Nairobi — Kenyan President, Mwai Kibaki, opened the 13th International Conference on Aids and Sexually Transmitted Infections in Africa (known as Icasa) Sunday in the capital, Nairobi, reiterating the challenges facing the continent worst hit by the HIV/Aids pandemic.
"Generations to come will pass judgement over us on the basis of our action in the management of this disease. What we owe future generations is life: a life free of Aids," said Kibaki in his opening speech.
"So within Africa, all of us - men, women, children, everybody - we have a duty to join in fighting against this disease. It is not something that can be fought sometimes. It must be fought all the time. Every moment. Every day. It is not something that you are called upon once in a while, when you remember. You are called upon to fight the disease every moment, every day. And the more you will assist everybody else, then thats your best contribution. So let us all make up our minds to fight this time, and not by word of mouth, but by action," was Kibakis concluding statement, spoken without notes.
Held every two years, Icasa is the leading continental forum on Aids in Africa, bringing together thousands of Aids campaigners and grassroots activists, people living with the pandemic, care-givers, doctors, health professionals and researchers, as well as policy and decision-makers. An assessment of the impact of the pandemic and best practice in tackling HIV/Aids are at the heart of the biennial conference.
This years official theme at the week-long gathering is "Access to care: the challenges". Provision of better, comprehensive care remains the "universal goal," said a statement by Icasa's organisers, as does "treatment for HIV/Aids/STIs (sexually transmitted infections) as a basic necessity in every setting from the richest to the poorest and embracing the whole continuum from home-based and palliative care to treatment of opportunistic infections and management of HIV disease."
Ludfin Opudo, a Kenyan Aids activist living with the virus for the past seven years, gave a moving speech at the opening of the conference and called on governments in Africa to provide quality health care for Aids sufferers.
"The fight against HIV/Aids must also see the greater involvement of those people living with HIV. We must support networks of people living with HIV and support groups in a programmed way. It can never be a tokenism approach any more," she said.
Michel Sidibe, a director at UNAids - the agency responsible for coordinating global efforts to combat Aids - released a UN report at Sundays Icasa launch, called "Accelerating Action Against Aids in Africa."
The report warned that Aids represented the foremost challenge to improving the lives of Africans, but that the pandemic could be contained with the right programmes and the required resources. The study laid emphasis on the need to treat HIV patients to keep them healthy and productive contributors to Africas workforce.
UNAids said Africa needed US$6bn to combat HIV/Aids, but was currently receiving only half of what was required by 2005; the organisation's officials said they were including in their projections the US$15bn pledged by U.S. President George W. Bush to fight Aids in Africa and the Caribbean, as well as other donor promises.
Sidibe said it was important "for us now to address these issues of HIV and Aids as development issues. We cannot ignore the emerging crisis, the nexus between food security, governance and HIV."
A summary of the UNAids report concluded: "The effects of Aids in Africa are eroding decades of development efforts. In high-HIV-prevalence countries, families are unravelling, economies are slowing down and social services are deteriorating."
Highlighting Southern Africa "where HIV prevalence is higher than anywhere else in the world," the study concluded that "Aids has exacerbated food insecurity, demonstrating how the epidemic and humanitarian crises intertwine."
UNAids reports that 30 million Africans south of the Sahara - that is one adult in 11 - are living with HIV and Aids. That figure accounts for three-quarters of the global total. Some 15 million people on the continent have already died from the pandemic, says the UN. Over two million have lost their lives to Aids in the past year alone.
Women and girls make up almost 60 percent of HIV-infected people in sub-Saharan Africa. UNAids appealed to governments to reduce this groups vulnerability to the pandemic.
Tough talk
There was immediate tough talking in Nairobi at the opening ceremony of ICASA 2003 on Sunday. Speakers' messages have not been kind to the West or to African leaders who are not pulling their weight to combat Aids.
