U.N. Envoy Lewis at Closing of AIDS Conference Calls for Gender Equality, Criticizes South Africa’s Response to Pandemic

The XVI International AIDS Conference in Toronto closed Friday with U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis saying that the pandemic will never be defeated until the status of women worldwide is equal to that of men, the New York Times reports. Lewis in his closing speech also criticized the South African government's response to HIV/AIDS in the country (Altman, New York Times, 8/19). In addition, he addressed the issue of donor funding to tackle the pandemic, the spending and management of aid agencies, and other HIV-related issues.

Women
"Gender inequality is driving the pandemic, and we will never subdue the gruesome force of AIDS until the rights of women become paramount in the struggle," Lewis said (Cobb, CanWest News Service/Vancouver Sun, 8/19). "It is the one area of HIV and AIDS which leaves me feeling most helpless and most enraged," he added (Dow Jones, 8/18). In particular, Lewis discussed sexual violence against women, saying, "The violence and the virus go together." He also said not enough is being done to prevent mother-to-child HIV transmission (New York Times, 8/19). Lewis said, "It is a bitter indictment that so few HIV-positive women have access" to antiretroviral drugs that would prevent MTC HIV transmission, adding, "It is inexcusable to continue to use single-dose nevirapine rather than full triple-dose therapy during pregnancy as we do in Western countries" (Mail and Guardian, 8/19). Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, also discussed the role of gender in the pandemic, saying, "HIV/AIDS is progressively taking on the face of a woman. It's absolutely essential that we address the special concerns of women and allow them to protect themselves" (Comte, AFP/Yahoo! News, 8/18). Lewis in his closing speech also reiterated his call to create a U.N. agency for women (Talaga, Toronto Star, 8/19). Lewis has presented his idea to a high-level U.N. panel that is investigating how to unify the agency's various sectors. If the panel endorses Lewis' idea, the agency would be on the agenda when the U.N. General Assembly opens in September (Kaiser Daily HIV/AIDS Report, 8/15). "My closest colleagues and I have come to the conclusion that one of the ways to diminish the impact of the AIDS virus is by creating a powerful international agency for women staffed to the teeth," he said. Lewis, whose term as special envoy ends in December, also said he would like his replacement to be a woman from an African country (Toronto Star, 8/19). The agency would not replace other U.N groups that work on women's issues, including the World Health Organization and the U.N. Population Fund (Kaiser Daily HIV/AIDS Report, 8/15).

South Africa
Lewis' criticism of South Africa centered around the pace at which the government has delivered affordable antiretrovirals to those who need them, the government's stance on how best to tackle HIV/AIDS, and the opinions held by some government officials regarding the cause and treatment of the disease, according to the Times. The South African government is "still obtuse, dilatory and negligent" about delivering HIV/AIDS treatment, Lewis said (New York Times, 8/19). He added that out of all the issues that have frustrated him about the global struggle to defeat HIV/AIDS, "South Africa is the unkindest cut of all" because it is the "only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state" (Dow Jones, 8/18). Lewis also made references to South African President Thabo Mbeki's initial denial that HIV causes AIDS, as well as Health Minister Manto Tshabalala-Msimang's promotion of African potatoes with lemon and garlic as an effective HIV treatment (Dow Jones/Wall Street Journal, 8/18). South Africa at the conference displayed an exhibition on beetroot, garlic and lemons alongside antiretrovirals (AFP/Yahoo! News, 8/20). Mark Wainberg, co-chair of the conference and director of the McGill University AIDS Centre, called the theories "scientific nonsense" (Blandy, Mail & Guardian, 8/19). Wainberg added that the world has "sat back for far too long watching South Africa continue to deteriorate in the growing number of millions of people contracting HIV and a health minister that prefers to talk about lemon juice versus bona fide means" (CP/CBC News, 8/18). Opponents of Tshabalala-Msimang's views have said she exaggerates the side effects of antiretrovirals, Baltimore Sun reports. They also have criticized her for supporting German vitamin advocate Matthias Rath, who has called antiretrovirals "poison" (Calvert, Baltimore Sun, 8/20). Lewis said, "The government has a lot to atone for," adding, "I am of the opinion that they can never achieve redemption" (Russell, San Francisco Chronicle, 8/19). Lewis, who is not allowed to perform U.N. work in South Africa, said, "It is not my job to be silenced by a government when I know that what it is doing is wrong, immoral and indefensible" (Dow Jones, 8/18).

