Inter Press Service - September 26, 2003
Ferial Haffajee

Anti-retroviral drugs can downgrade the disease from life-threatening to a manageable medical condition.

In New York, the UN general assembly declared making access to the drugs a medical emergency, while the World Health Organisation (WHO) pledged itself to a new goal. This is "3 by 5" - three million people on treatment by 2005. The price tag: 100 million U.S. dollars a year, excluding the infrastructure costs of more nurses, doctors and clinics.

Can it be done? "It's unprecedented but not impossible," said Peter Piot, the head of UNAIDS on Wednesday.

On the lawns outside the conference venue, the people made their voices heard. Treatment protests began on Tuesday at a People's Tribunal. Kenyans, South Africans, Ugandans and others came together in the Pan African AIDS Treatment Access Movement to say that treatment had to be made possible.

On their T-shirts, the words, "Treat a quarter million Kenyans now" were an eloquent message. The public watched with curiosity and the police stared from a distance.

Most of the women at the People's Tribunal were widows, whose HIV infected husbands died a long time ago, leaving them with the burden of caring for the children and themselves.

The first complainant at the Tribunal was Jane Wairago (not real name) whose husband succumbed to AIDS and died more than four years ago, leaving her with the virus and four children to take care of.

"It has been a sheer struggle to survive. None of my children has the virus, but I have been unable to educate and provide them with food," she said.

Wairago was evicted from her home when she could not afford the rent.

In addition, the virus weakened her system, making it impossible for her to work. She could not afford anti-retroviral drugs (ARVs) or the upkeep of her children and turned to the church. The Catholic Church put her on ARVs, and in a matter of months, she improved.

For three years now, the drugs have helped to strengthen her body and to enable her to work and care for her children - now she is an activist for state-provided assistance, as the Catholic Church's coffers are drying up. "I just want to appeal to our governments to come up with programmes that provide ARVs for free or at extremely low prices," said Wairago.

By Wednesday, the demands for treatment grew louder. "African leaders, shame!" shouted about 100 activists who stormed the conference centre on Wednesday. Holding hand-written placards, the group's leader shouted, "You talk", while the rest responded, "We die!" Soon, the centre shook with the shouts of: "You talk; we die. You talk; we die."

A World Bank press conference was drowned by the angry voices and soon aborted.

A pan-African movement to push for the drug treatment was given impetus this week. Only one percent (43,000) of the people who need the anti-AIDS drugs in sub-Saharan Africa gets them, according to a study by Medicins Sans Frontieres (MSF), released on Monday.

This is well below other regions that have been quicker off the mark. Over half the 370,000 people in Latin America and the Caribbean who need them can access the drugs, while the figure for North Africa and the Middle East is 29 percent (though these regions have a much lower base need).

Governments must co-fund the drugs, though the bulk must come from the rich north, said Piot. MSF says governments can do a lot to smooth the implementation of drug programmes. These methods include drawing up treatment plans; starting central drug procurement agencies (like Cameroon's) and exploiting the public health clauses in the Trade Related Aspects of Intellectual Property agreement (TRIPS) to limit patent protection.

Countries, like South Africa, which have generic manufacturing capacity, should use it, says MSF. "Unless our African leaders make a political commitment we can't do it," said Prudence Mabele, who has lived with HIV for 14 years and is on drugs bought and supplied by MSF in South Africa. Her country has no treatment plan, so she is in a minority of people getting the drugs.

Through public pressure like that exerted in Nairobi this week, the prices of ARVs have come tumbling from over 10,000 U.S. dollars to 350 U.S. dollars a year. But even the lower figure is still considered beyond the reach of many people in Africa who live on less than one dollar a day and a drugs deal reached at the World Trade Organisation is unlikely to make it easier, said activists this week.

But the WHO's declaration of HIV/AIDS drug treatment as a medical emergency provides a basis to initiate a movement to reach the "3 by 5" goal, said the agency's director for HIV/AIDS, Paulo Texeira who previously headed Brazil's national AIDS programme. Added Piot: "We must change gear now."

Three million is a modest goal since figures suggest that 5.5 million people are in the state of AIDS where drugs are necessary. Changing gear is going to entail huge challenges. Infrastructure is the most pressing: most African countries have poor or collapsed health delivery systems especially at the grassroots levels, a factor that may deny them the ability to roll out ARV programmes at a faster rate.

Even for those with a semblance of a good health system, human resources are an issue: doctors and nurses leave every month for greener pastures in Europe, the United States and the Middle East.

The incidental costs of monitoring and staying on the drug are huge and must also be brought down, says MSF. The capacity to carry out viral loads (the amount of virus in the body) and CD4 counts (immune cells responsible for fighting diseases) before putting those infected on ARVs is another challenge.

"The only solution to scaling up the access of the drugs is to simplify how they are taken. Literacy courses on treatment for the majority of the population would be the way forward," said Teixeira.

"If we rely on the classic model of doctors and experts in delivering the drugs, we might not reach there. We have to work with communities to see how to deliver the drugs in a very simplified way," added Piot.

Already, countries in Africa can learn from each other. Volunteers from communities, like those at Maua Methodist Hospital in Kenya, are helping to deliver and ensure those on ARV treatment adhere to it.

Simplified procedures will help to make the "3 by 5" plan a reality.

In Malawi, Didakus Odhiambo, the MSF head of mission, said the use of simple procedures to determine who is to receive treatment, is helping them make progress.

In Botswana, treatment buddies are being used to ensure patients stay on their medication - ARVs do not work unless you take them everyday.

While the activists on Wednesday sang the song, "All we are saying is give treatment now," success means going beyond drugs alone.

"Things have to be looked into in a holistic way. While we push for access to treatment, we should also ensure the infection rates reduce," said Matshidiso Moeti, a WHO regional advisor on HIV/AIDS. "Everything should come as a care and treatment package."(END/IPS/AF/EA/SA/WA/HD/HE/GR/WL/SD/FH/AO/MN/03)

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