide quality care, education, testing and easy access to ARVs, for this important segment of the population in the catchment area. Only through this, can stigma be addressed and help offered by peer educators.

The Food Security Session showed how hospitals can work closely with nutritionists to improve the diet of patients. The Nutrition Department prescribe donated food to patients based on their BMI.

However, a significant challenge to be faced is ‘leakage’, ie. the numbers tested and found positive amongst babies, children, youth and adults are far greater than those who actually commence treatment.

On the Sunday afternoon, a large crowd gathered near the Washington Monument as part of the Washington ‘Keep the Promise’ March. Andrew Young and Rev Al Sharpton gave inspiring speeches, setting the stage for some further introspection.

It was also good to see the AIDS Memorial Quilt, that was started by gay rights activists who wanted to make certain that their friends who had died of AIDS would not be forgotten. The quilt is now the largest community art project in the world, and is a poignant testimony to love, peace, and hope.  There are men, women and children from every continent, remembered in the panels. It is a wonderful and moving memorial to those who have died, but also a celebration of life.

Tuesday 24 July 2012

Hilary Clinton addressed the plenary session on Tuesday. The first item after that was entitled ‘Science to Public Health’, and discussed the tools necessary to end the epidemic. An AIDS-free generation was the ultimate goal. There was a moral responsibility to ensure this.

Tuesday also saw the opening of the Global Village, which is the focal point for science, medicine, civil society and the wider community. It is a noisy, vibrant and colourful area, with an eclectic array of fringe events and activities.

In the afternoon, an interesting session took place, on the critical and growing role of the faith community in treatment and advocacy, to increase the political will to fight AIDS locally, nationally and internationally. Access, dignity and inclusion are all part of our work for justice. Other meetings Ida attended dealt with developing community support and capacity, remuneration for Home-Based Care workers, and finally Prevention, which brought Tuesday to a close.

Wednesday 25 July

The Wednesday Plenary opened with research on the HIV vaccine and highlighted the effect of the epidemic on children, adolescents and women in particular. Women account for over half the 34 million people living with HIV worldwide, and the rate of infection is twice the male rate in Sub-Saharan Africa.

Ida spent a lot of time learning about finances and the efficient use of funding. She listened to DFID and Global Fund discuss the effect the present financial crisis was having on funding. Other areas of interest were scaling up PMTCT, and learning about the demand and supply side of pharmaceuticals. Ida was honoured to be able to speak about how policy-makers' decisions, and their implementation, affect people at the grassroots level.

Thursday 26 July

The plenary dealt with the dynamics of the epidemic, in particular, contexts with groups most vulnerable to infection, including sex-workers. Expanding testing and treatment, while at the same time ensuring greater adherence and prevention, were some of the approaches suggested. The Global Fund held more public sessions on:  political commitment, resources and pricing; a sub-Saharan session on the cancellation of Round 11 grants, and finally a meeting called "The Next Five Years", which outlined the strategic direction and future hopes.

Friday 27 July

The final day’s plenary was concerned with co-infections, including TB and other non-communicable diseases, such as heart disease, cancer and diabetes. We heard that the cost of treating a patient in Zambia is $200 per year. The closing session was addressed by a series of politicians and international worthies, and ended with a keynote address by Bill Clinton.

The XX International AIDS Conference (AIDS 2014) will convene in Melbourne 20-25 July 2014.

One especially memorable highlight for Ida was greeting Kenneth Kaunda on the escalator. He was going down as Ida was going up. We don’t know who was more surprised - Ida, seeing the First President, or Kenneth, being greeted by Ida so far away from home, in a Washington DC Conference Centre in the Lozi manner (Kukandalela)!


Ida Waddell and Marjorie Clark

Thanks to the Church of Scotland for their financial and logistical help to make attendance at this conference possible for Ida. Thanks, too, to her old friend, Megan. It was a good time of spiritual, personal and professional development. It was useful and enjoyable spending time with colleagues, and also meeting and speaking with other people from the diverse communities involved in the fight against the epidemic – science, advocacy, faith, politicians and vulnerable populations.

Sturm und Drang in Vienna: Our diary

Saturday 17 July: The Multi-Faith Pre-Conference of the International Aids Conference met at the Technical University. The opening religious ceremony was excellent, with all the various faiths found in Vienna taking part. It was also good to see that WHO are giving due recognition to the work of faith-based institutions on the ground but sad to hear that PEPFAR have 'straightlined' their funding. Ida found it a good forum to raise two major concerns she had on the unsuitability of some of the paediatric ARVs and the lack of variety in comparison with adults. The pharmaceutical companies need to be lobbied on this issue. Returning to PEPFAR, if budgets continue to be reduced, then universal access will fall by the wayside and faith-based institutions will end up having to play God which is not their role. Those two points were picked up and used during the conference by more authorative speakers.

