IMPRESSIONS OF THE BANGKOK AIDS CONFERENCE 11 – 16 JULY 2004 : YVONNE SPAIN

IMPRESSIONS OF THE BANGKOK AIDS CONFERENCE11 – 16 JULY 2004 :YVONNE SPAIN

A FEW FACTS • Theme : ACCESS FOR ALL; • Between 19 000 – 20 000 delegates; • Over 80 oral presentations to choose from in the following categories : • Basic Science • Clinical Research, Treatment and Care • Epidemiology and Prevention • Social and Economic Issues • Policy and Program Implementation

THE DILEMMA – INFORMATION OVERLOAD : WHAT TO ATTEND AND WHAT TO MISS? • Important Plenary Session between 0830 and 1000 each day (cutting edge developments and input by internationally acclaimed practitioners and researchers)? • Oral Sessions in the five tracks? • Bridging/Dialogue Sessions? • Case Studies? • Debates? • Symposia? • Meet the Leaders? • Skills Building Sessions? • Movies?

DILEMMA cont … • Global Village (cultural events, informal meetings, exhibitions, handicrafts and souvenirs)? • Posters (over 1 300 each day – regrettably most of these were removed by 1630 each day)? • Satellite Sessions (between 1800 and 2200)? • Informal Networking?

MY CHOICES • I attended each day’s early morning Plenary Session; • In view of CINDI’s decision to become a Funding Conduit, I attended many sessions on Policy and Program Implementation; • Skills Building Workshop on NGOs sustainability and a strategy for NGOs to become business entities; • I watched the movie “The Orphans of Nkandla” (Action : secure a local screening by contacting the Producer, Jill Swart Kruger in Durban);

MY CHOICES cont… • Attended the emergency session in which Zackie Achmat, Stephen Lewis, the WHO; Elizabeth Glaser Foundation and the AIDS Legal Project addressed the confusion created by Min of Health iro Nevirapine as a monotherapy in PMTCT; • Visited as many posters as possible;

MY CHOICES cont… • Informal networking (and distribution of CINDI’s Annual Report) included: • Helen Meintjies (Children’s Institute CT) • Ann Strode (UKZN Law School) (Action : Invite Ann to address a CINDI meeting on the ethics of vaccine trails with children as candidates) • Minister Zola Skweyiya • Johanna de Beer (Dept of Social Development Pta) who advised that the money for PADCA’s Pilot with the elderly has been increased and is being processed • Rev Ted Karpf (former Adviser to the current Anglican Arch Bishop, now with the WHO in Geneva)

NETWORKING cont… • Lynette Madekunye (Save the Children UK) (Action : SCUK may be interested in publishing our CBO Mentoring Action Research – Sixolile) • Sandy Thurman (who visited CINDI in ’99 as Bill Clinton’s AIDS Advisor) • Kevin Kelly (CADRE) • Monica Fairall who I met en route from Dbn to Jhb who is interested in CINDI’s Nutrition Guidelines. (Action : I have asked Kim Jones for the final document and will forward this to Ms Fairall)

MY IMPACT? • I posed the following four questions during “Meet the Leaders” sessions : • To the World Bank : the question of security of tenure for orphans iro rates, water & lights (their rep agreed that the Bank has not previously considered this aspect and would do so in the future); • To Stephen Lewis : how to sustain volunteers (esp women) (Mr Lewis advised that Swaziland had secured Global Funding to pay every HBC volunteer in the country $30 a month and suggested that SA do the same)

MY IMPACT? • To the Panel during a symposium on Education : the need for ECD sites to enable children caring for siblings to attend school (Acknowledged by Fr Michael Kelly World Education authority ex Zambia, as a key intervention)

MY IMPACT? Cont… • The difficulties experienced by NGOs with SA’s Country Monitoring Mechanism (the body responsible for allocations ex Global Fund) (The Panel acknowledged this problem and suggested that I refer the matter to our National Co-ordinating Body ie SANAC. So upon my return from Bangkok, I wrote to Cati Vawda who is the Children’s Sector Rep on SANAC, in this regard. Countries like Lesotho and Swaziland are getting their acts together – my fear is that this could lead to a flight of donor funds away from SA to countries that are more proactive and which pose far less difficulties that we do?)

