National AIDS conference opens

South Africa's first national AIDS conference kicked off on Sunday with a somewhat subdued opening ceremony – even the activists' shouts for access to treatment were muted. But for many, this conference could not have come at a better time. Last week the country's drug regulatory body announced that it was considering de-registering the use of nevirapine for the prevention of mother-to-child transmission because, it said, it had safety concerns over the drug. A single dose at the onset of labour, and a single dose to the newborn within 72 hours of birth, has been shown to reduce mother-to-child transmission by 50 percent. However, South Africa's Medicines Control Council is investigating the clinical trials of nevirapine in Uganda, after procedural flaws led to drug company Boehringer-Ingelheim withdrawing an application to have it approved in the United States. Before the opening of the national conference in South Africa's port city of Durban, relations between the government and AIDS activists were far from warm. An impasse had been reached over the state's delay in providing antiretroviral drugs through the public health system. At the weekend the AIDS lobby group, the Treatment Action Campaign (TAC), held its annual congress and decided to resume a civil disobedience action it had suspended earlier this year following talks with Deputy-President Jacob Zuma. Treatment access will undoubtedly be the buzzword at the Durban meeting. Even taxi driver David Ngcobo, who had been driving conference delegates from the city's airport to their hotels, was aware of the issue. "You are also coming to this AIDS conference? Everybody must tell the government to give our people the pills. Now our teachers and policemen are dying - how can we vote for them (the government) if they are not helping?" he asked. The debate is not limited to South Africa. "The continent is obsessed with treatment. There is absolutely no question ... in every single country, treatment is an abiding concern," Stephen Lewis, UN Special Envoy for AIDS in Africa, told journalists at a pre-conference briefing. South Africa, unlike its poorer neighbours, is in a better position to implement a national treatment plan. According to conference chair Professor Jerry Coovadia, the country has attracted resources for research "which are quite phenomenal". However, Coovadia noted, the wealth of information emanating from this research had not been translated into government or NGO action. Despite an "outstanding" legal framework for protecting the rights of people living with HIV/AIDS, widespread and severe stigma and discrimination were still practiced. The fact that few public officers have come forward to disclose their status was partly responsible. But the problem had been compounded by the absence of a comprehensive treatment programme, Justice Edward Cameron, a Supreme Court judge who is HIV-positive, pointed out at the briefing. Dr Nono Simelela, head of the government's AIDS programme, commented that the country was being asked to fast-track a response to the epidemic without acknowledging the struggle needed to overcome the previous apartheid government's failure to build human capacity. "How can you expect people to respond effectively when there has been no investment in the people of the country to move forward?" she asked. That is why people like Reggie Caroelson, a member of the St Joseph's Care and Support Trust project at Sizanani Village in Bronkhorstpruit, about 50 km east of the capital, Pretoria, are at the conference. The project runs a community-based programme for orphans and vulnerable children in need of care – a situation, which, according to Lewis, is "rapidly emerging as one of the most intractable problems associated with AIDS". The Bronkhorstpruit project has a stall displaying crafts made by HIV-positive patients who have benefited from the programme. "There are seven of us here and we are taking it in turns to get as much information as we can. When we go back we will use the information we learned to help the children," Caroelson told PlusNews. Both Simelela and Lewis hope that this conference, notwithstanding the debate about treatment, will come up with solutions to address children orphaned by HIV/AIDS. "On a personal level, I hope for something to alleviate the pain of those little ones," Simelela said. For Reggie and the rest of the team this is a rare opportunity to meet other groups from across the country, and come up with practical solutions to implement in their work. Political debates are not on their agenda.