AIDS 2016: Treatment, Prevention & Non-Discrimination is Still Our Human Right

*Speech delivered by Nkhensani Mavasa, Chairperson of the Treatment Action Campaign (TAC), at the opening of the 21st International AIDS Conference on 18 July 2016*

Nkhensani Mavasa, Chairperson of the Treatment Action Campaign (TAC) Photo: AP
Nkhensani Mavasa, Chairperson of the Treatment Action Campaign (TAC)
Photo: AP

Deputy President, Minister of Health, Premier of Kwazulu-Natal, MECs for health, foreign dignitaries, leaders of the global AIDS response, people living with HIV, friends, comrades. It is a privilege to address you on this historic day.

We are here 16 years after a young boy with HIV named Nkosi Johnson addressed this same conference. He was ignored by our political leaders then. We know he would not be ignored today.

We are here 16 years after the Durban Declaration said ‘NO’ to the madness of AIDS denialism.

16 years after many of us marched on the streets outside this building demanding access to ARV treatment and the start of PMTCT programmes in developing countries.

Our marches then helped save 15 million lives. After we marched, the world woke up to the political crisis of AIDS. It started to act.

If activists had not marched then I would have been denied treatment.

I would be one of your statistics.

My name is Nkensani Mavasa. I am 38 years old and living with HIV. I am the chairperson of the Treatment Action Campaign. We are a movement of 5,000 poor people in South Africa. Most of us are women. Most have HIV.

I come from Giyani, a rural town in Limpopo province where access to health services is still a challenge. Where I live, we have to travel far to clinics. When we get there, often there are too few healthcare workers. Often people wait for many hours and then have to go home without medication or even seeing a healthcare worker. The reality is that this has not changed much in the last sixteen years.

Friends, we learnt last year that all people living with HIV must have access to anti-retroviral treatment. That knowledge is so important – but it is like starting all over again. Once more we have a huge challenge: 20 million more people on treatment *as soon as possible*.

We know that today there are 17 million people on treatment. After many years of activism, billions in donor dollars, through the efforts of hundreds of thousands of healthcare workers we have achieved 17 million.

But another 20 million people still need treatment … and many of those people live in places like Giyani.

The main task before all of us gathered here is to ensure that an additional 20 million people can access treatment – and not just treatment, but also all the health care and counselling that is our human right and must go with it.

*We NOW need a road-map to treatment for all* – not just talk – a ROAD MAP that is backed up with the money and political will to make it a reality. In South Africa we have a 5 year National Strategic Plan. For the world we need an International Strategic Plan. Do you agree?

It is possible to treat everyone and prevent every possible infection. But to do so we must be honest with ourselves and we must be serious. I will briefly mention three MAJOR obstacles on the road to treatment for all.

Firstly, to bring treatment and care to an additional 20 million people we will need healthcare workers.

Where possible we will need to shift tasks to properly, supervised and paid trained community healthcare workers and lay councillors. We need a global plan for this now. We cannot leave it to chance because we know chance does not deliver.

Do you think we can have strong healthcare systems without people?

If we agree, why is it that here in South Africa committed community healthcare workers and lay councillors are losing their jobs?

Where I live in Giyani, people are defaulting because there are no healthcare workers to help them stay on treatment.

And healthcare workers who do have jobs are overworked and struggling to keep their heads above water.

How will we we ever reach the 90-90-90 targets without thousands more healthcare workers?

Secondly, we can’t bring treatment to an additional 20 million people if our healthcare systems are mismanaged and rife with corruption.

This is a problem across the world – not just here in South Africa.

Too often, at conferences like these, we focus on the technical side of fixing healthcare systems, but turn a blind eye to the political problems.

Let me elaborate on one example here in South Africa …

A man facing multiple serious charges of fraud and corruption is in charge of the collapsing public healthcare system in the Free State province. The Free State has a population of three million people. HIV prevalence is 14%. Life expectancy is the lowest of all SA’s Provinces.

This man has victimised community healthcare workers and whistle-blowers. On his watch the Free State lost a quarter of its public sector doctors last year.

This person’s name is MEC Benny Malakoane.

We cannot reach 90-90-90 if we turn a blind-eye to the Benny Malakoane’s of the world.

Thirdly, we will not bring ARV treatment to an additional 20 million people if we allow our political leaders to continue to be complacent about HIV.

Worse than that, in too many countries political leaders are clamping down on civil society organisations that fight HIV. We are not the enemy. The enemy is complacency and corruption.

We cannot continue to speak of an ‘end to AIDS’ when

  • less than half of people who need treatment have access to treatment;
  • when new infections are rising in parts of the world;
  • when over one million people still die of AIDS and TB every year;
  • when civil society organisations are being intimidated.

That is the old AIDS we know. It’s not going away without a big fight.

Yes, we have made massive progress. Thank you Mr Sidibe. Thank you Deborah Birx. Thank you Minister Motsoaledi. But it’s not been half enough. We ask UNAIDS and others to stop spreading complacency by talking about an ‘end to AIDS’.

Our lives are not an advertising campaign.

Friends, we must demand action from world leaders based on the facts … and the most important fact is that 20 million people need treatment right now.

