Stephen Lewis, the Special Envoy of the UN Secretary General, Kofi Annan, on HIV/AIDS in Africa, delivered a blistering address to the closing ceremony of the 12th ICASA in Burkina Faso (extracts follow). It was also announced that the 13th conference will take place in 2003 in Nairobi, Kenya, with the theme "Access to Treatment and Care: The Challenges".
We've heard it before
Mr Lewis expressed frustration that so much of what had been said at the conference had been said before, even at other conferences in the last year.
"How many times have you heard the history and evolution of the epidemic? How many times have you heard that it's a matter of political leadership; that youth are the most vulnerable; that young women are the most vulnerable among the most vulnerable; that the interlocking factors of gender and poverty compromise our responses; that we have to roll out mother-to-child transmission [prevention]; that the orphan population is growing dramatically; that the social and economic consequences of the epidemic are catastrophic; that societies are shredded; that health systems are defunct; that schools are without teachers; that behaviour change is elusive; that a contemporary plague has descended on Africa forcing upon the continent a struggle for survival?
"Within one year we heard it at Durban, at Addis, at Abuja, in New York, and now at Ouagadougou.
"And despite all the analysis; all the understanding, the epidemic grows horrifically with every annual report.
"So let me tell you what we haven't heard. We haven't heard where the money is coming from to stop the pandemic from further wanton spread ... to provide the antiretroviral drugs that will keep people alive ... to strengthen health systems, to fashion massive human resource training, to allow us to take the inspired workable community initiatives to scale, to give strength and staff to indigenous non-governmental organisations and community-based organisations, to implement the plans that countries have and to which the leadership is now committed, if only the resources were in place.
"Would it solve everything; save everyone? Of course not. Would it mean the breakthrough we're all ready for? Of course it would."
What's needed, what was promised
Peter Piot, Executive Director of UNAIDS, had said earlier that US$ 5 billion was needed every year for Africa to fight the pandemic, including US $3 billion for care.
"In 1969, 32 years ago, the donor countries agreed to the target for Official Development Assistance of 0.7% of their Gross National Products ... Only five countries in the developed world have reached the target: Norway; Sweden, Denmark, Holland, and just last year, Luxembourg.
And yet, "the wealthiest countries in the donor world, known as the G7 and made up of the United States, United Kingdom, Germany, France, Japan, Italy and Canada ... have never come close to the target, we stand between 0.2 and 0.3 rather than 0.7.
"If the G7 donor countries honoured their international commitments, we would have an additional $100 billion, and growing, every single year.
What's wrong with the world?
"I want to know what's wrong with this world? Within weeks of a terrible terrorist atrocity on September 11th, the donor governments started budgeting for expenditures of more than a $100 billion. I don't begrudge a penny of it. I agree with it. It comes in immediate response to the grotesque death of over 3,000 people. But what happens to the death of 2 million three hundred thousand people? Who makes these decisions of whether Africans shall live or die?
Describing a visit to the bedside of a woman, a mother, in a South African hospice, dying with no access to antiretrovirals, he had suggested that with ARVs she could live another two to three years. The Western Cape health minister accompanying him had disagreed. "No, Stephen, she could live another five to seven years, maybe more."
"And I looked at her, and I thought of her kids, and I thought to myself, has the world ever experienced a greater moral lapse, ever occupied a greater moral void? [the distributed text referred to 'moral failure']
"If I were an African leader, an African President, I would be so impatient, so angry, that the world would surely hear of it. At every international meeting, every G8 Summit, every gathering of the World Bank or IMF or WTO, every convention of the pharmaceutical industry, every scientific conclave, I would make it clear that the majority of African leaders are now solid in their determination to defeat the pandemic, they know what's required, they'll move heaven and earth to meet the goals of the Abuja Summit and the UN Special Session.
"The target [for African governments] of spending 15% of total country budgets on health must be met; school fees should be abolished, consistent with the Convention on the Rights of the Child; the workplace must be safe and secure for those infected and affected by HIV/AIDS, consistent with the Code of Conduct of the ILO; an entire legal framework rooted in statutes must remove discrimination against people living with HIV/AIDS; the struggle for gender equality, embodied in laws, must become the idée fixe of parliament ... moving community interventions to scale, with a special emphasis on orphans, must become a cri de coeur ... in other words, in every conceivable way, Africa must take the lessons of this conference and make them live in the culture of a nation. They mirror, exactly, the principles which have been espoused by the Secretary-General of the United Nations.
"If that is done, then the explicit, compelling demands for help are not only legitimate, they're not open to challenge.
"Kofi Annan has made AIDS his personal priority. We are your natural allies. We will not let you down."