Sunday 18 July: The Opening of the Conference with the 18th Life Ball which was being held out of doors at the Rathaus was washed out by a tropical thunderstorm called Petra just as Whoopi Goldberg dressed as Mother Earth started to sing. The great and the good including Bill Clinton, Mette-Marit, the Crown Princess of Norway and various other prominent German-speaking politicians and celebrities rushed for cover including 50 black Promenade Dancers dressed in white and 50 white dancers dressed in black, while those in fancy dress including avatars, fauns, elves and pixies plunged into the fountains. Other prominent personalities present were Boris Becker, Patti Labelle, Prussian and Austrian Princesses plus the Mayors of Berlin and Vienna. Unsurprisingly, there were no Scottish peasants invited.

Monday 19 July: The first Plenary Session of the Conference and Bill Clinton's keynote speech was a highlight. Regarding funding Faith-based Institutions should lobby Congress to make the right choice by supporting, continuing and increasing funds for care, treatment, infrastructure and systems. Greater care and stewardship was also a pre-requisite for a dollar wasted puts a life at risk. Jobs need to be done faster, better and cheaper, in other words doing more with less. African governments need to keep their part of the bargain and devote at least 15% of their national budgets to Health Care. As regards prevention, scaling up should be done with what works. Large sums of money of money can be raised through small amounts given by many people. Education and advocacy are priorities.

Ida presented her poster entitled The United Church of Zambia Mwandi Mission Hospital Voluntary Counselling and Testing Strategy for Hard-to-Reach Populations. This dealt with a mobile outreach program that visited social events and rural and fishing settlements to increase the number of people who know their HIVstatus, so that they can access the HIV Programme before they are ready to start anti-retroviral treatment and become sick.

Tuesday 20 July: The main event was a peaceful but noisy demonstration through the streets of Central Vienna by 15 000 people on Tuesday evening to show solidarity with the campaign for human rights throughout the world and especially for those living with HIV and Aids. It also called on Governments around the world to increase funding for fighting the disease. An interesting fact: the Church of Scotland has given much more money to the worldwide fight against HIV and Aids than the Austrian Government, who to its shame gave a paltry single contribution of E1m to the Global Fund away back in 2002 for condoms for Africa..It was pointed out that the city of Vienna would be benefiting to the tune of E45m going into the local economy from hosting this conference alone. The Demo closed with a live concert given by Annie Lennox, the former Eurythmics singer, who is now the United Nations AIDS Goodwill Ambassador.

Wednesday 21 July: Marjorie Clark's Presentation of the Church of Scotland's HIV/AIDS Project at the Global Village. This was also another good opportunity for networking. Marjorie explained that the Church of Scotland”s Programme started in 2002 and its position was reiterated in 2006. It is to bring life and hope by breaking the silence on HIV and Aids and standing with partner Churches to offer practical support and to speak up for the voiceless, involving all Church members. This year the project becomes an integrated programme of the World Mission Council.

One of the most successful fundraising ventures had been Souper Sunday. Congregations had a simple soup and bread lunch after a Sunday Service in January. Last year over GBP100 000 was raised in this way from over 300 individual Churches. These congregations' generosity was a good example of many smaller sums of money adding up and together making a considerable amount. Mony a mickle maks a muckle.

Thursday 22 July: A good day for hearing about the new WHO PMTCT (Prevention of Mother-toChild Transmission) and Feeding Guidelines. The mothers will in the future be covered by ARVs until they stop breastfeeding. This will mean that more babies should be able to be breast-fed. This is a step in the right direction but in an ideal world all pregnant HIV+ mothers would be able to access long-term triple therapy anti-retrovirals.

The integration of palliative and home-based care at a workshop was another useful meeting and contacts made for future-training. This is an area that is lacking at present in Mwandi but steps are afoot to work at this through the Woman's Christian Fellowship in our 13 out-of-station preaching points.

Another interesting talk was given by a Dutch doctor based in Mozambique who has formed his ARV patients that default into cell-groups that help support each other, provide a form of mutual accountability and pick up ARVs for each other. This is a simple and effective way of cutting down waiting time in queues and transport costs for these patients. This can only happen with stable patients but is another good idea that can be adapted for use by the Mwandi Programme.

Friday 23 July: The closing day. The Global Village is being packed up but nonetheless excellent presentations on the maltreatment of prisoners living with HIV and Aids in Eastern Europe. It has been good to see how HIV and Aids affects other areas of the world and not just Africa.

We have also managed to visit Schoenbrunn Palace and the Spanish Riding School. Keith Catriona and Mubita also toured the Zoo, went to a Gustav Klimt Exhibition and did a cycle-tour of the Wachau are where the imprisoned Richard the Lionheart was found by Blondel, the inconclusive Battle of Duerenstein between Napoleon and the Austro-Russian Coalition in 1809 and the Anti-Freeze in the White Wine Scandal of 80s.

On Saturday 24 July we set off by rail for Geneva via Zurich.