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| Sunday, 30 November 2003 |
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| News Business Features Editorial
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Tomorrow is world AIDS day : Seven years on... by Dr. Kamalika Abeyaratne, MBBS (Cey) FCCP (SL) FRCP (Edin) DCH (Lon) FRCPCH (UK) - Consultant Paediatrician It is seven years since I attended the first World Aids Day commemoration organised by the AIDS Coalition, as the first person in this country to admit to being HIV positive. Many changes have occurred throughout the world in the HIV/AIDS scene since and I felt that this would be a good time to look back on this period. The most heartening advance has been the change in attitude of the media which has advanced from the stage of "Case of Aids found in Madagoda" to a sympathetic yet meticulously accurate coverage of the whole scene. I was particularly heartened by the recent story of the little boy with Aids where the reportage was up to a standard or even better than anything in the world. At a seminar on Stigma and Discrimination held two years ago, the highly respected editor of a popular newspaper admitted that the media could not form or mould public opinion but could only go with public demand. Therefore the sensitive handling of the disease that we are seeing must indicate a mature attitude in the reading public. This is of great comfort not only to those who suffer from the disease but also to everyone who cares for them and is concerned for their well-being. Inexorable The HIV virus continues its inexorable spread throughout the Third World with a death toll which is destroying entire populations in Southern Africa. There is talk of a 20% (1 in 5) incidence or higher, in certain populations and certain areas! The big fear at the moment is for Asia and Central Europe. In India what may seem like a small incidence translates into huge numbers due to the size of the population. The speed of spread here is a mystery and raises the possibility that poor nutrition and living conditions can be a larger contributory factor than is acknowledged; perhaps President Tsabo Mbeki is right after all. India is in the millions and rising, surpassing Africa. The incidence in China raises fears that there may be millions affected there too, Cambodia, Vietnam and Laos devastated by war are not even able to assess their numbers. The scene is similar in Eastern Europe. Small hope arises from Thailand where the incidence has peaked and has begun to fall with near universal condom use. In Uganda, in addition, falling numbers have additionally been attributed to a campaign of abstinence. It is significant that in that country, the campaign against the disease is run by people with the disease. A very sad feature is that the hierarchy of the Catholic church in addition to dismissing condom use as being against the tenets of the church has gone further and claimed that this singlemost important defence against the virus is actually porous and therefore ineffective. It is quite clear that nothing but an effective low-cost vaccine is going to bring HIV/AIDS under control. The Vax Gen vaccine has recently been found to be ineffective and all hopes now rest on Prof. McMichael's Oxford vaccine. There have been many important breakthroughs on the drugs front. The first was the statements from both the past head of WHO and the head of UNAIDS stressing that treatment should go hand-in-hand with prevention and that equal attention and funding should be given to both. The next was the bombshell from Yusef K. Hamied of CIPLA India when he Emailed Medicin Sans Frontieres offering to provide a cocktail of three of the latest antretrovirals (anti AIDS drugs) FOR ONE DOLLAR A DAY when I had been paying over 30 dollars a day for an older and now outdated mix. Multinational The third breakthrough was when the case between the multinational corporations and the government of the Republic of South Africa was settled out of court and the MNCs announced price cuts on some drugs down to one tenth of the original, so that prices of around three dollars a day for branded drugs were possible. Hameid was the victim of a BBC programme where the outgoing head of Glaxo, Smith Kline called him a pirate and a thief but the last word was with a representative of MSF who said that Hameid's programme had drastically changed the entire world's attitude to the disease with an affordable medication which would stem the tide of death and bring hope and a decent life to millions. In addition to at least three firms in India, Brazil, Portugal, Thailand and Kenya are now manufacturing drugs. Recently there was some unease about a bilateral trade pact between the U.S. and Thailand which could bring an end to that country's drug production which now costs less than a dollar a day. The DOHA declaration exempts drugs for Aids, Tuberculosis and Malaria from patent laws upto 2005 and thereafter allows nations to resort to parallel imports and compulsory registration to continue to have access to these drugs at reasonable prices. The decision from our supreme court ensured that this protection should be incorporated in our Intellectual Property Law. It is, however, feared that any bilateral trade deal with the U.S. will probably lose us this right in exchange for some deal involving large money spinners like garments. Kofi Anan, Secretary General of the United Nations convened a special assembly of the UN (UNGASS) to support action against Aids, Tuberculosis and Malaria (ATM) where the intention now is to provide treatment for 3 million people by 2005 (Three by Five). Attitude In Sri Lanka, under the auspices of UNDP, the first association of HIV positive people Lanka + was formed and formally inaugurated at the end of 2001. In the past two years The Aids Coalition has worked hard through release in the media to try to change the attitude of the government to providing these very low-cost generic drugs to those unable to pay for them. Promises have been made and broken and with only some 400 surviving proven HIV positives of which about half will require treatment, the present attitude is hard to understand particularly among those decision makers who have taken the Hippocratic Oath. Aid from the 'Kofi Annan Fund' has been rejected on the grounds that it is 'not sustainable'. I am sorry to see that the proposed bill to cover, among other things, the human rights aspect of the disease has been 'put on hold' but am reassured that there is ample provision in our constitution to cover any specific problem that may arise. The vacant seat on the Aids Advisory Committee for a positive person has remained unfilled during this period. "The major hindrance to the survival of my fellow sufferers is that there is as yet no policy on the management of the disease. In order to have a policy it is essential to have reliable statistics on the extent of the disease in this country.... Those available constitute an epidemiological joke in poor taste as lives are at stake. The statistics quoted in the World Bank report are unacceptable and to me represent the third declension of the word 'lies'. This reflects very poorly on the powerful and respected organisation under whose name it is published. What is truly despicable is the crude attempt to frighten the Ministry of Health out of any action that it might think of taking on drugs. Perhaps it is aimed at the survival of the mantra chanted by a roomful of PhDs to the delegation from AIDS LANKA who visited the World Bank in Washington D.C. "In resource poor nations, treatment for HIV is not feasible" I appreciate that the survival of individuals in the Third World and preserving their human rights is not the concern of the World Bank. So we will await with eager anticipation the impact of the billion rupees plus grant on the disease that we suffer from. As those actually suffering from the disease, we will derive no benefit from it and we will be most interesting to see who actually does. To put things in perspective, the cost of a luxury 4-wheel drive SUV will keep the entire known HIV population of this country in lifesaving medication for a year. J was a young man who was infected with HIV/AIDS. In spite of intense tender loving care from his friends he died a few days ago. He was a man who believed as did the great Ashok Pillai in India that he would not accept drugs as an act of charity or be singled out for special treatment. He would not take them unless he was given them by right as a citizen of this country. He gave up his life with great pain and suffering to make his statement. Should we not make sure that he did not die in vain. To sum up, the past seven years has brought us only the benefits of a fair and concerned media. Only one organisation, The Salvation Army, has shown any selfless concern for our well-being. For our medication we are trapped in a situation created by foreign interests over which this country does not appear to have any control. The fear of a messy and painful death hangs over us all. Have we lost our rights as human beings to have the solace of a relatively low cost treatment which will preserve our health and our lives, allow us to earn a living and care for our children? |
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