AIDS conference fails to live up to its theme of 'Unity and Accountability'

South Africa's second national AIDS conference ended with a televised speech by former South African president Nelson Mandela, in which he reminded delegates of the great strides the country has made since the last national AIDS conference two years ago. The government has begun providing free antiretrovirals (ARVs) at public health facilities since the first AIDS conference in Durban in 2003, but the long-running debate over antiretroviral drugs continued during the conference this week, pitting AIDS activists against the government once more. Any hopes of an AIDS gathering free of controversy were dashed when health minister Manto Tshabalala-Msimang told delegates on Tuesday to focus on the impact of other diseases, such as cancer and diabetes, and restated her view that people living with HIV/AIDS should choose between nutrition and ARVs. On Thursday the AIDS lobby group, Treatment Action Campaign (TAC), urged the government to extend treatment to at least 200,000 adults and children by the end of 2006. TAC and the AIDS Law Project (ALP) also released an assessment of the state's treatment programme The report, 'Let Them Eat Cake', found that the government's performance should be rated "C, veering towards a D," said Mark Heywood, head of the ALP and a TAC executive member, during a press briefing. According to the study, 18 months after the government began providing ARVs in the public sector, only about 45,000 people are receiving the medication. In some of the hardest hit provinces, particularly the largely rural Limpopo and Mpumalanga, barely a thousand people were receiving treatment. The state's nutrition programme was only being rolled out at a few sites, and TAC had received reports that food parcels were stolen, rotten or not delivered to their destinations as a result of inadequate supervision, poor resources and the lack of proper guidelines. According to the TAC national treatment literacy coordinator, Linda Mafu, as its stands, the government programme was "nothing to cheer about". Mafu told PlusNews: "Very little has been achieved, when you take into account the hundreds of thousands of people who are also in urgent need of ARVs - the number is estimated between 400,000 and 500,000 at present." Although it was too early to say whether the government programme was a failure or a success, Dr Francois Venter, of the University of Witwatersrand's Reproductive Health and HIV Research Unit, agreed that the government needed to work harder to expand its rollout. "But we must also realise that the urgent need for treatment should not be allowed to detract from other anti-AIDS care issues, such as adequate prevention and treatment literacy," Venter pointed out. Commenting on the damaging debate that has tended to frame nutrition in opposition to ARV drugs, he suggested that "the programme should also ensure that accurate information on the benefits of ARVs, nutrition and multivitamins as a complete care package is understood by all people seeking prolonged life". He called for the health department to "stamp out opportunists" cashing in on the public's poor knowledge of anti-AIDS drugs. "People like Dr Matthias Rath, who ride on the steam of global efforts to tackle an epidemic of this magnitude, should not have a place in South African society," Venter concluded. Rath, a controversial vitamin salesman, has been running a high-profile media campaign attacking ARVs and TAC, saying the anti-AIDS medication was poisonous, and multivitamins alone could prevent AIDS. During the closing ceremony, leading AIDS academic Professor Hoosen Coovadia stressed the urgent need for all AIDS stakeholders to adopt the conference theme of 'Unity and Accountability', as the country could no longer afford to be divided when responding to the pandemic. "We need one [HIV/AIDS] plan, one coordinating mechanism and one monitoring system," he said. Coovadia also criticised Tshabalala-Msimang's comments on ARvs and nutrition, pointing out that "If you sow confusion, you create a situation that is not tenable ... sending out false or hypocritical information is bad for the country, but devastating for those who are sick."