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.

Two David and Goliath Struggles

Our Aids Relief Programme here at Mwandi has over 1500 people alive today thanks to affordable supplies of ARVs (antiretroviral drugs) from India. The cost of these drugs has fallen from around GBP200 a year to about GBP45 – thanks to the Indian generic drugs industry. This means that international donors, including ironically, the EU’s Global Funding, can help at least six million HIV-positive mostly people in the less-developed world.

Our programme also relies on generic medicines from India to treat other diseases and conditions. But a free trade agreement, currently under negotiation between the EU and India, could greatly restrict the ability of manufacturers in India to continue producing affordable generics that millions of people rely on to stay alive.

At the moment European Union is having trade talks with India and want to increase protection of the intellectual property rights and the commercial interests of European pharmaceuticals giants. They call it "data exclusivity" and along with this the EU is proposing an ambitious enforcement agenda. These harmful intellectual property (IP) provisions will hinder access to quality and affordable generic medicines produced in India, which have played a crucial role in scaling up HIV treatment to more than 6.6 million people across Asia, Africa and Latin America.

The Indian government has raised serious concerns, stating that the agreement could ‘impede legitimate competition and shift the costs of enforcing private commercial rights to governments, consumers and taxpayers’. The European Commission is also apparently pushing for the trade deal to be expanded to cover investments, and not only intellectual property but also an ‘investor-to-state’ mechanism.

This would allow multinational drug companies to bypass Indian courts and take the Indian government to private arbitration courts in investment disputes over intellectual property, which could also lead to the reverse of domestic health policies like tobacco warnings and measures to reduce prices of medicines

The EC are also trying to persuade India to accept restrictions on its generic medicine industry that would mean delays of up to 10 years in producing generic versions of any new, improved medicines and up to 15 years in the case of children’s versions of the same drugs. This is clearly an attack on the health of the world's poor motivated by the callous demands of profit-hungry multinational pharmaceutical companies.

It is vital that this is brought to light and stopped. The rights of people living with HIV having easy and affordable access to essential and life-saving medicine must be protected, especially for the world's most impoverished and vulnerable people.

Greed should not triumph over need.

Yesterday our Chipolopolo Boys, the Copper Bullets, aka Zambia’s National Football Team arrived back home from Libreville, Gabon, to an ecstatic welcome in Lusaka where an estimated 200 000 people thronged the streets all the way from the Airport to the Showgrounds. Winning the African Cup of Nations was something to really celebrate with pride nationwide. People all over the country, including Mwandi, wore football tops, clothes or chitenges in the national colours of green, red, orange and black. Zambia won the African Nations Cup for the first time on Sunday, beating the favourites, the Ivory Coast, 8-7 in a penalty shootout after a goalless draw in the final.

Zambia had been seen as the underdog and had to put up with all the usual patronizing and condescension from the World Soccer Establishment’s pundits at the competition. The Zambian team was considered second-rate, rank outsiders and potential also-rans. So the victory brought some joy and consolation too to this Zam-Scot after our own recent tennis, soccer and rugby disappointments.

The team had earlier paid a moving visit to the beach to commemorate the loss of the 1993 Zambian football team in a plane crash outside Libreville in Gabon where they were to play. That Zambian team was expected to win the game and qualify for the 1994 World Cup but the entire team was wiped out, except for Kalusha Bwalya, now the President of the Zambian FA. So the match on Sunday was a “Date with Destiny”.

The competition comprises of 54 teams and en route to the Championship Final Zambia eliminated Senegal, Equatorial Guinea and Ghana.

The presentation of the cup was a national occasion, to receive it were First Republican President Kenneth Kaunda, Rupiah Banda the former President, the present Vice-President Guy Scott, Kalusha Bwalya and Christopher Katongo, the Captain.

Ivory Coast (Orange): Barry; Gosso, K Toure, Bamba, Tiene; Zokora, Y Toure, Tiote; Gervinho, Drogba, Kalou.

Zambia (Green): Mweene; Nkausu, Sunzu, Himoonde, Musonda; Chansa, Lungu, Sinkala, Kalab; C Katonga, Mayuka, F Katongo.