Turning Point

The International AIDS Conference Makes a Commitment to Saving Third-World Lives

DURBAN, SOUTH AFRICA—Esther Guzha's dilemma springs from being one of the lucky ones. Two years ago, AIDS almost killed this Zimbabwean woman, wasting her down to a skeletal 80 pounds and leaving her prey to fungal infection of the brain. She was saved by medication that she could never afford but which she gets from the African AIDS Network, a small organization in San Francisco founded by Lee Wildes, a white gay man who sports tattoos and a silver thumb ring. Like Guzha, he has HIV and knows the grief of the plague. "By the time I was 27," says Wildes, a nurse who has worked in AIDS hospices, "I had been at the deathbed of 100 men." By collecting drugs that would otherwise be thrown out, Wildes's four-year-old program now supports 85 African patients.

Guzha works as an AIDS counselor at the Centre, a Zimbabwean organization that serves 2000 people with HIV. When they get sick, doctors frequently write prescriptions for medicine priced out of their reach, so they come to Guzha for advice. That's when her luck becomes excruciating. "I have the drug at home that could help this person," she explains, "but if I give it to him, then what would I do?"

Guzha's dilemma dominated the huge XIII International AIDS Conference held last week in Durban, South Africa. Past world AIDS conferences have been defined by scientific news, such as the success or failure of new drugs. While such findings certainly emerged at this meeting, attended by more than 12,400 delegates from around the world, speaker after speaker rose to decry what South African judge Edwin Cameron called "the shocking, monstrous, and intolerable" fact that more than 90 percent of the world's people with HIV cannot afford the drugs that have driven down AIDS death rates in rich nations.

Cameron, who just finished a term on South Africa's equivalent of the U.S. Supreme Court, is openly HIV-positive and is taking a drug cocktail that has restored his health. "My presence here embodies the injustices of AIDS in Africa," Cameron told a rapt plenary audience, which gave him a standing ovation. "I am here because I can afford to pay for life itself." He concluded, "Those of us who live affluent lives, well attended with medical care and treatment, should not ask how Germans or white South Africans could tolerate living in proximity to moral evil. We do so ourselves today, in proximity to the impending illness and death of many millions of people with AIDS."

As the statistics continue to swell—more than 10 percent of adults in 16 sub-Saharan nations are infected, and more than 12 million children have been orphaned—the clamor for treatment has become too loud to ignore. And so this conference marked a sharp shift. Before, developing countries rarely emphasized treating AIDS patients, preferring to focus on the much cheaper task of preventing new infections. But now, says Sophia Mukasa-Monicao, head of the AIDS Support Organization of Uganda, "They want the drugs."

The resolve among conference delegates to help them get the drugs was extraordinary. Even South African president Thabo Mbeki's much derided opening speech galvanized delegates. True, Mbeki missed a golden opportunity to lead his nation and continent into action and instead prolonged the pointless debate over whether HIV causes AIDS. But his very lack of leadership drove home the fact that AIDS workers will have to lead from the grass roots, just as they did in the United States under Ronald Reagan, who did not publicly mention the word AIDS until years into the epidemic.

South Africa's director general for health, Ayanda Ntsaluba, acknowledged the importance of activist pressure. "There is always a natural tendency in government to be complacent," he said, "especially in a situation like ours, where we have such a big majority." The African National Congress controls about two-thirds of South Africa's parliament, and many other developing nations are also dominated by a single party.

But it turned out that ordinary AIDS workers had a powerful ally, Nelson Mandela. "Let us not equivocate," Mandela stated at the conference's closing ceremony. "AIDS today in Africa is claiming more lives than the sum total of all wars, famines, and floods, and the ravages of such deadly diseases as malaria." He called, diplomatically yet firmly, for an end to the "distracting" debate and for getting on with "what works." Mandela's speech, said the conference's scientific chair, Salim Abdool Karim, expressed "the leadership and political will I have been yearning for in this epidemic. I was moved to tears."

Two years ago, the world AIDS conference in Geneva was also filled with rhetoric lamenting the gap between rich and poor. But this year's conference was marked by unprecedented global action that ranged from the small efforts of people like Wildes to new initiatives launched by governments and pharmaceutical companies. For example:

  • The World Bank announced a new $500 million loan program targeting AIDS.
  • The Bill and Melinda Gates Foundation and pharmaceutical giant Merck each pledged $50 million to create a soup-to-nuts AIDS program in Botswana, which has the highest estimated HIV prevalence in the world. More than a third of adults in that country carry the virus.
  • French president Jacques Chirac, through a statement read at the conference by his health minister, proposed an international summit devoted to drug access.
  • The Treatment Action Campaign, a South African group modeled on ACT UP, started the conference with a fiery rally and march demanding access to drugs. It ended the conference by announcing a "defiance campaign" to smuggle in fluconazole from India, where a company manufactures a generic version that costs about one-seventh what Pfizer charges for its patented version in South Africa.
  • The International AIDS Vaccine Initiative proposed major reforms so that once an HIV vaccine is developed it would be made available simultaneously in the first and third worlds.
  • The German pharmaceutical company Boehringher Ingelheim promised to provide its drug nevirapine free of charge for five years to prevent mother-to-child transmission of HIV. Just two doses of the drug, one given to the mother during labor, the other given to the newborn, halves the chance of passing on the virus.
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