KEY ISSUES THAT EMERGED DURING THE CONFERENCE • Acknowledgement that HIV/AIDS is currently the greatest threat to the world (and yet receives less funding than efforts against terrorism and weapons of mass destruction) • Gender Issues and Women’s empowerment (through access to education, information, treatment/ARVs, the development of a microbicide and a climate of Human Rights); • Eradication of stigma through creating a climate of Human Rights implementation; • Meaningful participation at all levels by PLWA, youth, drug users, refugees, sex workers, gay men and lesbians, and illegal immigrants; • The need for M&E at Govt and NGO levels SOONER rather than later (Action : URGENT implementation by CINDI and Members).

KEY ISSUES cont… • Provision of ARVs, parallel imports and compulsory licensing (for generics); • Condoms vs abstinence (The Thai example of 100% condom use by sex workers has significantly reduced new infections); • TB treatment to receive greater focus; • Abysmal lack of leadership by Governments worldwide; • MARRIED women are at the greatest risk because of their husband’s infidelity; • Home-based care entrenches gender discrimination against women; • Youth were very visible at the Conference;

KEY ISSUES cont… • The Global Fund provides our best hope and includes the commitment of each country to the “three ones” principle ie • ONE agreed action framework (TAC are using the provision of the Access to Info Act to force Govt to make SA’s final framework esp Annex 1, available for public scrutiny) • ONE national co-ordinating authority with a broad-based multi-sectoral mandate (our ineffective SANAC!) • ONE agreed country level M&E system.

KEY ISSUES cont… • Infant Feeding “When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV infected mothers is recommended. Otherwise exclusive breastfeeding is recommended during the first months of life” However women must ultimately make the choices they feel are best. (WHO Sept 2003)

KEY ISSUES cont… • The brain drain of health workers from developing countries. Peter Piot (UNAIDS) believes that there needs to be an international moral protocol to prevent this, and that funds must be forthcoming to provide for better salaries and human resource training;

POLITICS • Lack of worldwide leadership; • Lampooning of the US • Congressional delegation’s attendance significantly reduced • PEPFAR : undermines the funding to the Global Fund and promotes Pres Bush’s agenda of abstinence and no condoms (which is not possible for so many women and girls in developing nations) • The Conference will not be held in the US until access is granted to HIV+ve delegates • The US’s contribution to the Global Fund is insufficient and not in line with their original commitment.

POLITICS cont… • South Africa • The acrimonious debate between Zachie Achmat and the Min of Health on the provision of Nevirapine as monotherapy in PMTCT. (Recommended by WHO in the absence of funds for triple therapy.) Even Stephen Lewis expressed his dismay and bewilderment at our Government’s dithering compared to Lesotho, Uganda etc who do not have the same resources that are available in SA.

VALIDATION OF CINDI’S ACTIVITIES • Partnerships, partnerships, partnerships; • Development of CBOs – our Mentoring Project is a pioneering project; • Nutrition/African Roots; • Pyscho-social/bereavement support; • Development of M & E Tools

OPPORTUNITIES FOR CINDI MEMBERS • Seek ways to secure on-going income through business activities; • Ensure access to ARVs for children in care and their caregivers; • Vocational training for youth; • Involvement of youth – especially in decision making; • Micro-finance for job creation for PLWAs

