Putting the battle against AIDS epidemic back on track

By Nona Pooroe Utomo

JAKARTA (JP): More than a decade ago, the world discovered a new worldwide epidemic. Acquired Immune Deficiency Syndrome (AIDS) shocked a public accustomed to biomedical triumph, and the industrialized world, shorn of its technological armor, was forced to develop prevention and care strategies.

In developing these, the industrial world had to listen and learn from the universally available wealth of human experience and wisdom. These are qualities which exist in equal abundance in all societies, in contrast to wealth or scientific infrastructure.

The World Health Organization (WHO) developed a framework for a common action, a Global AIDS Strategy which was endorsed and followed by most of the nations of the world, including Indonesia.

As the global scope and impact of AIDS became evident, a remarkable period of solidarity started and a global AIDS movement was born.

Early international AIDS conferences witnessed an exchange of experience carried out in a spirit of intellectual and social equality rarely, if ever, seen before. Many of us felt, in joining the world against AIDS at any level, in any place, within any discipline or organization, that we belonged to something larger than a nation, an ethnic group or a profession.

AIDS made people aware of global interdependence and solidarity, something tangible, real, visible and alive.

But as new hope emerged with the news on the new combinations of antiretroviral drugs that gave a solid ground for finding a cure, we faced the decline of the global AIDS movement and decrease in solidarity.

As the media started the spin that "the cure is here" at the XI International AIDS Conference in Vancouver in July last year, the growing AIDS care gap, especially between the developed and developing world, became wider.

So many people all over the world had no access to even the simple drugs they needed for their opportunistic infections, no less to antiretroviral drugs.

Nearly 22 million men, women and children now live with the Human Immunodeficiency Virus (HIV), and 8,100 more become infected every day. About 1,000 of them are children. Over 40 percent of adult infections are in women and this proportion is still rising.

Losing solidarity

Jonathan Mann from the Harvard School of Public Health, who is a former executive director of WHO's Global Program on AIDS, confronted the Vancouver conference with the message that the world had begun to lose solidarity.

It was as if during that first period of global consciousness, the status quo of the world stood back briefly, gathering strength; they hovered over us, waiting for vengeance. There are many of these status quos, including the gap between the haves and have nots, between scientists and activists, between men and women and between infected and uninfected people. But beyond the details, the essence, the common characteristic of all the resurgent status quos, is that there are walls which separate and divide people.

Ultimately, these status quo realities propose that we can afford to forget about each other. It is now acceptable to think and live in isolation; people in the rich countries can receive treatment with whatever the latest and best science can provide, and the north has resume its limited, "charity-based approach" to international assistance against AIDS. The biomedical research establishment can pursue its course with diminished attention to pressing societal needs. Officials can speak at the conferences and elsewhere -- without fear of challenge or accountability -- as if they were activists rather than actually being responsible for policy and programs. And whoever we are, we can now feel authorized -- by the prevailing norms within the world of AIDS -- to go in our own way.

Of all the status quos which divide us, the gap between the rich and the poor is most pervasive and pernicious. Thus, the biomedical advances -- which we all desire so ardently -- have widened enormously the chasm between the rich and poor nations, and between the rich and poor within nations. The injustice is stark-- drugs are available to, at most, 10 percent of the world's people with HIV/AIDS in industrialized countries. Yet our problem is profoundly different from all the other health conditions in which the same inequity of access to drugs and other medical treatment between the "haves" and "haves not" has been the tragic rule.

For in AIDS, we all started in the same place, with the same lack of treatment and with the same hopes, but the unfairness has arisen right before our eyes. So the injustice, and the separation it creates, is all the more acutely felt, more personal, direct and real.

The global gap between richer and poorer has been intensified by the shape and direction of the pandemic. During the period of discovery, the dominant theme was global spread. Yet an ever- increasing proportion of the pandemic, today more than 90 percent, is in the developing world. As the epidemic matures, it moves along a clear and consistent pathway, which although different in its details within each society, nevertheless has a single, vital, common feature. In each society, those people who were already marginalized, stigmatized, and discriminated against become, over time, those at highest risk of HIV infection. The epidemic is focusing upon those whose human rights and dignity are least respected.

As a result, at the strategic level, separatism and fragmentation dominate where once was a coherent Global Strategy. Currently, instead of a strategy, we have a series of tactical approaches.

This loss of strategic focus is particularly evident and tragic, because in theory, global learning has worked, and we should be able to apply what has been learned to generate more effective action.

We have strength yet for the sake of global future, we must do more than witness the seemingly inevitable decay of solidarity. The challenge is to create and recreate the conditions in which a truly global movement will become possible.

To rebuild a capacity of global thinking and action, we need a strategic approach to restoring and reinforcing connectedness. And this connectedness starts with the involvement of everyone, those who are working against HIV/AIDS around the world, government, media, women and men -- every living individual.

In moving forward, we must challenge , boldly and without compromise, the notion that the future is not the inevitable consequences of the past. The chains of pain and suffering we have inherited can be broken, and we can each contribute meaning to the healing of the world.