Please read this startling document
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From: "Africa Action" <[log in to unmask]>
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Date: Sat, 6 Jul 2002 12:11:47 -0500
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Subject: Africa: AIDS Updates, 1
Africa: AIDS Updates, 1
Date distributed (ymd): 020706
Document reposted by Africa Action
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+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +gender/women+ +health+ +economy/development+
SUMMARY CONTENTS:
The XIV International AIDS Conference begins in Barcelona, Spain,
on July 7. Today's two postings include several related articles.
The official conference web site is: http://www.aids2002.com. Daily
coverage of the week-long conference is available at
http://www.kaisernetwork.org/aids2002
This posting contains a speech by Stephen Lewis at a UN Press
conference last week, and selections from the Kaiser Daily HIV/AIDS
Report summarizing other recent developments. A related posting
today contains excerpts from a speech by Zwelinzima Vavi, General
Secretary of the Congress of South African Trade Unions, and from
a UNICEF press release.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
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------------------------------------
Statement by Stephen Lewis, the Secretary-General's UN Envoy on
HIV/AIDS in Africa, at the noon briefing of UN media, July 3, 2002.
[excerpts: full text available at
http://allafrica.com/stories/200207030681.html]
This media briefing is driven, of course, by the publication
yesterday of the two new startling reports on HIV/AIDS. For ease of
reference, I'll refer to the omnibus Global document as the UNAIDS
report, and the document relating specifically to youth as the
UNICEF report. ...
Rather, I want to draw attention to two particular aspects, which
flow from the reports, and which relate directly to Africa. ...
First: amidst the unrelenting catalogue of horrors --- the
prediction of a possible 68 million additional deaths world-wide,
55 million of them in Africa by the year 2020; the ghastly finding
that the pandemic has not yet begun to level off in Africa, even in
the highest prevalence countries; the bracing public assertion by
Dr. Piot that the pandemic is still in its early stages overall ---
to this catalogue of horrors, there must be added, in the case of
Africa, that the pandemic is now, conclusively and irreversibly, a
ferocious assault on women and girls.
We all understood that the percentages were rising. We all
understood that women were particularly vulnerable. We all
understood that the pandemic was feasting on gender inequality. I'm
not sure, however, that any of us understood until now, the full
magnitude of the accelerating catastrophe for women. That's where
these two reports are indelibly interlinked.
The figures, carefully extracted from the various tables, tell the
story. And I make no apologies for using the figures: somehow the
world has to be made to understand what's happening.
According to the UNAIDS report, of the 26 million infected adults
in SubSaharan Africa (that is between the ages of 15 and 49), women
now constitute 15 million, or 58%. That figure is distressing
enough, but look what happens when it's linked to the data from the
UNICEF report. At the very outset of that document, there is a
breakdown of the numbers of young people (defined as 15 to 24)
living with AIDS in various regions of the world. For Sub-Saharan
Africa, the total is 8.8 million, two-thirds of whom, that is to
say 67% of whom, are young women. The ratio, young women to young
men, is an explicit two to one.
Put in the context that more than half the new infections now occur
among young people --- 6,000 a day --- and you can see what is in
prospect for Africa. I'm not a statistician, but if the present
reality is 58%, and the future reality is 67%, we're talking about
the unthinkable ... a looming cataclysm for the women of Africa.
There are, in both reports, endless pieces of evidence to confirm
the pattern. If you cull the tables at the back of the UNICEF
document (confirmed in the UNAIDS document), it's hard to believe
what emerges. There is a category on the percentages of young
people living with AIDS at the end of 2001. The category provides
a low range and a high range. For comparison purposes, I'll use the
high end because that's where we appear to be heading, given the
projections of the UNAIDS report.
On that basis, in Botswana, the percentage of young women living
with AIDS is 45%; the comparable figure for young men is 19%. In
Lesotho, young women are at 51%, young men at 23%. In South Africa,
the numbers are 31% as compared to 13%. In Swaziland, 47% to 18%.
In Zambia, 25% to 10%. In Zimbabwe, 40% to 15%. In Namibia, 29% to
8%. In Malawi, 18% to 8%. In Cameroon, 15% to 6%. In Central
African Republic, 16% to 7%. In Rwanda, 13% to 6%. The pattern is
comparable for all African countries.