South African Reaction
Tshabalala-Msimang on Sunday defended her HIV/AIDS policies and criticized the media's coverage of advocates from the group Treatment Action Campaign, who at the AIDS conference attacked South Africa's exhibit, according to Reuters South Africa. She said, "I think TAC was just a disgrace, a disgrace not only to the health department but a disgrace to the whole country," adding, "But I think, as South Africa, we demonstrated that we are doing pretty well" (Reuters South Africa, 8/20). Sibani Mngadi, a spokesperson for South Africa's Department of Health, on Saturday said, "We reject with contempt the statement made by Stephen Lewis with regard to the response of the South African government to the challenge of HIV and AIDS." Mngadi said the government in 2005 increased by threefold the amount of funding allocated for HIV/AIDS over the last four years to $500 million. "By June 2006, more than 175,000 people had been initiated on antiretroviral therapy and this treatment is provided free of charge by governments in all 53 districts of the country," Mngadi said. He added that the government provides 340 million male condoms and three million female condoms annually at no cost. "Lewis should tell the world which other developing country had invested resources comparable to South Africa in implementing HIV and AIDS prevention, care and treatment programs," he said (AFP/The Australian, 8/20). Mngadi also said, "What Africa needs now is not unsubstantiated attack on democratically elected governments but delivery on the many resolutions made with regard to addressing poverty and underdevelopment, which increases the vulnerability of our population to disease" (Quinn, Reuters, 8/19). TAC Chair Zackie Achmat praised Lewis' speech, saying, "These comments will help enormously in the struggle against HIV/AIDS in South Africa" (AFP/The Australian, 8/20).

Arrests
Lewis also discussed Friday's arrest of a group of protestors in South Africa led by Achmat, who staged a sit-in at government offices in Cape Town, South Africa, the Mail & Guardian reports (Mail & Guardian, 8/19). The 44 people arrested were protesting Tshabalala-Msimang's response to HIV/AIDS in South Africa, according to Agence France-Presse. "Rather than helping, she is obfuscating the issues and confusing people," TAC spokesperson Ralph Berold said, adding that the arrest of the demonstrators was "illegal." Mark Heywood, another TAC spokesperson, called for Tshabalala-Msimang's resignation (Agence France-Presse, 8/18). In addition, some protestors in South Africa carried signs calling for Tshabalala-Msimang's arrest (AP/CBS News, 8/18). Referring to the protestors' arrests, Lewis said, "It really is distressing when the coercive apparatus of the state is brought against the most principled members of society" (Ingham, AFP/Yahoo! News, 8/18). The protests followed the death of an HIV-positive inmate in a Durban, South Africa, prison. TAC said that the government was to blame for the prisoner's death because it had not provided him with antiretrovirals. The group called for a full inquiry into the incident. The country's Department of Correctional Services said the man had been taking antiretrovirals, according to the Associated Press (Nullis, Associated Press, 8/18).

Other Comments
Lewis in his speech also addressed the crisis of the growing number of children who have lost at least one parent to AIDS-related illnesses. "We're walking on the knife edge of an unsolvable human catastrophe," he said (San Francisco Chronicle, 8/19). He also criticized leaders of the Group of Eight industrialized nations for not living up to pledges they made in 2005 at their summit to provide more funding for the Global Fund To Fight AIDS, Tuberculosis and Malaria. "We are on the cusp of a huge financial crisis," Lewis said, adding, "No one is asking for any more than was promised. Everything in the battle against AIDS is being jeopardized by the G8" (Dow Jones, 8/180). He said $33.75 billion annually by 2010 will be required to fund prevention, treatment and care, compared with the current $9.8 billion annually. "This issue of resources makes or breaks the response to the pandemic," he said (Picard, Globe and Mail, 8/19). Lewis also said that international aid agencies spend too much money on bureaucracy instead of work that directly helps people living with HIV/AIDS. "What has to happen is that we place a temporary moratorium on the endless, self-indulgent proliferation of meetings, seminars, roundtable, discussion groups, task forces ad nauseum, plus the production of reports, documents, monographs [and] statistical data and concentrate every energy at country level," he said. In addition, Lewis criticized the U.S. policy that requires one-third of HIV-prevention funding to go to abstinence-until-marriage programs. He said, "Abstinence-only programs don't work," adding, "Ideological rigidity never works when applied to the human condition." He said the policy is an "antiquated throwback to the conditionality of yesteryear to tell any government how to spend its money for prevention" (CanWest News Service/Vancouver Sun, 8/19). Lewis also said that the fight against HIV/AIDS over the next 25 years should be focused at a country-specific level (Globe and Mail, 8/19).

Other Speakers
Other speakers at the close of the AIDS conference called for more training of health workers in developing countries to deliver antiretrovirals and provide preventive services, the Times reports. James McIntyre, a South African AIDS expert, said, "We need hundreds of thousands of new nurses" in developing countries. But developing countries have "too few people with the right skills" because of poor working conditions and low salaries that drive people into other jobs and away from the country, according to Anders Nordstrom, acting director general of WHO. "It's not enough to provide money and drugs to train people, as important as they are" in developing HIV/AIDS programs, he said, adding, "You need to pay people" (New York Times, 8/19). Conference delegates also reiterated their criticism of Canadian Prime Minister Stephen Harper's decision not to attend the conference, as well as the Canadian government's decision to delay the announcement of an expected major project for the country's AIDS program until after the conference (Dow Jones/Wall Street Journal, 8/19). Wainberg said of the conference, "Many people have said this was one of the best conferences ever at linking the north and the south," adding that the meeting cannot be considered successful unless the theme, 'Time To Deliver,' is realized (Toronto Star, 8/19).

Kaisernetwork.org served as the official webcaster of the conference. View the guide to coverage and all webcasts, interviews and a daily video round up of conference highlights at http://www.kaisernetwork.org/aids2006. A webcast of the closing session where Lewis made his speech is available online