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PATAM
Conference - Scaling up access to anti-retroviral therapy and other
essential medicines in Southern Africa
Speech
given by Bishop Trevor Manhanga
March
03, 2004
  The
Permanent Secretary in the Ministry of Health, Dr. Elizabeth Xaba,
the leadership or representatives of the following organisations:
the Pan African treatment Access Movement (PATAM), Zimbabwe Activists
Against HIV/AIDS, the Aids Law Unit in Namibia, the Southern Africa
AIDS Information Dissemination Service and the Treatment Action
Campaign (South Africa), conference participants from other countries
invited guests ladies and gentlemen, I am humbled at the privilege
to address this gathering this morning.
It is a matter
of great inspiration to see, gathered in this hall, distinguished
visitors from our sister African countries who have honoured us
with their presence in this conference. Your presence dear friends
has given both weight and joy to this occasion and an opportunity
for us to re-affirm our commitment to the strengthening of our ties
of solidarity and friendship for the mutual benefit of all our peoples.
On an occasion such as this we should, perhaps start from the premise
that there are only two kinds of people here this morning with regards
to HIV/AIDS, the affected and the infected and all bar none fall
within those two categories. With a plethora of conferences, workshops
and seminars relating to HIV/AIDS epidemic, it could be easy to
dismiss this gathering as another talk shop, out of which nothing
substantial shall emanate. My hope is that this will not be the
case and that practical, workable and implement-able resolutions
will emerge. In the letter of invitation I received it stated that
this conference will be to find out what is going wrong-where and
when practical and I hope that indeed it will be.
The range of
issues that will be covered in this conference is vast, but I urge
you not to get lost in a quagmire of phraseology, with high and
lofty statement. What is needed is for this conference to emerge
with an action plan that will not allow our governments and policy-makers
to drag their feet of indifference, inaction and ineptitude. At
this conference we must ask the right questions and get to the right
answers. We have to find out what is going wrong-where and when;
the suffering and death of millions of our compatriots, whilst for
the most part, we continue as though nothing is wrong. We must confront
it head on. If debt ridden, bankrupt African nations can find the
money to buy luxury vehicles for their government ministers and
political cronies then why can they not find the money to ease the
suffering of their people infected by HIV/AIDS with the access to
anti-retroviral therapy and other essential medicines? We must not
be afraid to ask these questions and demand credible answers.
In a continent
already ravaged by wars, mired in poverty and underdevelopment,
AIDS is wiping out much of our present generation. It continues
to sow further instability that in turn ensures the kind of desperation
where AIDS flourishes. The HIV/AIDS crisis in Africa may seem to
be a purely humanitarian tragedy to the rest of the world, but to
all of us African people who witness on a daily basis the far reaching
devastation of the epidemic it is more than that.
As AIDS wrecks
Africa’s already crippled political and social institutions, leaving
a trail of devastation in its path, it demands more than educational
campaigns, calls to abstinence and safer sexual practices. All these
are good and necessary, but what of the millions of those infected
by the virus, old and young alike, who with adequate medical assistance
could be saved from some of the worst ravages of the disease? I
am here to declare to you that something can be done for them, and
indeed something must be done for them. Many of them are voiceless,
unknown and unheralded, but we are here to be their voices. I hope
that at the conclusion of this conference those people will be closer
to salvation. We must take this time out, while we attended this
conference, in the journey that many of you are engaged in, that
of drawing up strategies to pursue towards ensuring people with
HIV in the need of treatment receive it urgently to get energised
for the battle many of you are currently fighting.
Nelson Mandela
in the Long Walk to Freedom wrote,
I have taken
a moment here to rest, to steal a view of the glorious vista that
surrounds me, to look back on the distance I have come. But I can
rest only for a moment, for with freedom comes responsibilities,
and I dare not linger, for my walk is not yet ended.
