UNIVERSITY OF PENNSYLVANIA - AFRICAN STUDIES CENTER
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).
The Association of Concerned Africa Scholars (http://www.prairienet.org/acas) has prepared a 130-page briefing packet of collected background and current articles available for $10 (including domestic U.S. postage) on "Tuskegee 2? Africa, AIDS and US. Send a check made out to ACAS to Bill Martin, 326 Lincoln Hall, 702 S. Wright St., Urbana, IL 61801, USA. For information on overseas postage write to firstname.lastname@example.org.
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 (email@example.com), Gareth Jones, UNAIDS, Geneva (firstname.lastname@example.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).
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.
From: email@example.com Message-Id: <199801101738.JAA28766@igc3.igc.apc.org> Date: Sat, 10 Jan 1998 12:37:21 -0500 Subject: Africa: HIV/AIDS Conference
Editor: Ali B. Ali-Dinar
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