World Aids Day

The plague known as Acquired Immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus (HIV). According to WHO and UNAID sources, by 2010 it is estimated that deaths from HIV/AIDS will rival that of the bubonic plague which killed 93 million during the mediaeval and enlightenment periods. Health activists worldwide hope that Saturday’s observance of World AIDS Day will heighten awareness and focus efforts to combat the pandemic. Experts warned against complacency in fighting the disease and called on governments worldwide to address a multi-billion dollar funding gap.

UN Secretary-General Ban Ki Moon launched the 20th World AIDS Day at a midnight ceremony at St Bartholomew's Church in New York. The UN estimates that there is an $8 billion shortfall in AIDS funding worldwide. The G8’s plan to provide universal access to Anti Retroviral Drugs (ARVs) requires an additional $27 billion on top of the $15 billion already pledged. Ban called for leadership among all governments in fully understanding the epidemic, “so that resources go where they are most needed,” he said. "And I call for leadership at all levels to scale up towards universal access to HIV prevention, treatment, care and support by 2010."

The highlight of Saturday’s events was a concert at Johannesburg’s Ellis Park organised by Nelson Mandela. 50,000 people watched local and international acts including Peter Gabriel and Annie Lennox. South Africa is one of the worst affected countries with 5.5 million of its 48 million population infected by HIV. The 89 year old Mandela told the crowd that the rate of infection is four times the rate of treatment. "Here in South Africa we are making every effort to reach into communities because we believe the answer is in our hands,” he said. “But what really matters are small acts of kindness ... such as protecting yourself.”

China also took the day seriously. The UN has warned that up to 50 million Chinese are at risk of contracting AIDS. President Hu Jintao appeared on the front page of major state-controlled newspapers shaking the hand of a female HIV carrier. He was inspecting HIV/AIDS prevention and treatment facilities in Beijing and enquiring how policy is being administered. Hu said AIDS prevention is an issue that affects the future of the country. “This is still a challenging task for China,” he said. “It needs effort from every member of society.”

But Africa remains the continent worst affected by AIDS. While the total number of those infected by the virus has decreased from 40 million in the late 1990s to 33 million today, two-thirds of these live in Africa. The World Health Organisation (WHO) had said that the number of people in Africa receiving antiretroviral (AVR) drugs has increased by 54 per cent from 2005 to 2006. WHO’s research also shows that the increased focus on prevention programmes adapted to reach those most at risk of infection is paying dividends. This means promoting increased use of condoms, delay of sexual activity, and fewer sexual partners.

Within Africa it is the south that suffers the most. The group of countries from Namibia to Mozambique has a HIV infection rate of 15 per cent for those in the 15 to 49 age group making it the hardest hit region in the world. The task of preventing AIDS is undermined by social and cultural practices, particularly traditional attitudes to male-relations and sexuality. Denial, lingering supernatural beliefs and fear of stigma also compounded the problem. South African president Thabo Mbeki disputed the link between AIDS and HIV until 2006. Only in the last 12 months have South African government reversed its denialist policies on AIDS promising increased availability of drugs and supporting groups battling the disease.

Botswana, with a third of its population infected, realised the scale of the issue in 2001 when President Festus Mogae called the epidemic “a crisis of the first proportion. In 2002 Botswana began a large-scale program of education and free treatment. By 2005 half the people in immediate need were receiving treatment. Dr Howard Moffat of Princess Marina Hospital in the capital Gaborone is now treating thousands of patients daily. "Botswana has shown what can be done," Moffat said. "But it will need help for a considerable time to come."

New hope for Libyan AIDS six

The EU said yesterday it has made substantial progress in talks with Libya over the release of five Bulgarian nurses and a Palestinian doctor. The six, who have spent eight years in prison already, are accused of the murder of 240 children EU officials spent two days lobbying Libyan officials on the weekend and met with Gaddafy's son who is in favour of an early release. A European Commission told a Brussels news briefing that efforts will continue to release the six, but didn't expand on what that will involve. The news came a day after US President Bush called for their release on a state visit to Bulgaria. The six medics have been sentenced to death after they were found guilty of infecting Libyan children with AIDS in a Benghazi hospital in 1998.