The United Nations Secretary-Generals special envoy on HIV/Aids in Africa, Stephen Lewis, did not mince his words as he took another swipe at the industrialised world for failing the continent on the crucial question of Aids and ignoring the plight of those living with the virus. Lewis took up the critical question of resources, commitments and priorities:
"This is a full-blown emergency. In every emergency there is a division of labour. Africa is struggling to hold up its end, the Western world is not. I have to say that what is happening to the continent makes me extremely angry and I dont feel I have to apologise for being angry. The job of an envoy isnt merely to observe and to report back, but also to identify with those he serves. And I serve Africa. And I am enraged by the behaviour of the rich powers. How much more grievous, by their neglect, they have made the situation in Africa," he said.
African leaders were also targeted: Lewis said the behaviour of some had been indefensible. "But," he said, "Africa has moved mountains in the last couple of years, while the Western world remains mired in the foothills. Africa needs no instructions from the West. Africa needs no arrogance from the West. Africa needs no churlish lectures from the West. Africans know HIV/Aids in all its manifestations and developments. Whats missing are the tools and support to do the job. Provide those to Africa and we can break the back of this pandemic. But that requires money."
Calling the lack of cheap, life-prolonging anti-retroviral drugs in Africa a "grotesque obscenity" Lewis issued another rallying call for Western governments to do more to help the continuing fight against Aids and condemned the cavalier attitude of those who failed to deliver.
Winning enthusiastic applause from the audience despite several interruptions of his speech by power cuts, Lewis was passionate as he championed the case for Africa, questioning the Wests commitment. "How can this be happening in the year 2003, when we can find over US$200bn to fight a war on terrorism, but we cant find the money to prevent children from living in terror?" he asked. "We cant find the money to provide the anti-retroviral treatment for all those who need such treatment in Africa. This double standard is the grotesque obscenity of the modern world."
President Kibaki said the twin obstacles of access to treatment and the high cost of anti-retroviral medication were as much of a problem as the social stigma still associated with HIV/Aids and poverty.
The Kenyan leader called on international pharmaceutical companies to reduce the prices of their products. Kenya has one of the highest HIV prevalence rates in the world and the government has declared Aids a national disaster.
The ambitious goal of the World Health Organisation is that three million people across Africa should receive life-prolonging drugs by 2005. A change in global trade regulations has meant a dramatic drop in the price of anti-retrovirals. Yet only a minute percentage of Africans currently has access to them.
Security fears
UNAids Director Sidibe, also took up the plight of thousands of Aids orphans in Africa. Sidibe said African governments needed to do more to provide for the growing number of children affected by Aids and those who now head all-child households. He concluded that 11 million children in Africa had lost at least one parent to Aids and that many would end up on the streets or become part of the ragged band of child soldiers, fuelling crime and conflict all over the continent.
Lewis echoed Sidibes concern saying that while the world dithered, Africas kids suffered. "In the meantime, millions of children live traumatised, unstable lives, robbed not just of their parents, but of their childhood and futures," he said.
Other topics on the Nairobi Aids conference agenda include "Gender taboos and traditions", "Sex work and HIV prevention" and "Assessing the role of anal intercourse in the epidemiology of HIV in Africa."
Concerns have also been expressed that Aids is fast emerging as a potential security hazard in Africa, with the possibility that the spread of the pandemic could spark regional wars, civil strife and terrorism in parts of the continent.
Sidibe warned that if more was not done to curb the threat of HIV/Aids, the security of the continent could be at risk, with the threat of rising crime and civil war. He also predicted that Africas armies and security services would be incapable of coping with the increased threat of instability, because they too had become seriously weakened by HIV/Aids.
In some African countries, as many as four out of every ten soldiers is reportedly infected with the virus.
Ahead of the Nairobi Aids conference, experts had already voiced such fears. Analyst Patrick Garrett, from the Washington-based think tank, Globalsecurity.org, explained that failed states, where law and order and the economy had broken down, risked becoming havens for terrorists.
Garrett said "If an economy implodes as a result of massive Aids prevalence, then certainly terrorism can take root".