As people involved
in the struggle to deliver anti-retroviral therapy and essential
medicines and affordable treatment to the millions of our compatriots,
we are all participants in the long walk. We all need a space to
survey our journey so far and to absorb the view. We all come from
different starting points and have become activists as a result
of diverse circumstances but we are here, bound together by a common
desire and vision. As we pause for breath and consult the road map
for the way forward, over the next couple of days in this conference,
our challenge is to find a common path to take, and we must start
by agreeing as to what is to be our destination, and how we intend
to get there.
As activists,
and ordinary citizens of our respective countries, none of us have
control of the myriads of challenges that face us on a daily basis;
government red tape, drug costs that are out of reach from the millions
of people that need them, orphans and the unemployed who do not
have the financial muscle to access treatment for themselves, failed
states, bankrupt economies, local currencies that are increasingly
not worth the paper they are printed on. We cannot predict exchange
rates or the cost of fuel or food in the next 10 years. But there
is something that we can do here in this conference. We can ask
ourselves on simple question: Do we have a common vision to guide
our actions and strategies? I am a Christian, a man of the church.
In the book of Proverbs 29:18 in the Old Testament we are given
the stark warning that:
Where there
is no vision, the people perish
And we are further
advised in the book of the prophet Habakkuk 2:2 to,
Write the vision
and make it plain, that they who read it may run with it.
In our discussions
in this conference, we must ensure that we leave here with a vision
for the future. A vision that will bring life and hope to millions
that so desperately need it. We must not flinch in the face of the
daunting obstacles that face us. But first let us pause to survey
the journey so far, it’s challenges and it’s successes.
I make no claims
to being a specialist on the subject before us, and yet I am compelled
to be a part of this commando force because the worst any of us
can do is nothing. The dire warnings that have been given over the
years have become a reality. The hard reality on the ground of lines
outside cemeteries as families wait to bury their overburdened mortuaries
that operate 24 hours a day, 7 days a week and the growing number
of people who have gone into the coffin making business, have starkly
brought home the point of the seriousness of the crisis that we
have with us. We cannot take responsibility for past crisis and
we may argue over past atrocities, hoping to draw lessons. Could
Roosevelt for example or others have done more to save the 6 million
Jews from extermination during World War II? What about the almost
1 million people who were brutally murdered in the genocide witnessed
in Rwanda? Could the UN not have acted in time to pre-empt that?
Yet my fellow Africans we have a new holocaust before us-of a very
different character, but on an even larger scale of human destruction.
I recognise that the war against HIV/AIDS is not a traditional war
replete with guns, tanks and landmines. This war is much more insidious,
but no less deadly. We owe it to ourselves and all the millions
of our fellow countrymen infected by HIV/AIDS virus to do something.
SAfAIDS in its
2002 publication ‘AIDS Africa-Continent in Crisis" gives the
following data: In sub-saharan Africa, there are 5500 official funerals
per day, 1600 children per day are born HIV positive, in the last
10 years over 9 million children under 15 have lost their mothers
to HIV/AIDS and of these 90% are in Sub-Saharan Africa, AIDS is
the 1# killer of youth between the ages of 13-24, 22.5 million orphans
were projected to be in Africa by the year 2000, life expectancy
has been reduced in Zimbabwe from 70 to 40, 50% to 70% of hospital
beds are for HIV/AIDS related illnesses. Now because these numbers
have been quoted for so long, it is easy to just say to ourselves
they’re just numbers, but they are more than numbers, they represent
people, men, women, children, fathers, mothers, husbands, wives,
friends, colleagues and that is why we cannot remain indifferent
to their suffering, to their pain. In Zimbabwe, we are disturbed
at the number of people who have been killed as a result of political
violence in our nation and justifiably so, but more people are dying
as a result of HIV related illnesses in a week than have died in
the past two elections combined.
