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| Sunday, 3 July 2005 |
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Features |  |
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Political leadership to meet challenge of HIV/AIDS Address made by Health, Nutrition and Uva Wellassa Development Minister Nimal Siripala de Silva at the Seventh International Congress on AIDS in Asia and the Pacific Kobe, Japan July 1-5, 2005. Since the emergence of HIV in the world in the early eighties and its rapid spread in the Sub Saharan Africa in the eighties and the nineties, the world public health community has learnt many invaluable lessons related to political leadership. We need to make use these lessons to our advantage today. One of the biggest lessons learnt globally as well in the Region and the affected countries is that national responses should not wait for HIV/AIDS cases to soar. Policies should not wait at a time when crucial prevention and care information and services are needed. HIV is particularly fuelled by situations of injustice and poverty and its impact is felt beyond health sectors. We saw this very vividly in the early and middle stages of the epidemic in Sub Saharan Africa. Success stories relating to the fight against HIV/AIDS clearly demonstrate the role played by the political leadership in the implementation of the successful prevention programmes; attitude changes, condom usage, fight against discrimination and treatment and care for people infected with HIV. Thailand is among the most successful countries in bringing down the rate of infection. 300,000 people have died of HIV/AIDS and close to 600,000 people have the virus. In Thailand comprehensive prevention efforts initiated by vibrant political leadership have reduced the number of new HIV infection today to less than a quarter of the number few decades ago. In recent history, some of the glaring examples of high-level leadership came from dignitaries such as Nelson Mandela, inspiring, fearless, forthright. He made such an important difference to the HIV situation in the whole world, and very specially to the African continent by his leadership. The charisma and the leadership he brought to the fight against AIDS in Africa, and the rest of the world is now part of our contemporary history. In a speech at the closing ceremony of the 13th International AIDS Conference in 2004, Mandela urged a move away "from rhetoric to practical action" in the global war against HIV and AIDS. Mandela admitted in public that his son has HIV/AIDS. We must acknowledge the courage and dedication to make a public admission of such an emotive subject. Clinton, another person who provided a sound leadership during his time, also recognized the uphill battle he faced by the HIV lobby. 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. Of course the actual resources the programs have received has been much less. We know that these leadership efforts resulted in huge sums of funds being contributed to the HIV/AIDs program. It also helped to get the multinational companies to withdraw the litigation that they had introduced against the proposed production of GENERIC HIV drugs by countries such as South Africa, Thailand and Brazil. The rest of course is now history and we now have HIV drugs being made available at less than a dollar a day - a reduction of about 100 times from the original cost. No doubt the political leadership has contributed a lot towards this achievement. In our struggle in fighting against the spread of AIDS virus, another important lesson that we have learnt is that any multi-sectoral response must be designed in the context of the overall development strategy of the country in order to ensure its sustainability and effectiveness. This is entirely in the hands of political leadership. A substantial component of AIDS prevention and care relies on strong political leadership and sound public health infrastructure in order to mount a more effective health sector response to AIDS. They include early diagnosis and treatment of Sexually Transmitted Infections (STIs) using the syndromic approach, safe blood transfusions, epidemiological surveillance and research and good HIV/AIDS care. This should link health institutions, community and home. It can only be achieved if the program is decentralized and owned up completely by States, Regions, provinces and the like in the countries for implementation. NGOs and private sector have an equally critical role to play in an effective response. The challenge is to identify appropriate, locally relevant interventions and experienced community based organizations to work with poor and marginalized populations who are particularly vulnerable to HIV infections. AIDS control programs in most countries have hitherto been seen as a public health matter dealt by the Ministry of Health. However, because of the behavioural nature and the strong socio-economic implications, the disease requires to be treated as a developmental issue that impinges on various economic and social sectors of Governmental and non-Governmental activity. As economically productive sections of the population are the most susceptible to the disease, participation of Ministries like Transport, Industry, Youth Affairs & Sports and other public sector undertakings, employing large workforce require to be actively involved in the program. Organized and unorganized sector of industry needs to be mobilized for taking care of the health of the productive sections of their workforce. Ministries like Social Welfare & Empowerment, Women and Child Welfare, Agriculture, etc. should devise and own up the HIV/AIDS control programs within their own sectoral jurisdiction. There should be strong budgetary and managerial support to these sectoral programs from within these Ministries. The epidemic is now recognized as a major threat to our Regions health and economy by scientists and the elite throughout the region. In some countries this is manifest in many ways. In China, Premier Wen Jiabao took a swipe against the stigma associated with the disease when he publicly shook hands with three AIDS patients in December 2003. In this context politicians in the second-wave countries would be in a very advantageous position to contribute largely towards eliminating the deep-rooted stigma against HIV infected patients, especially silence and taboo surrounding discussions on sex. Leaders can make a vital contribution towards protecting their societies against HIV/AIDS by ensuring that governments are open about the epidemic and that the public receives clear, accurate information about the disease and how to prevent its spread. Providing ARV drugs and the systems to deliver them to people with HIV/AIDS can pose a challenge to the budgets and healthcare infrastructure of developing countries. However, ARV drug costs are falling sharply and economic analysis shows the drugs represent good value for money. In Brazil, the first developing country to attempt ARV therapy on a large scale, the treatment has even proved a financial saving. Abuses faced by those infected with HIV range from job-loss to denial of schooling, denial of medical or other services, and even physical assault. This issue must be seriously addressed by the political leadership as legislation. It is a duty cast on the political leadership to enact suitable legislation to protect the rights of those infected with HIV and ensure that their fundamental and human rights are not eroded and safeguard them within their legal system and give them protection from any discrimination or abuses. The political leadership in a country being the primary decision maker in allocating financial resources and prioritizing them in the area of mobilizing resources for national budgets of the HIV campaigns and to anti-retroviral treatment, the intervention and the understanding of the political leadership would become an integral part of resource allocations which will have a direct bearing on the success of such programmes. The political will should also include monitoring and supervising the major trends and provide ongoing guidance and advice in the HIV/AIDS control activities. |
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