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Africa: HIV/AIDS Conference
Africa: HIV/AIDS Conference
Date distributed (ymd): 980110
Document reposted by APIC
This posting contains two press releases from the December 1997 conference
in Abidjan on HIV/AIDS in Africa, emphasizing new estimates of the scale
of the problem, the increasing gap between rich and poor countries, and
the controversies over prevention and treatment.
Additional note: Controversy continues on the ethics of clinical trials
on HIV-positive African women, including the use of placebo (no treatment)
control groups. The recent debate, continuing in both the medical press
and other media, began with an article by Sidney Wolfe and Peter Lurie
in the New England Journal of Medicine on September 18, 1997 (http://www.nejm.org/public/1997/0337/0012/0853/1.htm).
UNAIDS Presse Release
Abidjan, 7 December 1997
Unprecedented effort needed to combat AIDS epidemic
UNAIDS Executive Director outlines major challenges for Africa as figures
show alarming rises in HIV infections on the continent.
Leading figures in African politics and society, gathering for the 10th
International Conference on AIDS and Sexually Transmitted Diseases in Africa,
were today presented with major challenges to fight the HIV/AIDS epidemic
sweeping the continent.
Dr Peter Piot, Executive Director of the Joint United Nations Programme
on HIV/AIDS (UNAIDS), opened the conference in Abidjan, Cote d'Ivoire,
by saying that statistics just released by UNAIDS and WHO show that over
20 million people in sub-Saharan Africa are now living with HIV/AIDS. "The
situation in this region is unprecedented," he said. "One in
every thirteen men and women aged between 15 and 49 are now HIV-positive.
In South Africa, it is estimated that one in ten adults are living with
HIV, up by more than a third since 1996. In Botswana, the number of people
infected with HIV has doubled over the last five years, now reaching 25%
to 30% of the adult population. A quarter more infants are dying in Zambia
and Zimbabwe than would be the case if there were no HIV." While,
in general, West African countries have seen infection rates stabilize
at lower levels than elsewhere on the continent, some of the most populous
countries are an exception to this rule. For example, it has been estimated
that there are some 800,000 HIV-positive people in Cote d'Ivoire and 2.2
million in Nigeria.
Lack of access to treatment and care make situation worse
Dr Piot stressed that this situation was further exacerbated by inadequate
access to treatment and care. "The AIDS gap continues to widen. Although
progress is being made in treating those infected in the richer countries,
the vast majority of people in the developing world who should be benefiting
from these advances are unable to," said Dr Piot. While many industrialized
countries are now witnessing a drop in AIDS deaths as a result of the new
antiretroviral combination therapy, only a very small proportion of people
in the developing world have access to these treatments. Here, in general,
the major concern is still to obtain much simpler drugs to treat the opportunistic
infections that accompany HIV/AIDS and to relieve basic pain and suffering.
Similarly, insufficient resources and limited health service capacity have
precluded drug regimens found to be successful in reducing mother-to-child
transmission from being made broadly available in developing countries.
"The situation calls for an unprecedented global effort,"
said Dr Piot. "UNAIDS and its co-sponsors are currently developing
a variety of approaches to help make drugs more accessible in developing
countries, to strengthen health services and delivery systems, and to involve
community groups and the pharmaceutical industry in new partnerships with
governments. But much more needs to be done. We need an urgent and comprehensive
response on the part of all sectors worldwide."
African successes in confronting the epidemic
At the same time, Dr Piot drew attention to the many positive examples
in Africa of what can be done to confront the epidemic. "The real
question now is how do we learn from Africa's successes," he said.
Dr Piot said Uganda had already shown that extremely high HIV prevalence
rates could be turned around. This year's data, which were still being
analysed, showed that between 5% and 9% of pregnant women at three surveillance
sites were infected - one-fifth lower than a year ago.
There were other encouraging responses to the epidemic in Africa, added
Dr Piot, including Zimbabwe's AIDS education programme for schools supported
by UNICEF, AIDS in the workplace schemes run by Swaziland's sugar companies,
and South Africa's new constitution which protected the human rights of
people with HIV.
New evidence links voluntary HIV testing to HIV prevention
Dr Piot continued by drawing attention to the importance of unmasking
what is in many places still an invisible epidemic. UNAIDS now estimates
that nine out of ten people living with HIV do not know they have the virus
and therefore cannot seek care or plan ahead for themselves and their families.
Demographic health surveys in Tanzania and Uganda show that two-thirds
of people questioned would like to know whether they are HIV-positive.
