As the curtains drew on the 13^th International HIV/AIDS conference  in Durban, South Africa, in July 2000, it became obvious that the AIDS landscape may never be the same for many reasons. We will highlight the ten major gains of this epoch Conference.

The Conference may have broken the veil of silence about the disease in Africa. According to print and electronic media reports, HIV/AIDS became the major topic in many communities in South Africa. Citizens of South Africa reportedly spoke openly about the hitherto taboo subject of sex and its relationship to the spread of the virus. From now onwards, it is unlikely that rational governments in Africa can ignore the urgent need for national dialogue on HIV/AIDS.

A popular African government tasted the raw anger of its citizens. The harsh criticism that reportedly heralded the keynote speech of the host head of state, President Mbeki, during the Conference and swift, widespread bitterness regarding the perceived lack of action by the South Africa government on HIV/AIDS, should serve as a wake up call to African governments.

The medical and development side effects of AIDS dominated the mainstream media of Western capitals during the week-long Conference. During the South Africa conference, the Washington Post published an extensive and provocative three-part serial on HIV/AIDS in Africa. AIDS is now a legitimate, mainstream news item.

Perhaps, one of the most significant outcomes of the Conference is the firm consensus reached on the hitherto forbidden T alphabet  in HIV/AIDS advocacy: The treatment of HIV/AIDS no matter the continent, country or community of origin. For quite sometime, some experts considered it irrational, impractical, or sheer fantasy to talk about the need for the  international community to provide life saving drugs to AIDS patients in the hardest-hit countries. Now, the argument, is shifting to When, Where, and, How, the international community can deliver lifesaving drugs to all AIDS patients, especially in Africa.

The multinational pharmaceutical companies are now falling over themselves in their eagerness to provide cheap drugs for AIDS patients in developing countries. Although this development is a culmination of a long term campaign, the graphic stories of the destructive effects of AIDS in Africa made it prudent for global pharmaceutical organizations to now do the right thing.

The scourge of HIV/AIDS is now recognized in all Western capitals as a fundamental threat to globalization, and a tension-free world. The Clinton Administration had in April 2000 declared HIV/AIDS a national security threat, the first time in modern memory that a disease warranted such a declaration. Shortly before the conference, the President signed an executive order increasing the accessibility, affordability, and procurement of cheaper anti-AIDS drugs. The U.S. House of Representatives, in a major shift of emphasis, voted in July this year to ante up the funding for international HIV/AIDS programs, increasing the White House 2001 budget request from $244 million to $286 million. The recent signing of the U.S. Congress bill (sponsored by  Representatives Barbara Lee and James Leach) to set up the $500 million global trust fund for AIDS patients by President Clinton is another significant milestone. Britain, France, and Germany are also pledging additional resources to AIDS programs in developing countries.

 The international donor and relief agencies are now united in the global fight against AIDS. For example, the UNICEF leadership chose the venue of the conference to unveil its annual Progress of Nations report, devoted to the global effects of AIDS on children and youth. On the eve of the conference, the World Bank made a pledge of $500 million to fight the epidemic in Africa. Juan Somavia, the Director-General of the International Labor Organization (ILO) wrote a scathing commentary on the plight of children in the UNICEF report and called for a global moral imperative to assist them in this era of AIDS. In addition, the United States Agency for International Development (USAID) released a ground-breaking study on AIDS and orphanhood during the Conference.

The growing numbers of AIDS orphans are now recognized as a major long-term threat to the stability of hardest-hit nations. According to USAID, by 2010, one in seven children under 15 in Sub-Saharan Africa will have lost a parent to AIDS. Other estimates project that during the same period, AIDS will account for 40 million orphans, 95% of them in Africa. The extended family system in Africa is under severe strain because of the unprecedented numbers of orphans. Taking care of orphans in institutional setting is out of the question in Africa because of the hefty price tag of $2,000 a year for each child. These children are likely to miss out of school, become surrogate parents to their younger siblings or coerced into early sexual activities.

The conference reestablished the primacy of clinical, biomedical, public health, and qualitative research. Experts presented ground-breaking studies in areas such as accelerated vaccine development, modified dose therapy for developing countries, a relatively cheap, simple drug treatment (using nevirapine) that significantly reduces maternal transmission, and the economic implications of the disease. According to studies presented during the Conference, health experts in Africa and other developing regions face a major scientific dilemma on how to solve the problem of breast feeding for HIV positive mothers. These mothers can transmit the virus to their infants even after receiving nevirapine at birth. However, bottle-feeding is impractical in poor countries, and infants can easily die of dirt-induced diarrhoea diseases.

Finally, the greatest legacy of the Durban Conference is that the mobilization against HIV/AIDS will be equal part science and development. The science of AIDS will increasingly focus on the accelerated development of a vaccine. The development agenda will shift toward  (a) ensuring access to lifesaving drugs, (b) strengthening the health care infrastructure of developing countries, (c) implementing comprehensive prevention programs, and (d) adopting multisectoral approaches to AIDS programs at community levels, where, anti poverty strategies, macroeconomic policies, democracy dividends, and social justice programs will become as important as pills. An energized army of activists will become as prominent as the star scientists and researchers. Political careers in developing countries may soar or fail depending on support for urgent remedial action on HIV/AIDS.  In the final analysis, the global community will likely deploy formidable technical, financial, and human resources to stop the destructive effects of AIDS. That may be the ultimate legacy of the unprecedented gathering in Durban.

Melvin Foote is President and CEO, Constituency for Africa (CFA), Washington, DC. The CFA is a coalition of organizations and groups working to educate the American public about Africa and African issues.
Chinua Akukwe is former Vice Chairman, National Council for International Health (NCIH), Washington, DC.    

Published 09/09/00