Is the End to AIDS Just a PR Exercise?

Speech delivered by TAC General Secretary Anele Yawa at the opening of the HIV Clinicians conference on Wednesday 13th April 2016. 

Conference delegates, people living with HIV, clinicians, friends and comrades. My name is Anele Yawa. I am the General Secretary of the Treatment Action Campaign and a user of the public healthcare system.

The Southern African HIV Clinicians Society Conference is a conference that we at the TAC value deeply. At no other conference do we learn as much about our epidemic and the science and treatment of HIV as at this conference. We thank you for sharing your knowledge and research with us.

We are also meeting here today in the lead up to another important conference. Today, 16 years after the historic 2000 International AIDS conference, we stand ready to return to Durban.

Friends. We have unfinished business.

Although great progress has been made since the dark days of the 2000 conference that so dramatically shifted the course of the global AIDS response, our struggle is not even close to being over.

I am standing here to gain your support, comrades. I am here to engage those who stood beside us in the dark days. I am here to talk to you, our allies who stood with us as so many of our family members, friends and comrades died while Former President Mbeki’s government dragged its feet. We have not forgotten our allies who stood by us while the government intentionally delayed the introduction of ARVs to the people they were trusted to serve.

But, comrades, I say again, our struggle is not over. Although the dark days of denialism are over, new forms of denialism have begun.

The START trial showed us that all people living with HIV need treatment for their own health. The HPTN052 trial showed us that when people are stable on ART they become non-infectious. It is clear what we must do. We must provide all people living with HIV with ART. This is what the WHO treatment guidelines say, it is what the UNAIDS 90-90-90 targets say. In principle we all agree.

But, while everyone is talking about treatment for all, what is happening in reality? Where is the increased investment? Where are the new healthcare workers that we will need to sustain and grow these programmes? How can we provide quality care without many more healthcare workers? Where will we find money to buy the ARVs? Everyone talks about treatment for all, but where is the political will and financial commitment to make it a reality?

As with Ebola, the AIDS response is being undermined by dysfunctional healthcare systems. Our treatment programme is expanding at a much faster rate than capacity in the healthcare system. While the need for healthcare workers is growing, budget cuts are effectively leading to a freezing of posts in our provinces. While the HIV budget lines are growing (which is a good thing), the budgets for provinces are going down. We want to give treatment to more people, but we are reducing the numbers of healthcare workers. We are not investing in people and in stronger healthcare systems.

This is a crisis that nobody is facing.

As you are all aware, one of the worst examples is in the Free State – which lost a quarter of its public sector doctors from 2014 to 2015, in our view largely due to mismanagement by the MEC for Health, Dr Benny Malakoane. Malakoane is currently facing multiple charges of fraud and corruption. At the same time, the public healthcare system in his province is falling apart. Yet Malakoane is untouchable. He is untouchable because he is politically connected.

The deployment of loyal party members across our healthcare system is a crisis, but it is a crisis that nobody is talking about.

For years we fought against the unrelenting pressure of the pharmaceutical industry to ensure access to HIV medicines. We won a number of important battles for ARVs, but when it comes to intellectual property the pharmaceutical companies are undoubtedly winning the war. We are faced with an R&D system that fails to deliver many of the medicines we need – where the medicines do exist they are priced out of reach.

We would like to have raltegravir as part of first line ART, but we can’t because it is too expensive. We urgently need access to important new TB medicines, to cancer, diabetes and mental health medicines, but we can’t because we are too poor. Exactly the same thing that happened to AIDS patients in the early 2000s is now happening to people living with cancer and drug-resistant TB.

Today, women living with breast cancer are unable to afford the half a million-rand price tag of a lifesaving medicine called Herceptin.  Only 8 hepatitis B patients across the whole of South Africa have access to entecavir, because it is just too expensive.

High prices are one side of the problem – the other side is a lack of innovation when it comes to diseases of the poor. 1.5 million people died of TB last year, yet the entire world invested only 700 million dollars in TB research last year. Companies like Pfizer, Astrazeneka and Novartis are all pulling out of TB research. We have learnt to be happy with a few million here and a few million there. I say to you, that is not enough. Our people are dying of TB. We need dramatically more money for TB research.

The United Nations Secretary General has even appointed a High Level Panel to look into these problems. As TAC we are supporting the work of that panel and we urge you to do so as well. We cannot allow the inhumanity of denying people life-saving treatment to continue. We must say “stop” and “never again!”

Comrades, I urge you all to make a pledge to support local and global activism to make a change to the AIDS response. We need a second wave of AIDS activism – a second wave defined by dramatic increases in investment in people and in healthcare systems.

The reality is that right now, right now, we are not heading toward an end to AIDS. Nothing of the sort. It is a hypocrisy of bureaucrats in Geneva and New York to pretend that we are. We will not stand for such PR exercises, not now, and not when the International AIDS conference returns to Durban in July.

We will not end AIDS while we continue to neglect healthcare systems – and we are neglecting healthcare systems.

We will not end AIDS while we allow our healthcare system to be misused for political patronage – and we know that it is being used for political patronage.

We will not end AIDS if we fail to invest in healthcare workers – and we are failing to invest.

We will not end AIDS without much greater political and financial commitments from both rich and poor governments – and you know as well as I that political will and financial commitments are waning.

Comrades, these are difficult and uncomfortable questions – but they are the right questions that TAC must ask. The return of the International AIDS conference presents a unique opportunity to once again shape the global response – a response that is waning.

The next few months will see significant build up work to bring awareness of these issues and mobilise public and civil society support. We need people across the world to stop talking about an “end to AIDS”, while we know very well that that is not where we are heading. We cannot let people talk of an “end to AIDS while on the ground the AIDS response is unravelling. Our message is that the AIDS response continues to be at CODE RED.

Comrades and friends, here at this conference this week, and in the next few months leading to Durban, we must come together to find a common vision. We must once again cease control of the control rooms and demand a second wave in the AIDS response.

The battlefields are not in Geneva or in New York.

Our epidemic is here in Johannesburg and Durban, in Gert Sibande and Khayelitsha.

It is our lives. It is the lives of our brothers and sisters, our comrades, our patients and friends that are at stake.

As TAC, we will go to Durban not begging, but demanding a new era in the AIDS response. We invite all of you to join us.

I thank you