Reflections from the Durban Aids conference 2011

Being in Durban in 2011, eleven years after the first Aids conference in 2000 was a nostalgic trip down memory lane. The AIDS Conference in 2000 was a defining moment for the struggle for access to treatment.

The then South African President, Thabo Mbeki, spoke at the opening highlighting his lack of commitment to fight HIV/AIDS. He raised questions about the relationship between HIV and AIDS. Many people were dying of HIV in South Africa and access to treatment was a dream yet many people living with HIV in developed countries were accessing treatment. This was a dream on two fronts:

a)      The cost of drugs was too high for poor people to afford; and

b)      Many governments, in particular South African government, also couldn’t afford them.

Eleven years down the road, we have made positive strides in these two issues but what is clear is that we are in a different period where there is a wave of backlash on HIV/AIDS – that it is receiving a lot of resources. This of course is sometimes taken out of context and makes programmes compete for funding opportunities. The reality is that in South Africa, TB and HIV are still the main causes of death, followed by violence. 

This year’s conference was opened by a story of Mandisa Dlamini, Gugu Dlamini’s daughter. Gugu was stoned to death in KwaMashu, KwaZulu–Natal for disclosing her status. Mandisa was very young at the time and struggled to survive. This is an example of the struggles of many children affected by HIV. Her story highlighted the socio-economic conditions that facilitate vulnerability of young women and many children, and puts them at risk of HIV transmission thereby perpetuating the cycle. This certainly doesn’t mean we must drop the ball on HIV and that HIV is no longer an emergency but it requires us as activists to also address those issues.

In stark contrast to the Conference in 2000, this conference was not about whether antiretroviral medicines work or not; it was not about whether we can afford to treat or not. This conference was about, we know antiretroviral medicines work and we know we need to scale up access to prevention, care and treatment using cost effective patient centred ways that deliver health care cheaper and closer to homes of people and uses more community health care workers.

The Ugandan, Mozambican and Khayelitsha models of community-based antiretroviral treatment that were presented by MSF gave meaning to this. The TAC Khayelitsha condom distribution intervention and the impact it made on STI incidences in the Khayelitsha district; the ARV expansion in the Western Cape and decline in mortality as presented by Leigh Johnson are examples that we need scale up more of such initiatives. In this way, the programmes could be sustainable but it does not mean government will not pay for those services; global leaders must stop finding resources to fund this work.

Activism was very low during the conference until we hosted a session on the future of activism with the panellists, Lynne Wilkinson, Vuyiseka Dubula and Mark Heywood debating where we have come from and where we should go with activism.

The HIV activism brought about the 1.5 million people who have access to ARV’s in the public sector in South Africa, and acknowledgment of the right to health as a right not a privilege. It was this same activism that saw to it that the prices of drugs were reduced.

After the South African government changed its stance on HIV/AIDS by adopting a progressive HIV policy, mainly due to pressure by civil society locally and internationally, many communities must be feeling the void in the public leadership. This has demobilised many communities and there is a growing need to continue the leadership and find bridges with other comrades in other struggles. We need to find something that will re-ignite that fire in our communities to mobilise people on.

The first area is unity of people living with HIV to take on campaigns like adherence, fighting stigma and discrimination against people living with HIV and support of the health system. Civil society needs to remain independent of government at all costs and cannot afford to be co-opted especially now because with the signs of non-accountability and threats to transparency. The Secrecy bill and the freedom of the media are some examples that threaten all our gains.

However, there are clear threats to this activism because social movements are under pressure financially due to many donors pulling out or changing priorities. Activism shaped the response in the past and should continue to shape the response in the future.

Future activism cannot ignore that we need much more effort to prevent people from getting infected and address the conditions that creates vulnerability to HIV transmission such as sexual violence against women, men to men violence and unemployment or access to jobs. We cannot overlook that we are where we are because of small social movements like TAC who are now under immense financial pressure to perform optimally. Such social movements are vital to hold government accountable through building active citizenship.

The struggle is not over!