Until all life has equal value

It was fitting that the first plenary of AIDS2002 should be the second Jonathan Mann memorial lecture, powerfully delivered by Irene Fernandez of Malaysia. Fernandez needed special permission to leave Malaysia, and has been facing criminal indictment since 1996 for her work as a human rights activist. She is currently director of Tenaganita, an NGO campaigning for the rights of women and migrant workers.

Outlining the reality of the multiple worlds we live in, Fernandez described a rich world where 500,000 people with HIV have access to ARVs and 25,000 die of AIDS each year; and a poor world where, in sub-Saharan Africa alone, 30,000 people out of 30 million with HIV receive ARVs, and where 2.2 million died of AIDS last year.

Fernandez's speech looked at the role of globalisation in transforming national health care into a privately controlled commodity. Structural adjustment programmes and trade liberalisation have pushed nations to privatise health care services, and control over health care has shifted from governments to the drug and insurance industries, she said. Privatising health has compromised primary health care and as a result, helped "HIV to multiply."

Communities have the capacity and knowledge to address AIDS, Fernandez said. "It is not the lack of knowledge that is the bottleneck. It is lack of resources."

If the G8 countries had honoured their 1970 OCED commitment of 0.7% of national GDP towards foreign aid, US$175 billion would be available today and $200 billion in 2005, Fernandez said. Instead aid for the entire developing world is at $53 billion.

"We would have saved millions of lives and reversed the epidemic." New initiatives that look at increasing access to care are important and challenge longstanding global inequities but they do not "attack the root causes of denial of treatment." An intervention like the Global Fund for drugs becomes a "dole-out" unless we recognise that health is a fundamental right, not charity work.

We must believe that we can make a change, or we would not be here. But there will only be a real change when health is seen as a right, not a commodity and when "life from New York or from Mozambique or from India or from China has the same value."