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Slaughtering sacred cows
Sarah Boseley, Guardian (UK)
August 17, 2006

http://blogs.guardian.co.uk/news/archives/2006/08/17/slaughtering_sacred_cows.html#more

The Guardian's health editor, Sarah Boseley, is posting from the 16th international Aids conference for News blog this week. Here is her fourth report. You can read the first three here, here and here.

Perhaps it's because we're in north America, where time is money, but this year's International Aids conference has been brisk, sanitised and to the point.

It's mainly about preventing the spread of disease, which the Gates Foundation is especially focused on. Even the announcement of new figures showing that one million people in sub-Saharan African are on drug treatment has been something of a footnote to the microbicides and circumcision agenda.

It's not like the last meeting in Bangkok two years ago, which was a noisy, chaotic and passionate affair, with access to drugs still a burning issue.

But no conference is complete without an enfant terrible. Along came Gregg Gonsalves, with the sort of hand grenade one used to expect at these events on a regular basis.

Mr Gonsalves has long been one of the foremost Aids activists in the US, but has recently moved to South Africa. He was invited to speak at a major session with the UNAIDS director Peter Piot, among others, on 25 years of the pandemic. He took the opportunity to slaughter virtually every one of this new-style conference's sacred cows.

First, he slammed "the often misdirected energies and efforts, and the paralysing effects, of the international AIDS bureaucracy", which he said had created "a system designed to fail".

If things are still happening, it's because of the many unsung local heroes, he added, taking his first swipe at the new conference gods. "It's not Bill Gates or Bill Clinton who have made a difference in this epidemic, despite their welcome to this meeting as some sort of royalty." Sharp intake of breath all round.

Then he demanded that the fight against Aids be reinstated as part of a larger movement for social and economic justice. The epidemics flourish most among the poor, the vulnerable, women, sex workers and drug users because they are not rich enough, empowered enough or educated enough to be able to resist HIV infection.

Yet, he went on, we continue to focus prevention efforts on the behaviour of the individual and the promise of new technologies. Second swipe.

"Even those who profess to be deeply concerned about HIV prevention like our dear Mr and Mrs Gates, have little stomach for facing the structural and environmental factors that are the fuel for this great fire of an epidemic and watch the flames grow higher because to act on these issues moves beyond charity and far too close for comfort to them to politics," he said. Ouch.

But Mr Gonsalves' third point might have made some wonder if he is nostalgic for times past. We must re-politicise the fight against Aids, he said, with further swipes at the South African health minister, President George Bush and Vladimir Putin (for blocking access to methadone).

This was followed by a broadside against one of the pharmaceutical companies, Abbott, which refuses to drop the price of its Aids drug Kaletra to less than $500 a year - "the price of life for people who make less than $1 a day".

It was wonderful fighting stuff. Is it necessary? The Gates Foundation, the UN agencies and many of the delegates are upbeat about what is being done, and are optimistic about the future.

There is a lot of funding, a lot of goodwill from donor governments and a lot of commitment from many developing world governments too. That's a result of the sort of passionate and political advocacy Mr Gonsalves was offering. But perhaps it is no longer needed. Only time will tell.

Nobody doubts the need for more health workers in developing countries. Huge numbers from Africa and Asia now work in the NHS, although the government has tried to block recruitment. The WHO launched a major plan to "treat, recruit, retain" doctors and nurses in poor countries.

It also called for people with HIV to be tested and treated for TB and those with TB to be offered tests and treatment for HIV. There's now a growing tuberculosis epidemic in Africa because HIV depletes the immune system so it cannot resist the TB infection. Without treatment, anyone with both has only weeks to live.

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