The two officials, EU External Relations Commissioner Benita Ferrero-Waldner and German Foreign Minister Frank-Walter Steinmeier, left Tripoli on Monday. Steinmeier visited the five Bulgarian nurses on death row in Judeyda prison. "Libya has showed understanding on the case and I hope it will come to a positive end at my next visit to Jamahiriya [Libya]," said Steinmeier, whose country is president of the EU until the end of this month. His calls were echoed by Muammar Gaddafy son, Saif al-Islam, who praised European efforts to end the stand-off on the case.

Libya claims it will free the medics if an agreement is reached to pay compensation to the families of the children. Tripoli has demanded $13 million for each infected child's family. The EU has rejected this as an admission of guilt. However it has offered a fund for treatment for the children at European hospitals and already donated over $3 million to this plan. In 2005 Libya's ambassador to Britain, Mohammed al-Zaway, said Bulgaria should negotiate with the victims' families of the victims to decide on "dia", or blood money, which Sharia law allows to be paid to victims in murder cases to prevent a death sentence. "Any solution other than negotiations is a waste of time," said al-Zaway. "An agreement with the families of the children would reflect positively on the case according to Islamic law."

The nurses and a Palestinian doctor were sentenced to death in May 2004 by firing squad for infecting 426 children through contaminated blood products at Al Fateh Children's Hospital in Benghazi, Libya. They also were ordered to pay a total of $1 million to the families of the HIV-positive children. The Libyan Supreme Court in December 2005 overturned the convictions and ordered a retrial in a lower court. Finally an appeal court convicted the health workers in December 2006 and re-affirmed the death sentence.

The crisis first came to light in November 1988 when a Libyan magazine called “La” published an expose about a mass incidence of AIDS at a Benghazi paediatric hospital. The article quoted the Libyan Health Minister Sulaiman al-Ghemari, who said that most of the 60 known cases were children. The children’s parents blamed faulty blood transfusions for transmitting the virus. The article created a huge stir and countered the official propaganda that Libya was AIDS-free. An outraged Gaddafy shut down the magazine. Despite the shutdown, it soon became apparent that not only was magazine’s allegations correct, it was worse than initially thought. Up to 400 children were infected.

Scapegoats were needed and authorities immediately arrested Filipino, Polish, Hungarian and Bulgarian clinic workers on suspicion of organising the spread of the virus. Finally the court filed charges against five Bulgarian nurses, a Bulgarian doctor and a Palestinian doctor. They were charged with premeditated homicide, "activities which led to a massacre designed to sap Libya's strength" and "a violation of the Islamic way of life," according to the Bulgarian foreign ministry. The nurses were also accused of working for the CIA and Mossad. "Nurses from little towns in Bulgaria acting as agents of Mossad?" said a daughter of one of the nurses. "It all sounds funny and absurd until you realize your mother could die for it”.

The six have now been in prison for over eight years. Their names are: Ashraf Ahmad Jum’a, the Palestinian doctor, and Nasya Stojcheva Nenova, Valentinaa Manolova Sropulo, Valya Georgieva Chervenyashka, Snezhanka Ivanova Dimitrova and Kristiana Malinova Valcheva, the five Bulgarian nurses. In 1999, Libya commissioned a World Health Organisation (WHO) report on the growing crisis. The report cited multiple causes but particularly blamed the lack of supplies and equipment including sterilised needles and protective gloves.

At the trial, the six suspects claimed they were tortured and forced into confessions. They said police used many methods including sexual assault, electric shock, hanging by the arms, threats with dogs while the prisoners were blindfolded, and beatings with electric cable on the soles of the feet. It was also reported that police officers forced the nurses to undress before them, put insects on their bodies and set dogs on them. But the defence lawyers were denied access to files and investigation results. The court later rejected the torture claim and the accused police officers were cleared of any wrongdoing.

The court also ignored the testimony of Dr. Luc Montagnier, the French discoverer of the AIDS virus and Italian microbiology professor Vittorio Colizzi who evaluated more than 200 of the infected children and found the virus was present at least six months before the Bulgarian nurses arrived at the hospital. Montagnier and Colizzi’s report (pdf) concluded the virus was introduced through a contaminated injection and spread as a result of poor sanitary practices.

But at the trial the judge accepted the confessions backed up by testimony from Libyan medical experts for the prosecution who claimed the medics deliberately injected the AIDS virus into the patients. The six were sentenced to death in December 2006 in front of delighted parents of the infected children. The father of one child told the BBC “justice has spoken out with a ruling against those criminals and the punishment they deserve, because they violated their obligations and sold their consciences to the devil”.

