Prelude to the
Durban South Africa
International AIDS Conference

_AIDS in Africa: Exactly Which War Is That?


On last January 10, one of our oldest slogans became the very official watchword of a special meeting of the UN Security Council concerning the devastation caused by the epidemic in Africa. There it was, finally: "AIDS IS WAR."

That day, everyone contributed their own metaphor. For Peter Piot, chairman of UNAIDS, the United Nations' AIDS agency , "conflicts and AIDS are linked like evil twins." And thus Kofi Annan, UN Secretary-General, urges the Security Council -- because the Council is in charge of preserving peace -- to make the international fight against AIDS an "immediate priority".

James Wolfensohn, chairman of the World Bank, also gives in to the rapture of the new rhetoric: "in AIDS we face a war more debilitating than war itself because in so many countries it is seldom spoken of; because it does not catch the headlines; because the voices of its victims do not reach the corridors of power". Probably moved, Al Gore, the US Vice-President and chair of the session, announced exceptional aid from the United States: $100 million. The amount is insufficient, everybody knows it and Mr Wolfensohn even mentions it: "Every war needs a war chest, but that provided by the international community is woefully empty." But there can be no doubt left in our minds: in the future, fundraising is to mean army-raising ... an army of dollars.

And a strange conversion it is. When the keepers of world peace assert that "AIDS IS A WAR," one should undoubtedly hear an appeal to mobilization, which is closely akin to ours: AIDS kills, just as (and more than) armed conflicts do. But above all one should hear, very literally, a strategic concern which has very little to do with the essence of our demands. AIDS, they explain, destabilizes economies, causes indigence, and favours war; conversely, war, its violent acts and disturbances, further the propagation of the epidemic. The preservation of peace thus becomes a parameter of the fight against AIDS, but it is the reverse which particularly concerns the UN. United States Vice President Al Gore says, "no one can doubt that the havoc wreaked and the toll exacted by HIV/AIDS do threaten our security." In the opinion of the Western nations, AIDS in Africa is only a war in so far as it threatens the stability of the world -- their world.

On last January 10, AIDS became a military hypothesis. We at ACT UP Paris are thinking of another, less abstract war. Its horizon is not the "security" of worried nations, but the very basic, very dogged and very precarious survival of people with HIV. They treat us now to the geopolitics of HIV; geopolitics which are close, doubtlessly, to the vital interests of countries, and therefore capable of unlocking safes, but very far from the realities behind the disease. There lies the whole issue : the stake of this "war" of the Security Council, is the epidemic, not the dying sick and the persons still living with HIV. They seem to only appear in relation to statistics, as virus carriers or potential contamination vectors. It seems that the millions of people with HIV in Africa are only good for the role of bugbears of the world contagion.

What observers have presented as a step forward may very well turn out to be, on the contrary, a step backward : the return to a strictly epidemiological view of the disease, the resurgence of official suspicion toward persons with HIV, the relegation of care far behind prevention. By making it subject to "the work for peace and security", ie in the bureaucratic lingua, to "the politics of conflict prevention", the United Nations, far from reorienting the world fight against AIDS, are sinking it even deeper into the "prevention-only" disaster. For that matter, James Wolfensohn has made no mistake about it. If he goes as far as lecturing sponsors for being too niggardly, it's only to use this new geopolitical emergency to refresh old World Bank creeds : "We must put prevention at the center. We estimate that the cost of prevention is between $1.5 and $3.5 per capita per year -- compared to over $7 per capita per year needed for basic treatment -- and, of course, the cost of treatment per patient is astronomically higher."

You can't get any clearer than that: to protect from the virus those who have not yet been contaminated, who will assure tomorrow the repayment of Debt as well as the stability of countries, even if it means to sacrifice those already sick, who are considered too expensive and forever lost as labour; even if it means to give greater importance to prevention over access to treatments: to the epidemic, over people with HIV.

Beyond the moral reserves aroused by this type of speech, this is first of all miscalculation. " Prevention-only " programs have already proved limited when it comes to prevention ! There is not one single African country where " prevention-only " has permitted to curb the propagation of the epidemic. Just because no prevention program can be efficient nor credible without health care of the people affected : no one can hope, in a context of extreme social rejection of people living with AIDS -- a rejection nurtured by the fact that these poeple are provided with no care -- that PWAs will submit to the requirements of prevention -- especially when they know nothing of their serological status -- and impose the use of condoms ( making themselves out clearly as virus carriers). As long as the desease will remain a fate, with no scope but death, nobody will ask for testing that would mean anything to lose and nothing to gain. AIDS will remain a taboo because you can cope with problems when you have the means that for. But the United Nations are reasoning to high to be aware of what is obvious. Many of us considered AIDS as health problem; we were wrong. AIDS can't be confined to health and social fields any longer, Mr Wolfensohn says.

Once again, it is crystal clear and totally wrong: AIDS has never been considered in Africa as a question of public health. It has always remained a question of prevention, that is, of security. Before being apprehended as a disease, it has been dreaded as a danger from which the Africans turn away because they are helpless before it. But the chairman of the World Bank hammers it in: "we can estimate the total amount necessary for prevention in Africa as high as $1 to $2.3 billion, and at the moment, Africa only gets $160 million official aid against AIDS." What about the necessary sums for testing, prevention and opportunistic diseases treatment? How much does it cost to give AIDS a human face, to get to the end of the denial, in Africa and inside the U.N. as well? James Wolfensohn says nothing about it. He takes up in full the UNAIDS chairman's speech at Lusaka's Conference, who had said nothing more about it. So does Al Gore whose aim is exactly the same as the others' : prevention only. And if they remain silent, that's because they refuse to get out of the denial they intend to fight in Africa. If they spoke, they would be unable to conceal the obscenely low sums invested to provide people affected with health care. Actually, the "prevention-only" option is only taken for strategic reasons totally disconnected with any efficiency's sake. The January 10 event must thus be reinterpreted. The special meeting of the Security Council doesn't reveal any awareness. It is not the sign of a change from passivity to fight, not even of the gap between the emergency and the parsimony. It marks the apotheosis of overhanging geopolitics the PWAs have no part to, and the triumph of blind macroeconomics where investments are linked to their profitability for the sponsors, not to their efficiency on the health of people. The real front of the fight against AIDS in the South is the one opposing the supporters of "prevention-only" policies, which are motivated by self-interest and anyway, lead nowhere and those who claim for access to treatments by all means : compelling the pharmaceutical industry to lower its drug prices, pushing the Northern countries to grant funds to buy the drugs, and demanding that the international rules allow the local production of generic drugs. AIDS is a war; which side are you on ?

This article was released in Le Monde January 29, 2000 _ Act Up-Paris


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see also:

Durban International AIDS Conference Report Index (South Africa 2000)

When PWAs first sat at the AIDS Conference Table (Montreal AIDS Conference 1989)

Vancouver International AIDS Conference ACT UP ACTIONS Report (1996)

Geneva AIDS Conference "Bridging the Gap" (1998 )