Hope and dangers emerge from Vienna

In a dramatic change of its image in the global fight against the spread of HIV/Aids from the days of denialism under the Mbeki administration, South Africa delivered one of the shining rays of hope at the 18th International AIDS Conference in Vienna last week. The conference, however, fluctuated between careful talk about possible cures to despair about the possible impact of the global financial crisis on the fight against the disease.

The mood, and South Africa’s contribution to it, was probably best reflected in a report on the penultimate day of the conference by the Financial Times, which wrote: “It was the talk of Vienna and spread rapidly around the world: a study unveiled… suggested a microbicide gel (developed in South Africa) would significantly cut women’s risk of contracting HIV.

“This boost to demoralised researchers, who have been battling for three decades to halt the virus, follows a rising optimism among doctors and patients in the two years since the previous conference in Mexico City. An increased availability of treatment has helped tackle an epidemic that has infected more than 33 million people around the world and still kills 2 million annually.

“But the brutal realities imposed by the financial crisis mean budget cuts threaten to squeeze domestic and international support for healthcare and halt recent progress. The alarm is only just being raised about the painful trade-offs that are likely to be required ahead,” the report added.

Against this background, some groups were lobbying in Vienna for a “Robin Hood” tax, claiming that a tax of a mere fraction of a percent on financial transactions could be used to overcome the funding gaps for global HIV/Aids programmes. Funding the battle against HIV/Aids is estimated to have cost close to $8 billion last year.

Last week, Leadership Intelligence Bulletin reported about the danger to accessibility to essential medication imbedded in trade talks between the European Union and India. Later in the same week, Aids groups accused the United States of violating the health rights of millions of poor people around the world through trade policies that make it more difficult for them to obtain life-saving drugs.

A non-governmental organisation coalition active in the fight against HIV/Aids accuses the US of using its report-ranking countries with the worst records on violating US intellectual property rights to pressure countries to give up public health rights under a World Trade Organization agreement. They were urging the United Nations Special Rapporteur on the Rights to Health to investigate the matter.

With effective treatment of HIV/Aids and its related illnesses (such as tuberculosis) now in place, for the first time in Vienna there were serious discussions about the possibilities of finding a cure. Scientists were discussing the idea that the human immunodeficiency virus can be eliminated from the body, or at least battered into quasi-permanent remission.

However, there were warnings emanating from the Vienna conference – attended by more than 20 000 delegates from 185 countries – that in the immediate years to come, the world will face considerable medical, cost, and social challenges as millions of people living with HIV will survive into old age. The challenge is coming to the fore as the first generation of people living with HIV, on a large scale benefiting from effective antiretroviral drugs, are heading toward 60 years of age and beyond.

At the same time, a panel of experts from host country Austria have suggested that people should be tested for HIV in young to middle ages to ensure early detection, thereby lowering treatment cost. Their research indicated that the treatment cost for an Aids patient is almost five times that of monitoring and treatment for an HIV carrier in the early stages.

Vienna also saw the start of a Canadian-led campaign to change governments’ approach in the battle against drug use, claiming that research has found that the criminalisation of drug use is fuelling the spread of HIV/Aids.

The argument goes: Law enforcement, at tremendous cost, has failed to curtail the market for illicit drugs, which is worth in the order of $300bn plus per year. Instead of merely arresting and jailing those who take illegal drugs, money should rather be spent on public-health efforts such as needle exchanges and methadone treatment.

There was strong difference of opinion on the matter, particularly among political leaders and law enforcers, regarding the approach of the particular groups of HIV/Aids activists.