While the fate of the six remains unknown, Libyan children continue to be at risk of AIDS due to poor sanitary practices in hospitals. The Association for Child Victims of Aids in Benghazi told Human Rights Watch in 2005 that 19 mothers of these children are also infected with the virus. The association’s spokesman Ramadan al-Faturi has demanded better training for Libyan doctors and psychological support for the families. “Tell the world that these children are innocent and suffering,” he said.

South Africa criticised for its AIDS policies

The South African government was criticised for its handling of the HIV crisis by speakers at the 16th international conference on Aids in Canada. The conference was held from 13 to 18 August in Toronto, Canada. Stephen Lewis, the UN special envoy on Aids, told the closing session: "It is the only country in Africa, amongst all the countries I have traversed in the last five years, whose government is still obtuse, dilatory and negligent about rolling out treatment." The country has the single biggest HIV-positive population in the world, estimated at five million or 11% of its population. About 70,000 children in South Africa are born with HIV each year. According to the Joint UN Programme on HIV/AIDS (UNAIDS), by the start of 2006 there were an estimated 39 million AIDS sufferers worldwide. Most of these people live in developing countries. In the last 12 months alone, 4.1 million people were infected and 2.8 million died of AIDS related illnesses.

The concluding report from the conference with a call for a quickening of the pace of HIV prevention measures and care and treatment programs in resource-strapped environments. The theme echoed the sense of hope tempered with growing impatience at government inaction. Of 7 million sufferers in the lowest GDP countries in need of antiretroviral medication, barely a quarter of these people have access to the drugs. The treatment access gap is even worse for children under 15. Approximately 90% of the 800,000 children in need have access to the treatment. In total, barely 1 in 5 people of high risk of infection have access to effective prevention. The new President of the International AIDS society, Dr Pedro Cahn, called for political action. “All the knowledge, innovative research and new tools will not be effective without the political leadership that is essential to halting the disease,” he said on the final day of the conference.

Thabo Mbeki's government was openly criticised by many speakers at the conference for denying that the human immunodeficiency virus is a cause of Aids and for its resistance to offering HIV drugs to its people. Dr Manto Tshabalala-Msimang, the Soviet-educated South African health minister prefers to promote traditional cures such as garlic, beetroot and lemon while also referring to possible toxicities of AIDS medicines. Stephen Lewis told the conference "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."

The South African government denies the charges and issued a statement that said "The ANC reaffirms its support for government's comprehensive plan for management, care and treatment of HIV and Aids, and for an approach that aims to combat HIV and Aids in an all-embracing and integrated manner.". Nelson Mandela has weighed in on the argument and criticised the government for not making drugs freely available across the country. Several South African provinces announced that they would ignore the government policy and start distributing a key anti-retroviral drug, nevirapine.

Many believe that Tshabalala-Msimang is merely carrying out the pseudo-scientific wishes of President Thabo Mbeki. In 2002, Mbeki, convened an international panel to consider the causes of and appropriate solutions to AIDS in the African context. The panel included representatives from the so-called AIDS dissident community. The willingness of the President to entertain, if not unequivocally endorse, dissident science created an international stir. Although the conference’s outcome, known as the Durban Declaration, supported the orthodox view of AIDS, Mbeki continued to stall the pilot of antiviral drugs.

The question is why South Africa’s leadership is so obdurate on this question? The answer probably lies in the speed and force of the AIDS epidemic in South Africa. There are neither clear reasons nor simple solutions for the spread of AIDS and its complexity has made it extremely difficult to assimilate. And so, in a denial of reality, leaders proclaim that the presence of AIDS is not true. President Mbeki publicly questioned the importance of HIV in causing AIDS, controversially suggesting that the main cause was "poverty." The appearance of AIDS as an everlasting affliction precisely at the point when the end of apartheid should have brought a better life for all has also rankled with the ANC government. As one South African journalist put it “how is it possible that, at the very moment we assume our victorious place as the leaders of a democracy we struggled for decades to bring about, we are presented with a dying populace, with a plague to which we have no answers?” And so while the South African government argues that the drugs are too expensive, they ignore the high costs of not preventing the further spread of the world’s worst killer virus.