The grim conclusion to be drawn from the 13th International Conference on AIDS is that most of the world's 34 million people currently infected with HIV/AIDS will be left to their fate. This is despite the fact that the conference in Durban, South Africa July 9-14, drew the attention of the world's media and pledges of financial support by the World Bank, the United States government, Bill Gates and a number of drug corporations.
The epidemic is now spreading at a phenomenal rate, with a further 5.4 million added to the total last year. Over 90 percent of the 34 million infected are in the underdeveloped countries where there is no treatment available. In sub-Saharan Africa 24.5 million are infected.
Former South African President Nelson Mandela received a standing ovation from the 12,000 scientists, professionals and campaigners assembled in Durban for his concluding speech. Yet the agenda he outlined, which Western governments, aid agencies and the United Nations back, will do little to overcome the epidemic.
Mandela's speech tacitly accepted that the antiretroviral drugs and advanced health care used to tackle HIV/AIDS in Western countries could not be afforded in Africa and other underdeveloped countries. All that he called for was a prevention campaign promoting sexual abstinence, condom use, drugs to prevent women in labour passing HIV infection to their babies, and other measures such as HIV counselling and testing services. However important these measures are, even they are beyond the budget of many African countries and fall far short of more effective treatments available for HIV/AIDS sufferers in the West.
Many speakers at the conference expressed their anger at the lack of concern by Western governments, as well as the huge profits made by drugs companies out of antiretroviral treatments. However, Mandela was able to use his prestige to keep the conference within the agenda backed by the UN. His call for an “African resolve to fight this war” essentially amounted to absolving Western governments of any responsibility for the continent's unprecedented social crisis.
Whilst the conference was organised by the International AIDS Society, its main financial sponsors were the major drug corporations.
Mandela was particularly helped by the highly publicised and reactionary intervention of South African President Thabo Mbeki in the run-up to the conference. Mbeki had attempted to promote a tiny number of dissident scientists who disagree with the well-established scientific theory that the HIV virus causes AIDS. Mbeki strongly suggested that an “African solution to an African problem” was required. Not only did his questioning of basic science create confusion in Africa, where there has been virtually no education about AIDS, it helped set the limited agenda for the conference.
Just before the conference a declaration of over 5,000 leading scientists, including 12 Nobel Prize winners, was published in the science magazine Nature affirming HIV as the source of the disease. However, Mbeki made clear he would not back down in his opening speech, saying, “We could not blame everything on a single virus.” This prompted a walk out by hundreds of participants and repeated attacks were made on Mbeki during the proceedings.
Mandela did not fundamentally challenge Mbeki's stance, however. He attempted to divert from the serious issues that had been raised, making statements such as “the dispute about the primacy of politics or science [should] be put on the back burner” and that “we proceed to address the needs of those suffering and dying”. It is impossible to speak of making any significant headway against the AIDS epidemic so long as political leaders are able to undermine a scientific response to the crisis.
It is unlikely that the South African ANC government will implement even Mandela's restricted proposals. None of its ministers attended the conference and it has continued its stance on refusing to supply the antiretroviral drug AZT to HIV pregnant mothers. UN figures show that 22 percent of pregnant women in South Africa are now HIV positive.
It has also became clear that the UN's limited agenda for sub-Saharan Africa as a whole will not receive anywhere near the finance required, despite the conference publicity and Mandela's pleas. UN estimates are that this would require US$3 billion a year, 10 times the current amount spent. At the conference, the World Bank claimed it would make $350 million available; Bill Gates and drug company Merck & Co. pledged $30 million each, far short of the UN's appeal.
Perhaps the most callous response came from the United States government with headline proposals for up to $1 billion a year to be made available in loans for AIDS drugs. The loans are conditional on countries purchasing drugs from US pharmaceutical companies, which have offered to reduce their prices, and are concerned that African countries may purchase drugs elsewhere. Under the WTO's Trade-related Intellectual Property Rights (Trips) system, countries are supposed to be prohibited from manufacturing their own, cheaper version of the drugs rather than buying from the global corporations; although some countries such as Brazil and India are in fact doing so. The loans would also have to be repaid at commercial interest rates averaging 7 percent, by countries that are already amongst the most debt-burdened in the world. Sub-Saharan Africa presently pays some $15 billion a year in debt repayments, approximately four times more than these countries spend on health or education.
The conference report by the independent PANOS institute gave some indication of the scale of the resources that would need to be mobilised to tackle the AIDS calamity. To treat the 400,000 HIV/AIDS infected people in Zambia with antiretroviral drugs for one year would cost £2 billion, and to provide an adequate health infrastructure to deliver the treatment would cost a similar amount. The corresponding figure for Uganda is £1.9 billion. In other words, the amount proposed by the UN for its basic package for the whole of Africa would not pay for effective treatment in just one country. That this global catastrophe could elicit no more than a call to “break the silence”—the educative theme of the conference—is a huge indictment of world political leaders and current government attitudes to social welfare.