Please note that in every single country, the young HIV positive
women represent two to three times - or more ---- the infection
rates of young men. I despair of the numbing recitation of
statistics, but they reveal a relentlessy grim picture. ...
In background papers, prepared by UNAIDS, it is said that one-third
to almost one-half of new mothers in the worst-affected countries,
could die of AIDS.
And then as if all of this isn't bad enough, we have the UNICEF
document, based, I would emphasize, on more than 60 new national
surveys --- the most up-to-date definitive material now available
--- which shows, in alarming page after page, the astonishing lack
of knowledge about AIDS, and transmission, and prevention and
sexuality among the young people surveyed.
In the course of those pages, there are the following
representative glimpses of reality: in Cameroon, Central African
Republic, Equatorial Guinea, Lesotho and Sierra Leone, more than
80% of young women, ages 15 to 24, do not have good knowledge about
sex; in Nigeria, 95% of girls, age 15 to 19, perceive their risk of
contracting AIDS to be minimal or non-existent; in Nigeria again,
61% of unmarried sexually active young men, 15 to 24, did not use
a condom at the last episode of sexual intercourse, and, incredibly
enough, 93% of these young men felt no risk or a small risk of
contracting HIV; in a large number of African countries,
specifically, Somalia, Burundi, Comoros, Uganda, Zimbabwe, Rwanda,
Tanzania, Sierra Leone, Chad, Niger, Mauritania, Cote d'Ivoire,
Guinea-Bissau, Senegal, Central African Republic, Sao Tome and
Principe, Gambia, Togo, a majority of the girls surveyed did not
know where to get tested; and in corroboration of what I have
already noted, 17% to 22% of girls age 15 to 19 in major urban
areas of East and Southern Africa are already infected. In
Ethiopia, 14% of young women surveyed, said that they had had sex
before the age of 15; in Nigeria the figure is 17%. These two
countries, with a combined population of nearly two hundred
million, stand at the very precipice of an explosion in the
pandemic.
The report also chronicles the sexual violence, the predatory
sexual behaviour of older men, the girls pulled out of school to
care for sick and dying parents, the complicating malevolence of
the sex trade, the growth of the orphan population, and much more.
It is a true and full compendium.
If it can be said, as it can, that by the year 2020, the number of
deaths from AIDS in Africa will approximate the number of deaths,
military and civilian combined, in both world wars of the 20th
century, then it should also be said that a pronounced majority of
those deaths will be women and girls. The toll on women and girls
is beyond human imagining; it presents Africa and the world with a
practical and moral challenge which places gender at the centre of
the human condition. The practice of ignoring a gender analysis has
turned out to be lethal.
And that brings me to the second point I want to make, albeit far
more briefly. I listened carefully yesterday to Peter Piot and to
Jeffrey Sachs, advisor to the Secretary-General, both of them
speaking to the high-level session of the Economic and Social
Council. They both made the same unanswerable points: AIDS is
wrecking human havoc in every sector of a steadily-increasing
number of African countries; we have all the knowledge we need to
turn the pandemic around, but to do it, there must be a huge
quantum leap in financial resources.
On those truths, there seems to be an international consensus. At
the recent G8 Summit, the New Partnership for African Development,
or NEPAD, included a strong paragraph which said, unequivocally,
that unless the communicable diseases are defeated (and by that
they meant primarily AIDS), economic and social development in
Africa would be an "impossible hope".
In the formal G8 response to NEPAD, called the Africa Action Plan,
under the section titled "Improving Health and Confronting
HIV/AIDS", there appears this language: "To this burden (meaning
other communicable diseases) has been added the devastating
personal and societal costs resulting from AIDS, the consequences
of which stand to undermine all efforts to promote development in
Africa ... Therefore, recognizing that HIV/AIDS affects all aspects
of Africa's future development and should therefore be a factor in
all aspects of our support for Africa, we commit to ...". And then
there follows a series of predictable commitments which resonate
with goodwill and purpose.
What has not yet resonated are the dollars to meet the commitment.