UNAids chief advisor for Africa, Michel de Groulard, said that uneducated and isolated by society, children became easy targets for criminals and militia, "prey to all kinds of organisations and manipulators, who can turn them into child soldiers or eventually terrorists. Its a genuine risk." He said that, put together, these explosive ingredients were a potent formula for dislocation and civil violence.
In May, the United States Secretary of State, Colin Powell, warned that some African countries were becoming progressively weaker and that Aids was "not just a health crisis, its a crisis of nation states. Nations will collapse if they dont fix this problem."
The U.S. Central Intelligence Agency (CIA) chief, George Tenet, in February said that Aids was a threat to national security in America because it could "further weaken already beleaguered states."
Signs of hope
But there were also signs of hope. The UNAids report, launched in Nairobi, catalogued successful HIV/Aids prevention and treatment programmes in Africa. These included an Aids awareness campaign in Uganda, a workplace anti-Aids programme in Cote dIvoire and the distribution of generic anti-retroviral drugs in Senegal, a country with a low HIV prevalence rate.
"These examples prove that Aids is a problem with a solution: human intervention works, even under the most difficult circumstances," said the report. The authors called for more international funding for programmes that worked, saying that "The growing number of effective prevention and treatment efforts in Africa proves that a massive expansion of the epidemic need not be inevitable. Aids is not unstoppable in Africa."
The report concluded: "After two hard, painful decades of experience and accumulated knowledge - much of it gained in Africa - African governments and the international community are beginning to understand what is required."
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Sidibe argued that Aids must not been seen as a death sentence in Africa. He noted that more money was becoming available to combat the pandemic and cheaper drugs were increasingly on offer. But he said that the challenge remained to ensure that these gains be channelled to help truly needy people, including the poor and destitute in Africa. "We dont want to just say that things are changing for the good. We know that those exciting developments are not enough."
The opening ceremony of the 13th conference on Aids in Africa was thrown into confusion as the venue was plunged into darkness by intermittent power cuts at the Kenyatta International Conference Centre (KICC). An embarrassed and apologetic President Kibaki began his speech assuring thousands of delegates that Nairobi was capable of hosting the international conference and wishing them a pleasant stay.
Controversy
The run-up to the 13th African Aids conference has been dogged by controversy. The original Kenyan organising team was dismissed at the eleventh hour, amid allegations of corruption. A new team was brought in only weeks before the scheduled opening of the six-day international gathering, leading to complaints of disorganisation and potential chaos. Hundreds of delegates queued for late registration, Sunday.
But the focus in Nairobi is on concrete and workable solutions to the Aids crisis in Africa and ways to reverse the trend of high HIV prevalence on the continent. "This is a cry for all humanity, let us all unite and fight with one voice. This is the challenge," sang one of the performers at the opening ceremony. Her words will echo throughout the week as the projected 8,000 delegates in Nairobi work towards that common objective.
The Nairobi conference was preceded Saturday by a 10km (six mile) run organised by Kenyan women to show their solidarity with those living with the pandemic. As she joined thousands of runners, Kenyas health minister, Charity Ngilu, said "Today marks the day when women and girls have spoken and said we are now joining the world in the fighting against HIV/Aids. We are going to stop the suffering. We have come together to declare total war and our slogan today is "One man, one woman, all the time."
Kenyas first lady, Lucy Kibaki, also took part in Saturday's race, walking briskly and urging men to support womens efforts to stop the spread of HIV/Aids. Her husband, President Kibaki, said: "Men are only required to make up their minds today and to promise that they will not continue to spread Aids."
With a second warning to his fellow men, Kibaki repeated the same message as he opened the conference on Sunday. He said: "The people so far have shown terrific support. But we need them to continue, particularly men who are doubtful sometimes. Im not joking. It is not a matter of merely saying it. This is a truth that we need everyone in society to fight this disease vigorously and without any hesitation. Otherwise we cannot succeed and we all know it. It is very serious."
