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Keynote Speech by Stephen Lewis at the 11th Conference on Retroviruses and Opportunistic Infections
Stephen Lewis, UN Special Envoy, HIV/AIDS in Africa. 08 February, 2004. 11th Conference on Retroviruses and Opportunistic Infections.
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This keynote Speech was given by Stephen Lewis, UN Special Envoy, HIV/AIDS in Africa at the 11th Conference on Retroviruses and Opportunistic Infections on 08 February, 2004 in San Francisco, CA.
Mr. Chairperson, Ladies and Gentlemen: I want you all to know how much I appreciate the invitation to speak to this auspicious gathering, even though I stand before you with no scientific credentials whatsoever.
Allow me to set the stage for my remarks in this fashion: last Monday night, in London, I was privileged to attend a preview showing for the United Kingdom of the film Angels in America. Doubtless there are those in this audience who have seen it; it?’s a brilliant piece of film-making. It deals, as you know, with the early days of AIDS in America, and the dehumanizing process of death of one of the male leads, mid-way through the movie, is as harrowing and numbing an episode of horror as I?’ve ever seen in the cinema. The audience was laid waste. It was of course a faithful rendering of the way death from AIDS used to be in this country, and is no longer. But I must say that I sat in the theatre, emotionally clobbered, and thought to myself ?“That?’s the way people die in Africa, now, at this very moment, day upon day upon day?”. How do we get the world to understand?
I?’ve been in the UN Envoy role now for something more than two and a half years. You will understand when I say that to visit Africa repeatedly, and to observe the unraveling of so much of the continent, is heartbreaking. There are simply no words, in the lexicon of non-fiction, to describe the human carnage. I have heard, from African leaders and social commentators alike, language that startles and terrifies: ?‘holocaust?’, ?‘genocide?’, ?‘extermination?’, ?‘annihilation?’, and I want to say that on the ground, at community level, watching the agony, the language is not hyperbolic. And what makes it even worse is the tremendous resilience and courage and effort and compassion with which the entire population, especially the women, attempt to withstand the pandemic.
The individual and collective work, therefore, of people attending this conference, is truly invaluable. That?’s not a flippant or gratuitous remark: it?’s important for everyone here to recognize that you?’re part of the most significant battle against a disease that has ever been waged in human history ?… and when you?’re consumed in your laboratories, or wrestling with the esoterica of science, at the end of that long exploratory road there lies the whole fabric of the human family fighting for survival, searching, desperately, for hope. The grieving villages, the funerals, the hospital wards, the orphans, the women at the clinics; it?’s an hallucinatory nightmare; it should never have come to this. Your work can bring it to an end.
What I want to try to do in these remarks is to flag the signals of hope as we enter 2004, and to look at some other related issues as well. The items are six in number; I shall deal with some elaborately, and others more briefly.
First, the single most dramatic development that has happened in years around HIV/AIDS is the decision, by the World Health Organization, in conjunction with UNAIDS, to achieve the goal of three million people in treatment by the year 2005: ?“3 by 5?” as it?’s colloquially known. It has the potential to revolutionize the struggle against the pandemic. Up until now, large numbers of people have resisted testing for the obvious reason that confirmation of a fatal disease, without any promise that the information would improve or prolong life, made no sense, had no appeal. Finding out that you were HIV positive simply intensified, for many, the risk of depression and stigma. A prognosis of death, without hope, is hardly an inducement to seek the prognosis. All of that is about to change. Give people hope through treatment, and with well-designed programmes, they will seek to get tested in ever greater numbers. And if stigma proves so powerful as to limit the uptake of testing, there is always the alternative of doing what Botswana is now doing until testing becomes de rigeur: require routine testing for HIV whenever someone presents at a medical facility, with the option of course to opt out.
The new leadership of WHO, under Dr. J. W. Lee, is absolutely bound and determined to pull off 3 by 5. It?’s amazing to see the depth of commitment; it?’s as though WHO had undergone some religious metamorphosis ?… they are collectively possessed. I almost expected to see flashing iridescent lights and hear celestial thunder when I visited WHO headquarters in Geneva ten days ago.
I?’m not going to go into detail of 3 by 5?… there are handbooks and monographs available ?… but it is worth emphasizing that WHO sees the entire initiative as ?“the antiretroviral treatment gap emergency?”; that emergency teams are already evaluating needs in high prevalence countries; that WHO is working with multiple partners, for example partnering with those doing the Prevention of Mother to Child Transmission Plus, where the ?“Plus?” represents treatment for the woman and her family; that the improvement of health systems and human capacity is a sine qua non of the goal; that the logistics of drug distribution and delivery are very much a part of implementation; that the principle of equity of access will be determinedly followed, women-men, rural-urban, rich and poor; that a secure supply of medicines and diagnostics will be pursued; and that this is just the beginning. In its publication on 3 by 5, titled ?“Making it Happen?”, WHO writes: ?“This Initiative does not end in 2005. Antiretroviral therapy does not cure infection and must be taken for life ?… withdrawing or ending treatment will lead to the recurrences of illness and with it the inevitability of premature death. Lifelong provision of therapy must be guaranteed to everyone who has started antiretroviral therapy. Thus, 3 by 5 is just the beginning of antiretroviral therapy scale-up and strengthening of health systems?”.
And so it must surely be. On the continent of Africa, it is estimated that 4.1 million people need treatment now ?… ie, their CD4 counts are below 200 ?… and approximately 70,000 to 100,000 are actually in treatment, or roughly two per cent. Quite frankly, that?’s an abomination. The total number of people worldwide who should be in treatment measures six million. In other words, even if the target of 3 by 5 is reached, some three million people --- fifty per cent of those eligible --- will continue to be in desperate straits come 2005, with the numbers growing daily.
The full speech can be downloaded on the righthand side of this page |
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