GAPS AT THE CONFERENCE • AGAIN WHERE WERE THE CHILDREN? IS IT NOT TIME FOR A TRACK TO BE DEVOTED ENTIRELY TO CHILDREN (AND ANOTHER FOR WOMEN?) SEXUAL ABUSE OF CHILDREN WAS NOT DISCUSSED IN ANY DETAIL. • WHEN WILL WE SEE PRESENTATIONS BY MEN ATTESTING TO PROJECTS THAT HAVE CHANGED THEIR BEHAVIOR. WOMEN, SEX WORKERS AND CHILDREN ARE MADE VULNERABLE BY MEN’S ACTIVITIES. • THERE IS A NEED FOR A GREATER FOCUS ON THE ELDERLY AND THEIR VITAL ROLE IN CARING FOR CHILDREN ORPHANED BY HIV/AIDS

UNFORGETTABLE MOMENTS • A picture of a young Haitian man before taking ARVs and after taking ARVs; • The movie “The Orphans of Nkandla”; • Mr Kofi Annan’s address at the opening ceremony; • Mr Mandela’s presence; • Being in the presence of 19 000 HIV/AIDS activists; • My time and leave after the Conference (in the Thai jungle near the Bridge over the River Kwai)

CONCLUSION • What has changed since Barcelona? • The epidemic marches on through SS Africa, India, Asia and E Europe; • There is mounting political pressure. This must be stepped up beyond the confines of the Conference so that world leaders realise that HIV/AIDS is the greatest threat ever to be confronted by the world; • The realisation that ARVs must be made accessible to PLWAs in developing countries; • Women received far greater attention in Bangkok ; • Young people were present and very visible; • Alas : vaccines and microbicides continue to elude the scientists; • South African researchers are at the cutting edge of the epidemic and they are receiving recognition by their peers;

CONCLUSION cont… • My thanks to our many funders for their support that enabled CINDI to budget for my flight, accommodation and attendance at the Bangkok Conference. • Thanks to DCI, Sixolile attended the Conference too, and I valued her company and companionship. Yvonne Spain 26 July 2004

PUBLICATIONS (to be loaned to Members) • Journals • What Religious Leaders can do About HIV/AIDS (UNICEF) • Strategies to strengthen NGO capacity through Business Activities (UNAIDS) • National AIDS Councils M & E Operations Manual (UNAIDS) • Palliative Care in Resource Constrained Settings (HIV/AIDS Bureau of Health Resources and Services Admin USA) • 2004 Report on the Global AIDS Epidemic (UNAIDS) • Access for All : Final Conference Program

PUBLICATIONS (to be loaned to Members) cont … • Journals cont • HIV/AIDS & Education : A Strategic Approach (Joint UN Program on AIDS) • Global Campaign for Education • Education and HIV/AIDS : A Window of Hope (The World Bank) • The Sound of Silence : Difficulties in communicating on HIV/AIDS in schools (ActionAid) • Quality Education and HIV/AIDS (UNESCO) • Children on the Brink (UNAIDS/UNICEF/USAID)

PUBLICATIONS (to be loaned to Members) cont … • CDs • 2004 Report on the Global AIDS Epidemic (UNAIDS) • UNAIDS Library (HTML versions of all UNAIDS publications Jan 1996 – April 2004) • A Clinical Guide to Supportive & Palliative Care for HIV/AIDS (US Dept of Health and Human Services) • Nutritional Guide for Providers and Clients (US Dept of Health and Human Services) • Mitigating HIV/AIDS Impact on Education Systems : Lessons from the African Field (HEARD UKZN) • Palliative Care e-Education Module 1 (PeriNatal HIV Research Unit and DCI)

PUBLICATIONS (to be loaned to Members) cont … • CDs cont … • Access for All : Conference Abstracts • Resource Kit for HIV/AIDS Programming 2003 (UNICEF) • Strategies to Strengthen NGO Capacity through Business Activities (UNICEF) • Women Children and HIV : Resources for Prevention and Treatment (Int AIDS Society, Francois Xavier Bagnoud Center etc) Contains info and training courses on PMTCT, VCT, Infant Feeding and Nutrition, Clinical Care, Care and Support of OVC.

IMPRESSIONS OF THE BANGKOK AIDS CONFERENCE 11 – 16 JULY 2004 : YVONNE SPAIN