Why has it taken
us so long to get mobilised to fight this disease? Clearly for a
long time there has been a lack of leadership from our political,
spiritual and civic leaders. The complicity in the lack of action
in souring affordable treatment for our people by our political
leaders must be stated and condemned in the strongest terms. Take
the fact that not a single Head of State attended the 1999 World
Conference on AIDS held in Lusaka, Zambia-not even the President
of Zambia? In the face of such apathetic leadership how on earth
can we expect to mobilise our people and the rest of the world to
come to our assistance in fighting this disease? How will history
judge us as leaders? How will history record and justify this deafening
silence as millions of African people face certain death, entire
families destroyed and millions of children orphaned. In the same
way that the slave trade decimated Africa’s population unleashing
a downward spiral that set back Africa’s development by at least
two centuries, so it is with the HIV/AIDS crisis and yet we see
such an apathetic response from our leaders. I call you in our activism
to make HIV/AIDS an election issue. No government should be elected
that does not have a solid workable plan on treatment for HIV/AIDS
sufferers. If we did this perhaps we would get the attention of
our political leaders. This crisis left uncontrolled will set back
Africa again. Ladies and gentlemen the time to act is now.
We can talk,
and justifiably so of the devaluation of the lives of Black people
when compared to whites, one can only imagine the scale of international
intervention if 5000 French or English people were dying of AIDS
daily. A quick comparison of the amount of money, the international
community spent on refugees in Kosovo, US$1.50 per day for each
refugee, but by comparison spent 11 cents per day per refugee for
refugees in the conflicts in Sierra Leone and Rwanda. But we as
African people cannot expect other people to do for us, what we
can and must do for ourselves. If we do not take our own destiny
in our hands then no one else will. This is where leadership, and
strong and daring leadership may I say needs to be exercised. However,
I must clearly state that this is not simply an African problem.
In January 2000, the then US Ambassador to the UN Richard Holbrooke
speaking on the implications of the rising HIV/AIDS crisis in Africa
said, " The spread of this disease could not be contained in
Africa, and the destruction of Africa from AIDS will not be limited
to the continent. If we don’t work with the Africans themselves
to address these problems…they will get more dangerous and more
expensive." Sobering words and ones we as Africans need to
consider ourselves.
You cannot tackle
the issue of HIV/AIDS without addressing the issue of the lack of
material resources and poverty. There can be no doubt of the link
between poverty and the spread of HIV/AIDS. We in Zimbabwe and Africa
are not any more promiscuous than people in Europe and North America,
but the difference in infection rates is very clear and the availability
of resources for treatment and care for HIV positive people is s
definite factor. Houston writing in SAfAIDS News, "HIV care
in Africa –. antiretrovirals in perspective" makes a very pertinent
point by saying, "The disparity in access to HIV treatment
between the world’s rich and poor is unjust – profoundly, obscenely
unjust . . . it has long determined access to prevention and treatment
for common diseases . . . and to basic human needs such as food,
clean water, shelter and education . . .Whatever we do in regard
to ARV in Africa must be in the context of this much larger inequality.
At the very least we must ensure that any ART initiative should
not contribute to increasing inequality."
Poverty is one
of the most pressing of all Africa’s many depressing problems. Poverty
has at least four serious manifestations, which directly impact
on the HIV/AIDS crisis. They are;
- Hunger. One
of every three Africans does not get enough eat. A study covering
the period 1988-90 showed that 168 million Africans were the victims
of chronic hunger. This cannot help in the fight against HIV/AIDS.
- Income. Poverty
means not having adequate income to meet basic needs and imprisons
people in ignorance and superstition
- Disease.
Poverty means disease. Africa is still plagued by numerous diseases,
which are both curable and preventable. In Africa millions of
people are still the victims of many infectious diseases such
as malaria, river blindness, bilharzia, and respiratory infections.
- The fourth
manifestation or consequence of poverty is dehumanisation. In
the bible the parable of the rich man and Lazarus shows us that
the poor man us no better that the dogs with whom he shares crumbs
from the rich man’s table. The church must be deeply concerned
about the dehumanising effort of poverty and ultimately HIV/AIDS.
The UN declared
in 2000 that "Everyone has a right to be treated, and to die
with dignity, and the relief of pain, physical, emotional, spiritual
and social is a human right and essential to this process."
We cannot but fight for this basic human right to be extended to
out people.