Apart from its other benefits, voluntary testing and counselling can cut
the risk of transmission, new research shows. Studies carried out by UNAIDS
and the United States Agency for International Development (USAID) in Kenya,
Tanzania and Trinidad over the past two years, and presented at the conference,
provide conclusive evidence that volunteers who receive an HIV test and
counselling go on to have fewer sexual partners and less unprotected sex.
"There is clearly a demand and a need for greater access to voluntary
HIV testing and good-quality counselling," said Dr Piot. "We
call on governments to make voluntary testing and counselling widely available
and to work to ensure that the right policies and attitudes are developed
to support our communities living with HIV. If voluntary testing really
can help reduce HIV transmission, it must become another vital tool in
Africa's battle against the epidemic."
Challenges to leaders
In concluding his address to the leaders of African society who had
gathered in Abidjan for the five-day conference, Dr Piot issued the following
challenges:
"Break the silence." Dr Piot asked delegates to inspire their
fellow citizens to acknowledge the epidemic, fight the spread of HIV, the
virus which causes AIDS, and support people living with HIV/AIDS.
"Focus on the next generation." An investment should be made
in young people, he said, who can turn the tide of the epidemic for Africa.
"Make AIDS a development issue." Because the impact of AIDS
was felt in all sectors of society, said Dr Piot, the active involvement
of a number of ministries had to be secured.
"Ensure solidarity to help Africa scale up its response to the
epidemic." Help must be given to expand the existing islands of hope
across the rest of the continent.
In a message to the conference, the Secretary-General of the United
Nations, Mr Kofi Annan, emphasized that through UNAIDS and its partners,
the UN system was "more committed than ever to generating solidarity
with Africa".
"Together we can mobilize the international support that Africa
needs to ensure a brighter future for all its people," concluded Dr
Piot.
For more information, please contact Anne Winter, UNAIDS (wintera@unaids.org),
Gareth Jones, UNAIDS, Geneva (jonesg@unaids.org,
tel: +41 22 791.3387) or Lisa Jacobs, Ogilvy, Adams and Rinehart, New York,
(tel: +1-212 880.5325) You may also visit the UNAIDS Home Page on the Internet
for more information about the programme (http://www.unaids.org).
NEWS STORY
FINAL CONSENSUS ON AFRICAN ACCESS TO AIDS TREATMENT "SAYS VERY
LITTLE"
Abidjan, 9th December (via Presspack.com) -- A consensus statement on
anti-retrovirals in Africa was due to appear two days ago but a long meeting
came and went with no consensus. Today, the consensus finally appeared
but no-one seemed happy with a document that was long on good intentions
but short on details.
At the start of the conference, some Aids activists were furious at
what they saw as a backing away from a commitment to making new treatments
for Aids available in Africa. French activist Jerome Soletti was loudly
applauded by African delegates on Sunday as he accused the European Union
and the World Bank of "murderous policies" and warned that activists
would resist them. Both institutions had, he said, promised action to make
promising new drugs available to Africans. These drugs, used in combination,
have given new hope to hundreds of thousands of European and American patients.
Now, according to Soletti, both institutions are talking only about prevention.
The Network of African People Living with HIV/ AID (NAP+) said that many
of their number could handle new treatments, "it is within our power
to care for and support each other, be compliant to treatment programmes,
when available but also to demand services and access to services which
will allow us to continue as productive members of our communities,"
said a statement.
The activists had felt that decisions had been taken and that they were
largely protesting in vain. On Sunday night, President Jacques Chirac of
France arrived to give unexpected support for their position. "We
cannot accept a two speed epidemic," he said. He echoed the activists
saying that some believed, wrongly, that they could talk about treatment
in the North but only about prevention in the South. He suggested a new
international fund to pay for treatments in Africa and Asia and to accelerate
the search for and testing of vaccines. He called on pharmaceutical companies
to dramatically lower their prices.
The forces of "realism" rallied on Monday. Experts from prestigious
institutions such as Harvard University and the World Bank cautioned against
getting carried away with the idea of making treatments available across
Africa. They cited the continent's other health and development needs which,
they said, should have an equal call on scarce resources. Some spoke of
their fear of widespread resistance to new drugs by mutant strains of the
virus allowed to develop in those who took medicines sporadically. They
cautioned that prevention efforts might be neglected.
The European Commission came in for fierce attack with claims that it
had spent less than half the funds allocated to AIDS over the past decade
because its mechanisms were too unwieldy and that it was doing almost nothing
about treatment and vaccines. On Tuesday, former French health minister
Michele Barzach said that the implication of this might be that a new multinational
mechanism or a new EU fund might be required if vaccines were to get the
priority they deserved. Lieve Franson, principal administrator at the EU's
Health, Family Planning and AIDS Unit defended EU policies, telling Agence
France Presse that "a study in Kenya clearly showed that giving priority
access to AIDS treatment increases mortality among those not infected with
HIV ... This is due to limited funds and human resources. Prioritising
one disease over another destabilizes already fragile health systems."
