August 16, 2006

Abe Janzen, MCC Alberta Executive Director

We started the day taking some shots of the AIDS Flags display - 8,000 flags on a patch of grass just south of the CN Tower, towards the water. It is a nice display that is getting some attention here. (see photo at left)

The first session today was on the theme of Advancing Treatment and Universal Access. Some amazing progress has been made even though it is being said that only 10% of the people who have HIV in the world are actually aware of their status, and still less than 1.3 million are receiving treatment. 90% of the medication is in the North and 90% of the infected people are in the South. Only 10% of those needing treatment are getting it. But costs have gone way down, to less than $150 per year per person, and the number of pills people living with HIV actually have to take has been reduced from 10 pills to 1 pill in many cases. That is good. Clinton pointed out yesterday, and I read this in the Herald last week, that in Africa, of those who do have access to medication, 77% are faithfully taking it. And that is much better than in the North, where apparently less than 50% are faithful in taking their medications. This speaks loudly to those who think money for drugs is being wasted in Africa.

A strong case is being made for HAART (Highly Active Antiretroviral Therapy) medication; trials in BC and in Taiwan show that when HAART is used, infection rates even go down… meaning people are less likely to pass on the virus. They know this because during the same time period, syphilis, in both places, continued to go up… people continued to have sex, dangerously, but HIV didn’t infect as many people. Quite stunning stuff.

Ruth Ndusti of Nairobi spoke about children, the group still most neglected. 14% of 5 million new infections occur in children; 18% of 3.1 million deaths last year were in children. But, and this is huge, the risk of death for an HIV + child is halved if the mother stays alive. Half of all new infections now are in young people under 25.

A note about professional workers: the world affected by AIDS is 4.3 million workers short, and Sub-Saharan Africa needs 620,000 nurses to do the basic work needed, now.

Agnes Binagwaho, from the ministry of Health in Rwanda, spoke next. Rwanda is a country that has organized itself and claims to be managing the epidemic in a sustainable way now. They have put a strong emphasis on government leadership and coordinated work, which is one of the major themes emerging here throughout the entire conference. Rwanda also works with a strong emphasis on food security and nutrition. It is a bit frightening to me that Agnes is the only speaker, besides Bill Clinton, who has emphasized nutrition and food security as a major component of managing and defeating AIDS anywhere. Yet, it is so very obviously true.

A final speaker from the World Health Organization talked about the G-8 goals as testing/counseling, prevention, systems building, and strategic information sharing. The Gates and Clinton push on that last item as well… the need for all of us to be sharing information with each other, liberally.

Session Two was on Stigma and Discrimination. There were 5 speakers, and what struck me was my own ignorance of what stigma is and how damaging it is to everything. The speakers encouraged all of us to start at home with the whole story of beating back the stigmatization of AIDS. Two things happen… People with AIDS assume all kinds of internal guilt, fear, and shame. So they often don’t get tested, fearing the discrimination they will face if they are positive. So they die of TB (which is being re-stigmatized because of its connection so often with AIDS) or malaria, but not of AIDS, and they avoid dealing with their fears. It’s a self-imposed isolation that seems entirely normal, but it almost neuters all the work at making testing and treatment available to everyone. So, NGOs, churches, and clinics all need to take leadership in finding ways to de-stigmatize the lives of drug users, homosexuals, poor people, people infected with HIV… so that those who are infected, or think they might be, will not wait (waiting kills people all the time) to be tested and if they are positive, and will be able to go with some confidence of support, to their church, their local hospital, local clinic. I remember the Sunday afternoon Support Group at the Faith Alive Clinic in Nigeria, where 200 people come together once a week to sing, eat, pray… whatever. It made sense then, but it makes more sense to me now. That is their key to maintaining some level of self esteem against incredible odds and keeps them motivated, as they said then, to staying alive at all. 60% of people in Zambia, by the way, preferred, recently, to not be tested… they would rather not know. Apparently hospital workers often stigmatize AIDS patients. One professional said to a patient, “Why didn’t you tell us you are hemophiliac? We would have treated you much better.”

Session three looked back 25 years, and also forward. One speaker was an advocate now living in South Africa who was quite upset with the way the Gates and Bill Clinton can drive an agenda and become heroes, when it is the local people, those dying, the grandmothers and many others, who are the heroes.

At 4 pm, we went to the Aboriginal Booth in the Global Village, where they presented the public and the press with “The Toronto Charter”, a plan to fight AIDS in Aboriginal Communities. I also attended a fairly large meeting called “The Developing World Epidemic in the Developed World”, and they spoke only about the black communities in the Netherlands, the UK, Canada, and the USA, but Aboriginal Communities were not even acknowledged. Yet, one Aboriginal leader said that they have received more attention at this Conference than at any of the others, going back at least 4 Conferences.

Another note from yesterday… The former Soviet Union has the fastest growing infection numbers right now. Though in a presentation yesterday, my sense was that they think they have the crisis managed. I may have misread the presenter, but it was the first presentation about a specific country that seemed to me a bit defensive and protective. Most country representatives here seem to be open and wanting to be connected to every resource that is available.