International AIDS Society chief signals aggressive commitment to treatment access

Joep Lange, President-elect of the International AIDS Society, pledged that IAS will be at the forefront of efforts to scaling up access to antiretroviral therapy in a speech at last week's XIVth International AIDS Conference in Barcelona.

His typically forthright remarks included condemnation of international donors and NGOs for not moving quickly enough to support scale-up efforts, and he called for a country by country inventory of treatment needs to be developed, so that needs can be addressed systematically.

The full text of the speech is reproduced below.

"Today, I want to focus on one specific issue that has been close to my heart for several years. An issue that should be burning like a fire inside the heart of all of us, and that was the real theme of this conference. That of course is access to decent HIV care, including antiretroviral therapy, for the millions and millions of infected people in developing countries who need it.

The world can simply not afford to let them die:

• from a humanitarian perspective,
• from a developmental perspective, and
• from a security perspective.

And it is possible to do something about it - it is actually quite simple.

It is going to require an enormous effort, yet it is simple.

Do not be fooled: people make simple things complex to condone their inertia. I would like to be very concrete: Things did happen since the watershed conference in Durban - from a political and advocacy perspective the most important event in the history of HIV/AIDS thus far:

• drug prices have come down further;
• UNGASS put treatment on the political agenda - finally we may say;
• the Global Fund was created;
• WHO in a very short time produced first rate treatment guidelines to guide developing countries in their choices;
• antiretrovirals were put on the Essential Drug List.

Don't underestimate the importance of these steps - they are milestones, and they deserve to be acknowledged as such.

Yet the enormous gap between numbers of people on treatment – 20,000 maybe 30,000 in Africa, and the 6 million that need to be treated today, hurts and the slow pace at which the world reacts hurts even more:

• Whole societies are being destroyed by this deadly virus;

  it causes human suffering on an unprecedented scale; as it halts, no, reverts development;

• it fuels a global TB epidemic.

And yet, despite the rhetoric - including the rhetoric about moving beyond the rhetoric - we dismally fail to act.

And again, it is not difficult. Complexity is introduced to condone the inertia of those who are living off this epidemic. Or maybe not inertia, but simple lack of imagination. It is so clear what needs to be done: we need to make a plan of action for a concerted global effort. Do you think that smallpox would ever have been eradicated without such a concerted effort?

Providing comprehensive HIV/AIDS care may be more difficult than eradicating smallpox, but that does not mean that we should not go about it in a similar fashion. Why do we have a STOP TB initiative, but not yet a STOP HIV initiative?

If we are serious about scaling up access to treatment, we need to go about it like a military operation:

• we need to make an inventory, country by country, of needs to put all eligible people on treatment;
• we need to identify the organizations who can help countries do the job, enlist them and divide tasks;
• We need to be creative: for instance you do not need a lot of infrastructure to deliver HIV/AIDS care, you do not need complex regimens; you do not need doctors and nurses to deliver the care in every remote comer of Africa.If we can get cold Coca Cola and beer to every remote comer of Africa, it should not be impossible to do the same with drugs;
• For scaling up rapidly, community mobilization and involvement of community workers is far more important than waiting for enough health care professionals to be trained.

Above all you need to keep it simple; Paul Farmer and his group have convincingly shown that all you need is a community worker providing daily observed therapy!; there is actually very little evidence that laboratory monitoring prevents mortality due to drug toxicity, but there is an awful lot of evidence that not treating symptomatic HIV infection is lethal, and usually not in a nice way; why are we always more concerned about doing harm than about not doing good?

We need to link prevention efforts to treatment; and yes, we need to look at sustainability, but we don't have to wait for that to begin, we simply cannot wait for that.

We should also not rely on the public sector only; I am extremely pleased with the presence of so many heads of state here, with the presence of President Clinton, with the presence of that hero of all of us, Nelson Mandela, with the presence of other high government officials from many countries, and especially with the large Royal Thai Government delegation here.

But let's face it: these are the exceptions. And please be reminded of the fact that "Of all the ills that kill the poor none is as lethal as bad government." Bad government and lack of leadership has actually killed more people with HIV than anything else. Should we refrain from doing something for people who happen to live in those countries where there is bad leadership? Should we be punishing them twice?

Yet, when you try to mobilize forces for this concerted global effort - the one word that keeps coming back in conversations with donors, with UN bodies, with philanthropic organizations, even with some high profile NGOs like MSF, with these Lords of Poverty, is CONCERNS, CONCERNS, CONCERNS.

I am sick of this word, because all these concerns are about process, about keeping up appearances. At IAS we are more concerned about the millions of people who are dying. About the millions of deaths and the suffering we could prevent if we got our act together.

Finally, a word about money: As my friend Joseph Scheich, from the Dutch AIDS Charity STOP AIDS NOW! said yesterday: "A few years from now people will not be asking where are the ten billion (dollars) but where are the 3 million (people)." I am actually convinced that the 10 billion dollars that is often quoted is an underestimation of what is needed. But even if it were 25 billion dollars per year, it would still be peanuts.

Do you know how much the England - Argentina Worldcup football match cost the UK economy?: 2 billion dollars. It just takes 5 to 12 football matches and a concerted global effort to really do something about HTV7AIDS. What are we waiting for?