Let us also not beat around the bush about political priorities. The United States spends $600 billion on defence every year. That, while the Global Fund struggles to raise not even $30 billion.That, while the world invests less than $0.7 billion on TB research per year.

This is a disgrace.

 

HIV and TB is still a crisis in our communities. We must make it a crisis for our elected representatives.

We have rights. We must demand better.

Friends, comrades, when your house is burning with your family inside it you don’t quietly ask for help.

You beg. You scream and shout. You demand.

Our house is still burning.

President Obama, Chancellor Angela Merkel, President Xi Jinping, President Zuma

… our house is still burning.

Please don’t turn your backs on us.

I thank you

Our house is still burning: We need your help

By – Anele Yawa

What is the state of play as the world returns to Durban 16 years after the historic 2000 AIDS conference? It is simple: less than half of people who need HIV treatment have access to it.

Around 17 million people living with HIV are receiving antiretroviral therapy, 20 million are not. We now know that 20 million people are at increased risk of developing tuberculosis and cancers – even if some of them still have high CD4 counts. We also know that providing those 20 million people with treatment will help prevent many new HIV infections.

It is clear what we need to do – we need to make sure an additional 20 million people have access to treatment. On this score most of the researchers, doctors, diplomats, policy-makers and activists gathering in Durban will agree. We have all the slogans and all the right rhetoric. We all agree that 90-90-90 is the way to go.

But 20 million? Twenty million when all we’ve achieved so far is 17 million – and that 17 million only through years of struggle, sweat and tears, with years of donor assistance, and unprecedented political will. Is it not madness to think we can get another 20 million on treatment? Is a reality check overdue?

If we are ever to get near an additional 20 million, then Durban has to be a turning point. It has to be the moment where we once again get serious about the HIV epidemic.

What should we be getting serious about? Firstly, we must get serious about where we will find the healthcare workers to support an extra 20 million people on treatment. Secondly, we have to stop pretending we can end AIDS without dealing with the widespread dysfunction in our healthcare systems. Thirdly, we have to get serious about how we are going to produce and pay for the medicines needed to treat an extra 20 million people. Lastly, we need detailed, fully funded plans that will make treatment for all a reality.

Getting serious also means an unwavering commitment to the evidence in all aspects of our AIDS response. It means being guided by the scientific evidence rather than by what sounds good or by what “sells on the hill”. It means never again wasting money in the way money was wasted on, for example, abstinence-only programmes. It means standing up to the moral Mother Grundys and providing young people with proper sex education and access to condoms. It means asking “Why are we so quick to stigmatise ‘sugar daddies’? but so slow to ensure young people have easy access to condoms?”

Getting serious means addressing the political obstacles to fixing our healthcare systems. It means dealing with corruption, mismanagement and patronage in our healthcare systems. It means not turning a blind eye when healthcare systems are wrecked by people who are politically well-connected – as is happening in the Free State province here in South Africa. It also means acknowledging that while PEPFAR giveth, the United States Trade Representative taketh away – the latter by bullying poor countries into trade deals that compromise access to medicines.

Getting serious also means not tiptoeing around cruel and inhumane legislation such as the anti-gay laws in place in many countries. At a conference like the International AIDS Conference IAC, we must say loudly and clearly that what countries like Nigeria and Uganda are doing is unacceptable and an affront to our common humanity.

Getting serious means an end to empty rhetoric and spin. It means that UNAIDS must stop talking about an end to AIDS while there are 20 million people who still need treatment. We cannot spread complacency just because we want to tell a positive story. Our lives are not an advertising campaign.

At this point in the AIDS response, complacency is our greatest enemy.

Even though a staggering 20 million people still need treatment, we have allowed the spotlight to shift. We have allowed the world to think AIDS is no longer a crisis. To the extent that we have allowed this to happen, we have betrayed the 20 million people needing treatment today. We have no choice. We are morally obliged to change this in Durban.

Getting an extra 20 million people on treatment will not be easy. If we are serious about things like 90-90-90 then we are going to have to rock the boat. I know that most of us want to be polite and not offend anyone. But our moral obligation is not to ourselves, or our own comfort, but to the 20 million people who still need treatment. We have to say to the governments of high burden countries: “You have to invest more. You have to do better.” We have to say to rich countries that they have a moral responsibility to the people still dying of AIDS and their families. And if governments don’t do their part we must name and shame them and stop the quiet diplomacy.

We don’t have to go hat-in-hand to Geneva or New York. We don’t have to accept ‘no’ for an answer. If a house is burning with people inside, then we help. That is what it means to be human.

If we are truly serious about things like 90-90-90, then we have to once again turn our crisis into a crisis for our political leaders. Together we must demand that HIV and TB is on the top of the agenda when the G7 or G20 meet. We must demand that more money is invested in TB research. We must say ‘no’ to a world where the United States government spends US$600-billion a year on its military, but the entire world can only find US$700-million per year for TB research.

We have the moral authority to demand a second wave in the AIDS response. We have no choice but to use it.

Welcome to Durban 2016, let’s roll up our sleeves and get serious. We have 20 million more people to treat.   

 

Anele Yawa is the General Secretary of the Treatment Action Campaign.