The shortfall is staggering: billions and billions of dollars meant
to prolong and save human life in Africa over the next generation.
The Global Fund is desperately underfunded. The Secretary-General
has asked for $7 to $10 billion a year to fight the pandemic. This
year the Fund has roughly $800 million. Peter Piot uses the figure
of $10 billion overall from all sources. Everyone agrees on that
range or higher. This year we're closing in on $3 billion.
Jeffrey Sachs says the necessary money is readily available; it's
a simple matter of arithmetic. He argues, as the MacroEconomic
Commission on Health argues, that to reach the Millenium Goals for
Health would require setting aside, annually, one penny of every
ten dollars of income in the rich countries ($25 billion required
out of a $25 trillion pot). But the penny won't drop.
These two reports make as eloquent an argument as we're ever likely
to hear for the world to come to its senses. For the African
continent, it means economic and social survival. For the women and
girls of Africa, it's a matter of life or death.
************************************************************
KAISER DAILY HIV/AIDS REPORT
A free service of kaisernetwork.org
http://www.kaisernetwork.org/dailyreports/hiv
Excerpts from issue of July 5, 2002
GLOBAL CHALLENGES
1. $27 Billion Boost for HIV Prevention Programs Could Avert
Majority of Projected HIV Infections Worldwide
Nearly two-thirds of the HIV infections projected to occur
worldwide by 2010 could be prevented if an additional $27 billion
were allocated to HIV prevention programs, according to two
studies released yesterday, the Boston Globe reports (Donnelly,
Boston Globe, 7/5). In the first study -- published in the July 6
issue of the Lancet -- epidemiologists, demographers and
mathematicians from UNAIDS, the World Health Organization, the
U.S. Census Bureau and the private organization The Futures Group
International created a model to predict the future of the
epidemic and how new infections could be averted. The researchers
predict that an additional 45 million people worldwide will become
infected with HIV by 2010 but add that 29 million of these
infections could be prevented if HIV prevention efforts are
rapidly expanded or instituted. Such efforts include advertising
campaigns, school and workplace education, condom distribution and
needle-exchange programs, the study states.
According to the study, while the majority of HIV infections
could be averted if fully expanded programs were in place by
2005, half of the projected benefit would be lost if the projects
were not in place until 2008 (Brown, Washington Post, 7/5). The
researchers project that the cost of such a "concerted, global
campaign" would require a quadrupling of current spending on HIV
prevention. "These deaths are not inevitable. We can actually
do something which can substantially decrease this epidemic," WHO
epidemiologist and study co-author Dr. Bernhard Schwartlander said
(Garrett, Newsday, 7/5).
The model did not take treatment into account because the
researchers said that there is "no research to quantify how the use
of antiretroviral drugs changes population-wide transmission of
HIV" (Washington Post, 7/5) Schwartlander said that "prevention
and treatment efforts are intertwined, and there should not be a
debate of funding one over the other."
Prevention Plan Outlined
A separate study released yesterday outlined a plan for expanding
current HIV prevention programs and creating new ones. The study
was drafted by the Global HIV Prevention Working Group, an
independent panel of 40 "leading HIV prevention specialists" that
was assembled by the Bill & Melinda Gates Foundation and the
Kaiser Family Foundation (Boston Globe, 7/5). The group convened
to evaluate the projections made in the other study and "determine
what an all-out global HIV prevention campaign would take,"
Newsday reports (Newsday, 7/5). The group proposes a number of
initiatives, including allowing countries to set their own
priorities for funding, boosting health system infrastructure,
expanding successful prevention programs, mobilizing political
leadership, improving HIV surveillance and "dramatically"
increasing access to treatment. To successfully achieve these
goals would require an additional $4.8 billion annually by 2005 and
a total of $27 billion in funding by 2010. Helene Gayle, co-chair
of the working group and an official with the Gates foundation,
said, "We are going to continue to face devastation if we don't as
a world community wake up to this and put in the resources that we
need to make the difference. By presenting some practical
solutions, and some things we know are doable, it's not just saying
'Give us the money and trust us.' It's 'Give us the money ... and
there are solutions available today'" (Boston Globe, 7/5). ...
