Mail & Guardian (Johannesburg) - September 26, 2003

This wave, said the report, "threatens to pull societies under: [it is] the impact that Aids is having on the continent's economic, political and social service structures".

"We are beginning to see the decimation of economies," UNAids director of country and regional support Michel Sidibe told the Mail & Guardian.

"HIV is the first wave of the epidemic, entering silently and virtually unnoticed," said the report. "The onset of Aids, the second wave, follows lethally behind, its effects no longer possible to ignore." The third wave is the social and economic impact.

On Monday the World Health Organisation (WHO) declared the situation a "global health emergency". Developing countries, said Sidibe, are failing to procure anti-retrovirals (ARVs), "despite their availability".

Access to anti-Aids drugs emerged as the central theme of the conference. South Africa - home to half of all HIV-positive people in the nine Southern African countries - is seen as a laggard in the battle against Aids because the government has only recently agreed to make ARVs widely available.

Experts were cautiously optimistic. Sidibe said that the South African government's announcement in June that it would begin an ARV programme showed it was moving beyond a "talk shop" approach. But, he indicated, the international community would adopt a wait-and-see attitude.

Countries such as Uganda, Senegal and Botswana are streets ahead of South Africa in mounting a response to HIV/Aids. Infection rates in Senegal and Uganda are now manageable; Botswana has responded with massive ARV provision. In Eastern Africa, infection rates are flattening out, but in Southern Africa, the high prevalence rates in both Botswana and South Africa mean the region is still in trouble.

Five million people are living with the disease in South Africa, which has surpassed India as the country with the highest number of people infected. India has about four million infected.

Only 300 000 people - 50 000 of them in sub-Saharan Africa - have access to ARVs. South Africa, Zimbabwe, Sierra Leone and Rwanda are rated between 0% and 1% for ARV treatment coverage. In Botswana, by contrast, about 34% of HIV-positive mothers are receiving ARV therapy.

The WHO committed itself to achieving a "3 by 5" target - that is, getting three million people on ARV treatment by the end of 2005. At the current ARV roll-out levels, however, only one million people will be on treatment by that date.

Protestors crowded the stalls of pharmaceutical companies at the conference centre in Nairobi, demanding that the companies - GlaxoSmithKline and Bristol-Myers Squibb Company -"treat the people and stop the war".

Joseph Lange, president of the International Aids Society, told the M&G that he was heartened by the increased pledges of funds by governments and multilateral agencies. They proved, he said, that the international community is beginning to "galvanise their response" to the pandemic. Funds to fight Aids have more than doubled (to $950-million) since 2000.

But, said Sedibe, the developing countries still needed $2-billion at the end of 2002 and $6-billion by 2005. He also indicated that there is a gap between policy and implementation. He emphasised the "feminisation" of the pandemic as essential to curtailing the new wave: "We need to keep women alive ... we must address the disease as a social rather than an individual issue. For example, it is feasible to change the subordination of women to men over time."

At the conference, Botswana, Uganda and Senegal were hailed for their success in managing Aids, which they were able to do because they "have the support of our leaders", said Dr Tendani Gaolathe, coordinator of the Infectious Disease Care Clinic at the Princess Marina Hospital in Gaborone. This hospital is the largest ARV treatment site in the world.

According to Professor Souleymane Mboup of the Virology Faculty at the University of Cheikh Anta Diop in Senegal, "South African leaders need to listen and trust their scientists ... This is part of the secret of the Senegalese success in combating HIV." Senegal has a 0,5% prevalence rate and Uganda 5%. South Africa's is 20%.

A report released on Monday by M d cins Sans Fronti res documented ARV procurement in 10 countries, including South Africa (see story on opposite page). Access to ARVs in South Africa has been limited by a "lack of registered generics" and the absence of a "public sector national guideline", meaning that the government is at present providing no leadership on the issue. This may, however, change since the Cabinet's decision to roll out an ARV strategy.

The experts are non-committal. "A few weeks ago I would have slammed the South African attitude towards the disease," said Sidibe. "But since their announcement to begin treating people, I believe all the conditions are there for it to lead the rest of the continent ... We'll have to see what happens."

Still, the lack of a strong South African government presence at the conference - precursor to the 15th International Aids Conference in Bangkok next year - was glaring. There were civil society researchers present, but the only representative of the South African government was one Eva Marumo from the Department of Health.

The M&G asked Professor Mutuma Mugambi, scientific chairperson of the conference, whether any specific resolutions would arise from the conference. He said it was primarily an opportunity for African and international leaders and HIV/Aids experts to meet and "share their experiences and research."

The conference (which is held every two years) aims to track patterns and trends on the continent. Mugambi indicated, however, that the conference orgainsing committee would meet on Friday to "wrap the week up"."This conference pulls together the practical experiences, more than theory, to take to Bangkok next year," he said.

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