By Monday evening, Chirac's views had been re-stated and strengthened
by a domestic political opponent. The French Secretary of State for Health,
Dr Bernard Kouchner said, ... "to the guardians of the temples of
public health, who often live in too much comfort to feel empathy, I want
to speak about treatment as well." He told a press conference that
he thought there should be a new tax on the movement of capital across
the world's financial markets. This would create a new global fund for
vaccines and treatment. He also suggested that drug makers might lower
prices and enable a small amount from every sale in Europe or North America
to go to fund treatment in Africa. Like Chirac, he stressed a vaccine as
the only long-term solution.
Federico Mayor of UNESCO joined in, telling Reuters, "it is shameful
to let AIDS patients in poor countries die without benefiting from the
new treatments available to those living in developed countries."
Caught in the midst of all this was the Joint UN Programme on Aids (UNAIDS/ONUSIDA)
which is preparing pilot programmes to make new anti-virals available to
patients in Chile, Cote d'Ivoire, Uganda and Vietnam. "How many, where
and at what cost?" asked Raffi Babakhanian of the European Aids Treatment
Group. "The million dollars allocated by this organisation to the
pilot projects ... for medicines to treat HIV infection constitutes 0.3
percent of its overall budget ... With such derisory sums, is it proper
to speak of a commitment to combatting AIDS in Africa?" asked Therese
Lethu, editor of Afrique Medecine et Sante. "With over 20 million
cases in Africa, talking about just prevention is very difficult for me,"
Dr Peter Piot of UNAIDS told Reuters. He said that effective prevention
required some access to treatments, "as long as the epidemic is invisible
why would a community react to it ... There needs to be an incentive to
come out and admit AIDS and that can come from care and support,"
he added.
Kouchner, whilst congratulating Piot on progress, said that those who
found the UNAIDS efforts too timid were right. He and Chirac called for
far more rapid and intense programmes to deliver AIDS medicines to Africans.
The consensus document which tried to bring together these divergent
views could, of course, say very little. Much of it is common sense. For
example, "anti-retrovirals should only be prescribed when one can
reasonably count upon compliance and a correct patient follow-up ..."
and "taking into account the complexity, adverse effects, toxicity
and costs of anti-retrovirals, the prescription of ARV treatments must
be always be based on a confirmed diagnosis of HIV infection."
Activists welcomed a strong statement that a combination of three anti-virals
was the best option and that single drugs should never be given.
Several of the thorniest issues could not be settled. For example, is
it better for an African mother to breastfeed her child even if she might
be HIV positive and might pass on the infection through her milk? Breastfeeding
has historically been shown to help babies to thrive but is it still the
best practice in communities where up to 1 in 4 mothers is HIV positive
and where the vast majority have no way of knowing their HIV status?
American studies show that HIV positive mothers treated in the last
trimester of pregnancy seem far less likely to pass on HIV to their babies
during birth. The consensus statement says that this kind of treatment
should be a priority and that the medicines should continue to be offered
to the mother after the birth. It is silent about the controversy around
placebo-controlled trials in Africa in which half of the expectant mothers
get a sugar pill whilst half get the real medicine. Some researchers say
that only these sort of trials can show whether the US experience is applicable
to Africa. Others say that the trials are unethical since no American woman
would be offered a placebo under similar circumstances. The consensus statement
is also silent about what should happen where a health system can only
afford treatment during pregnancy, protecting the baby but doing nothing
for the long-term health of the mother and possibly leaving her with virus
resistant to the new medicines.
"These are live debates this week but everyone will leave here,
UNAIDS will get a few million dollars more and everyone will forget about
Aids in Africa until the next meeting," said one participant who has
been to every such meeting since 1987. "We have begun to conquer the
evil at home among the rich whites. 'Quick, let's close the door,' we have
begun to hear, even amongst members of the parliaments of certain comfortable
countries ... What a mistake!" said Kouchner promising immediate and
continuing action. When delegates gather for the next African AIDS meeting
in Durban in 1999, they will know whether resignation or hope should have
clouded their view of Abidjan 1997.
This material is being reposted for wider distribution by the Africa
Policy Information Center (APIC), the educational affiliate of the Washington
Office on Africa. APIC's primary objective is to widen the policy debate
in the United States around African issues and the U.S. role in Africa,
by concentrating on providing accessible policy-relevant information and
analysis usable by a wide range of groups individuals.
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