Against this
backdrop of economic depravity we must look for ways and means where
something can be done with the limited resources that may be available
to us. All of us have been presented with a great opportunity to
show the love of Christ to people who desperately need love and
acceptance. The magnitude of the crisis is such that no single group
or organisation has the resources to adequately respond to the multifaceted
needs that HIV infected people bring, but we can do something and
what we can do, that by grace of God we must do. With the cost of
anti retroviral drugs out of the reach of the majority of HIV/AIDS
sufferers we must do more to prevent infection in the first place.
One of the areas where this can be done is in treating STD’s that
make people more susceptible to HIV. Studies have shown that by
treating conditions such as Chlamydia and gonorrhoea, with mush
cheaper, accessible antibiotics, we can cut new HIV infections by
as such as 40%. This is very significant number and more should
be done to bring these antibiotics within reach of ordinary people.
I don’t believe
that we can get on top of this disease until we begin to see a very
significant move towards getting our people to voluntarily submit
to testing. There is no way we will win this war whilst the majority
of Zimbabweans do not know their status. The church once again must
be at the forefront of this drive to urge people to be tested. Testing
centres should be established on a massive scale and leaders once
again should set the example by going for testing themselves and
break the stigmatisation of going to be tested. I would not be against
mandatory testing and neither would I be against making it illegal
for one person to infect another. As a church we have now made it
mandatory for all couples getting married by our marriage officers
to be tested. This also means that all our marriage officers have
to subject themselves to going for testing themselves. The results
are to be known by the couples themselves but it is our way of getting
people to deal with the whole issue of knowing their status. Another
area that the knowledge of the ones status would be helped is in
the area of mother to child transmission. Once a woman knows she
is HIV positive my personal opinion is that we should discourage
her from getting pregnant, but where that fails, then put in place
strategies to curb the transmission of the virus to the child. Other
countries have done this we can too. At the risk of going against
the grain of those who champion the rights of individuals not to
know their status I state that we are in a war, a war far more than
that unleashed on the US on the 11th September 2001.
In that act which resulted in thousands of deaths, led the US to
embark on a war against terror and the subsequent suspension of
individual rights, why should we insist on rights when we are losing
far more people than those lost on 9/11?
In closing let
me state that none of what we decide upon this week will come to
pass without the will to make the strategies arrived at a reality.
The key is to develop coherent strategies, which will support the
vision of ensuring that HIV positive people have access to anti-retroviral
therapy and treatment at affordable prices and if possible at no
cost. We must emerge from this conference with a very human and
HIV positive person’s strategy. In Shakespeare’s Merchant of Venice,
Shylock the Jew of Antonio:
He hath laughed
at my losses, mocked at my gains, scorned my nation, thwarted my
bargains, cooled my friends, and heated my enemies. And what’s his
reason? I am a Jew.
He then asks:
Hath not a Jew
eyes? Hath not a Jew hands, organs, dimensions, sense, passions,
fed with the same means, warmed and cooled by the same winter and
summer, as a Christian is? If you prick us, do we not bleed? If
you tickle us do we not laugh? If you poison us do we not die?
I make that
same pleas for all those infected by the HIV virus. We must assume
it to be true that all of us here for this conference are here because
we believe that we can contribute a little to the creation of a
better life for all those suffering from HIV infection. We are all
entitled to expect that when the record is tabulated, we shall each
be judged as having been joint architects in the making of a future
filled with hope for all those who have become afflicted by HIV/AIDS.
No doubt we
are faced with a daunting task out we can make a difference. The
worst thing we can do is to throw our hands up in the air and say
this is too huge a problem for us. First we must get real, admit
the enormity of the problem, but then we must come up with a strategic
plan with clear and specific objectives to deal with the problem.
We must also develop partnerships with other people, who are prepared
to help us, as we do not have the resources needed to fight this
epidemic. Ultimately it is going to take courageous leadership,
similar to that which was witnessed when Winston Churchill stood
and lead the fight against the rampaging German advance. Nothing
less than bold leaders who are prepared to take whatever blows come
their way will be needed. We can do it and I pray that we will not
be found wanting. Let’s do it.
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