2. Debate Over Funding for Treatment, Prevention to Be
'Centerpiece' of XIV International AIDS Conference
The debate over how to divide funds between prevention and
treatment efforts will be the "centerpiece" of the XIV
International AIDS Conference that begins on Sunday in Barcelona,
the Wall Street Journal reports. While those favoring prevention
programs and those favoring treatment programs agree that the $2
billion in the Global Fund to Fight AIDS, Tuberculosis and Malaria
is "paltry," the "clash" between the two groups will "profoundly
affect" the distribution of the funds.
At next week's conference, treatment advocates, doctors and people
with HIV/AIDS plan to present research supporting funding for
HIV/AIDS treatment programs and stage "massive" protests, the
Journal reports. Treatment Action Campaign Chair Zackie Achmat
said those treatment advocates also are planning a "new
pan-African treatment movement, demanding everything from vitamins
to antiretrovirals."
Prevention Has 'Long-Term Impact'
The Bill & Melinda Gates Foundation's new HIV/AIDS and tuberculosis
prevention taskforce, which is focused "almost solely" on
prevention, also will "tak[e] center stage" at the conference, the
Journal reports. The group, led by AIDS prevention expert Dr.
Helene Gayle, advocates HIV/AIDS prevention through condom use,
voluntary HIV testing, behavioral changes, needle-exchange programs
and research of microbicides and HIV vaccines. The taskforce
focuses on prevention "because it has the best long-term impact,"
according to Gayle. "It's relatively simple to say dollar for
dollar that prevention is more cost effective," AIDS Vaccine
Advocacy Coalition Director Chris Collins said, adding, "The more
complex point is what happens in societies where one in five or
one in three people in the professional class are wiped out."
Shifting Focus
Although the South African government has focused almost
exclusively on prevention, the HIV infection rate there has
continued to rise, according to Achmat, who advocates a Medicins
San Frontieres program that links prevention and treatment to
fight HIV/AIDS. But economists say that such programs are
"expensive" and "take many years" to implement. Meanwhile,
pharmaceutical companies are "relieved" that the debate over
prevention and treatment efforts has "shift[ed] focus" away from
the debate over the high cost of AIDS drugs, the Journal reports
(Zimmerman/Schoofs, Wall Street Journal, 7/3).
4. Constitutional Court Denies South African Government's Right to
Appeal High Court Ruling on Nevirapine Distribution
South Africa's Constitutional Court today denied the government's
right to appeal the Pretoria High Court's December ruling that
the government must provide nevirapine to HIV-positive pregnant
women in state hospitals to reduce the risk of mother-to-child
HIV transmission, SAPA/SABCnews.com reports (SAPA/SABCnews.com,
7/5).
The court's ruling -- a "victory" for HIV/AIDS activists,
including the advocacy group Treatment Action Campaign, which
originally filed the suit against the government -- "removes the
last obstacle put up by the government" for universal
distribution of the drug, according to Reuters/Lexington
Herald-Leader.
Chief Justice Arthur Chaskalson said that the government's
restriction of the drug's distribution to 18 pilot sites "fell
short of its constitutional obligation to offer the best
treatment available." He added, "Government is ordered without
delay to remove the restrictions that prevent nevirapine from
being made available for the purpose of reducing risk of
mother-to-child transmission of HIV at public hospitals and clinics
that are not research and training sites" (Chege,
Reuters/Lexington Herald-Leader, 7/5). TAC leader Zackie Achmat,
who is HIV-positive but refuses to take antiretroviral drugs
until the government makes them available to all South Africans,
"welcomed" today's decision and said that the court's ruling
"gave him hope that the government would change its position on
making antiretroviral drugs available as therapeutic treatment
for all HIV-positive people, not just for mother-to-child
transmission prevention" (SAPA/SABCnews.com, 7/5). According to
Patricia Lambert, special adviser to Health Minister Manto
Tshabalala-Msimang, the government planned to "study the
decision" before releasing a statement. The universal provision
of nevirapine, which can reduce vertical HIV transmission rates
"by up to half," could prevent at least 30,000 infants from
contracting HIV from their mothers each year in South Africa
(Reuters/Lexington Herald-Leader, 7/5).
************************************************************
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