Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
South African Press Association - August 15, 2006
Fran Blandy
Clinton and Microsoft head Bill Gates came together to discuss issues around HIV/Aids at the International Aids Conference.
Gates said cultural problems around issues such as injecting drug users and men who have sex with men are "pretty universal", and no country can give itself an "A" for the way it has pursued these issues.
Clinton agreed and, to applause from the audience, said the ability of even the poorest people to take their medications properly and effectively has "driven a nail into the coffin of those who want to patronise the poor".
As the meeting got under way, protesters calling for more nurses stood up and interrupted proceedings. "I agree we do need a lot more nurses," Clinton said.
In many African countries, a shortage of nurses is a problem in delivering Aids medication in an effective manner.
"It is great that there is recognition that the world's capacity to treat people is not as much gated by drug price as it is by personnel issues," said Gates. He added that training capacity has to be increased in both broad and specialised roles.
Clinton said countries like India have large numbers of nurses and doctors, but they do not necessarily know very much about Aids.
Gates said money from the Global Fund to Fight Aids, Tuberculosis and Malaria, and the President's Emergency Plan for Aids Relief (Pepfar) is being put into these issues. Both Clinton and Gates lauded the work being done by Pepfar, which has contributed greatly in terms of treatment.
Asked about conditions connected to Pepfar, such as that condom use be placed on a lower level than the other two members of the ABC prevention method, abstinence and faithfulness, Clinton said: "As I understand the law, 30% of money for Pepfar has to be spent on abstinence programmes, but 70% is still a whole lot of money."
Regarding abstinence, Clinton said research shows aggressive abstinence programmes do seem to delay the first sexual encounter. However, once the encounter does occur, youth are more likely to contract HIV.
"An abstinence-only programme is going to fail. On the other hand, if you want the benefit of American money and research, it is a mistake to walk away from the message altogether," he said.
Gates admitted that the first-generation microbicide trials under way have a good chance of not providing the necessary impact. Second-generation trials will take four or five more years. Oral prevention trials have fallen apart in some cases because of lack of coordination. "We could have done a better job," he said.
An Ethiopian audience member asked whether Aids can be addressed without addressing poverty in Africa or relieving debt.
Gates said one cannot wait for poverty relief to address health issues, and that by solving health issues a lot of economic issues can be addressed. "You have got to have healthy people to grow an economy," Clinton added.
Agricultural productivity is very important in driving up nutrition levels so that people can take their medications effectively, Gates said.
Moderator Charlayne Hunter-Gault asked about the effect of South African Minister of Health Manto Tshabalala-Msimang's nutrition policies, which have been received negatively in the media.
"I think nutrition has gotten a bum rap because some people have offered it as a substitute for ARVs [anti-retrovirals] and care. It doesn't mean it's not important, it is important. If you can get a decent diet, medicine is far likely to work better. As long as it is not a smoke screen of denial, but a way to give people a healthy life," said Clinton.
He attempted to detract from the "doom and gloom" surrounding the African continent. Clinton said people in Africa are "just as bright and informed and insistent as any group anywhere in the world. There is no shortage of intelligence, dreams or desires -- there is a shortage of investment opportunity and programmes that work".
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