"What we desperately need in the response to AIDS today are voices of advocacy: tough unrelenting, informed. The issues are so intense, the situation is so precarious for millions of people, the virus cuts such a swath of pain and desolation, that your voices, as well as your science, must be summoned and heard," Stephen Lewis, UN Secretary-General’s Special Envoy for HIV/AIDS in Africa, told those attending the opening plenary of the Third IAS Conference on HIV Pathogenesis and Treatment on Sunday.
Around 5,000 of the world’s leading scientists, public health experts and clinicians are attending the meeting, which is being held this week in Rio de Janeiro, Brazil. Lewis challenged the audience to lobby for a better international response to the pandemic. He highlighted seven key issues that need to be addressed.
Debt relief and foreign aid
"I would argue that the G8 Summit was not a breakthrough; it was in fact a disappointment," said Lewis. He said that even though the cancellation of multilateral debt for eighteen countries (14 of them in Africa) "was a start, Africa still carries the insurmountable burden of over $200 billion of debt, debt that cripples the battle against poverty and the pandemic."
Lewis said there a good chance that the G8 nations won’t follow through on promises to double official development assistance to Africa. "Between principle and delivery," he said, "there lies an unblemished record of failure."
"Despite the tremendous energy and commitment of Tony Blair as current chair of the G8, we require your vigilant voices to keep everyone else honest," he added.
Three by five
Even though WHO’s target to get three million people with HIV in the developing world on antiretroviral treatment (ART) is unlikely to be met, Lewis said that "the initiative has made all the difference in the world. There are now more than a million people on treatment who would otherwise be dead."
He continued, "by setting the target and breaking the miasma of inertia that seemed to paralyse the world, WHO unleashed an irreversible momentum for treatment". He continued, "further, the entire language of treatment has changed: we now talk of ‘universal treatment’ or ‘universal access’ ... gone are intermediate goals. The three by five initiative launched us on such a trajectory that nothing short of treatment for everyone who needs it is seen as acceptable. [But] it needs your tenacious voices to keep three by five on track."
The Global Fund’s funding shortfall
The Global Fund to Fight AIDS, Tuberculosis and Malaria is running dangerously short of funds. It needs several hundred million dollars to meet its commitments this year and several billion dollars over the next two years.
This is at a time when the Fund is receiving more proposals on treatment, capacity and orphan care than it ever has before. "It must not be forced to turn away countries in urgent need of help," said Lewis.
The vulnerability of women
Lewis also called on the audience "to lobby ferociously to make gender inequality history." The disadvantaged position of women in society has contributed greatly to their vulnerability to HIV/AIDS. Lewis said that "the greatest single international failure in response to HIV/AIDS is the failure to intervene dramatically on behalf of women."
Just as UNICEF acts on behalf of the world’s children, Lewis believes that a multilateral organization is needed to represent the needs and rights of the world’s women globally. He noted that while the UN is currently in the process of reform, there is a unique opportunity to create such an international agency promoting the health and welfare of women.
Vaccines and microbicides
Microbicide and vaccines to prevent the spread of HIV may be years away from market but Lewis says that we cannot afford "any lapse in the determined pursuit" of their development. He called on those present "to pressure your governments and the scientific community, relentlessly, until the breakthrough occurs."
The question of human capacity
There is a severe shortage of doctors, nurses, pharmacists and other health care workers needed to provide treatment in resource-limited settings. Training and technical assistance are desperately needed.
Orphans
"The proliferation of orphans has become a deluge" said Lewis, "absolutely overwhelming in country after country. No one has any firm grip on how to handle these millions of frantic children."
Enter the fray
Lewis urged those in attendance to enter the fray as advocates. "In this battle, no one is exempt: no government, no sector, no agency, no NGO, no part of civil society, no multilateral organization, no individual, no expert, no scientist, no public health professional. We can subdue this pandemic, but it will take the collective and uncompromising voices of principle and outrage to make it happen."