San Francisco Chronicle - Saturday, July 13, 2002
Sabin Russell, Chronicle Medical Writer

Reflective and showing the wear of his nearly 84 years, Mandela declared that "AIDS is a war against humanity," the outcome of which is still uncertain.

Mandela spoke to about 7,000 scientists, care workers and activists gathered for the conference's closing ceremonies in Barcelona's Palau St. Jordi. He was joined by former President Bill Clinton, who also acknowledged the failings of the world response to AIDS.

Mandela's speech lacked the fire and lofty rhetoric of his remarks at the previous AIDS conference two years ago in Durban, South Africa, where he electrified the gathering with a warning that "history will judge us harshly" if the world did not respond to the epidemic.

This time, Mandela seemed to recognize the lost opportunity. "Eloquence on this pandemic is good," he said. "But it is not sufficient. . . . Unless we are able to follow what we say by doing something practical, our eloquence is less than useless."

He ruefully acknowledged that since the Durban conference, "6 million more have died of HIV/AIDS and that in the next 20 years 70 million will die unless drastic action is taken."

Mandela's speech in Durban was praised by the scientists there as an affirmation of their work. Shadowing that conference was the controversy surrounding South African President Thabo Mbeki, who doubted that the human immunodeficiency virus, or HIV, was the sole cause of AIDS.

Since then, Mbeki's administration has continued to equivocate on the need to combat the virus with drugs. It has blocked a grant from the U.N. Global Fund to Fight AIDS, Malaria and Tuberculosis and was successfully sued in court by activists for refusing to provide antiviral medicines to infected pregnant women, a step that helps to protect newborns from HIV transmission. Drugmaker Boehringer Ingelheim had offered the drugs free of charge for five years.

As he spoke in the crowded forum -- a blaze of color from African delegates in traditional dress -- Mandela never mentioned his successor and protege, whom he has recently criticized. Yet his remarks often seemed as if he were speaking directly to the younger president, whose father, Govan Mbeki, was a close friend and fellow prisoner of Mandela's in a South African prison.

"One of most difficult things in life is not just to influence others, it is to change your own character. We are required to do this today," Mandela said.

Declaring that he himself has been found to have two deadly diseases -- tuberculosis during his prison years and prostate cancer more recently -- Mandela said his friends and colleagues did not shun or stigmatize him.

"You must not be ashamed of speaking out and telling the community, 'I suffer from HIV/AIDS.' . . . This must be repeated a hundred times: When you keep quiet, you sign your own death warrant."

Clinton, who spoke before Mandela, also recognized the uphill battle the conference participants are waging. "We cannot lose our war against AIDS and win our battle against poverty, promote stability, advance democracy, and increase peace and prosperity," Clinton said.

Clinton reiterated his remarks of the previous evening, when he called on rich nations to pay for antiviral drugs in poor countries. He urged the United States and other Western nations to decide what portion they can pay of the $10 billion wanted by the United Nations. For the United States, he figured about $2 billion.

He urged poor countries to pool together and negotiate for the lowest- priced drugs -- brand name or generic. "Developing nations should figure out what they can pay and send the rest of us the bill for the difference," he said.

Clinton's last budget for fiscal year 2001 was $789 million, while the Bush administration budget for fiscal 2003 is $1.3 billion, said Anthony Jewell, spokesman for Health and Human Services Secretary Tommy Thompson.

Despite the grim assessments of the epidemic during the week, Clinton offered a note of encouragement: Sen. Jesse Helms, R-N.C., said this year that he had been wrong not to support financing for international AIDS relief, and he tried to increase spending by $500 million.

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