07/07/2006

UN Envoy Warns of 'Terrible Price to Pay' for Aids

The HIV/AIDS pandemic has thrust Mozambique "into a grave crisis", and unless it is treated as an emergency, "there will be a terrible price to pay", warned Stephen Lewis, special representative of UN Secretary General Kofi Annan on AIDS, at a Maputo press conference on Friday.

Lewis has spent the past week in Mozambique, and reached the conclusion that the provision of anti-retroviral therapy for AIDS sufferers must be rapidly increased.

Speaking shortly before leaving the country, he thought it was "desperately urgent" that the government reach its target of 55,000 people on anti-retrovirals by the end of the year. So far there are somewhere between 25,000 and 28,000 people undergoing treatment - so the target requires that this figure be doubled in six months.

"The government must move heaven and earth to roll out treatment in these next six months", urged Lewis.

The key to meeting the target, he argued, was to ensure that treatment is available throughout the country, and not simply concentrated in Maputo. By the end of the year, the Health Ministry hopes to ensure that anti-retroviral therapy is available in at least three districts in each of the ten provinces, "so that people who can't make it to Maputo will have treatment available".

Lewis noted that women are disproportionately at risk from the epidemic, a fact brutally illustrated during his visit to the central city of Beira.

In the Beira Central Hospital, he found that the general ward for women was overflowing with HIV/AIDS cases. There are 54 beds in the ward, but it was accommodating over 80 patients, and over 90 per cent of these were suffering from AIDS-related conditions.

"They were lying in the corridor, on the floor, under the beds. The entire ward was a nightmare scene", said Lewis. "And they were all young, in their teens, their 20s or their 30s".

But in the men's general ward, which Lewis believed to be the same size, some of the beds were empty. 40 to 45 of the men had AIDS-related diseases. "There just aren't as many men infected as there are women", he said.

(The Beira situation is actually worse than Lewis imagined. Another visitor to the hospital told AIM that in fact the men's ward is larger than the women's ward - which makes its unoccupied beds even more scandalous).

Lewis believed "one of the most important things the government can do is to empower women, to pass legislation against sexual violence, reduce the levels of gender inequality and change male attitudes to sexuality".

Despite the grim situation in Beira, there were some grounds for optimism. Lewis had found that, "in spite of all the difficulties, and how serious the pandemic is, particularly in the centre of the country, there are a lot of good pilot projects which show that Mozambique can break the back of this pandemic, if it's treated as an emergency".

He was particularly impressed by the DREAM (Drug Resource Enhancement against AIDS and Malnutrition) centres set up by the Italian NGO, the Sant'Egidio Community. Their programme against HIV transmission from mother to child has been so successful that nowadays all children born to HIV-positive women in the DREAM programme are HIV-negative.

Lewis hoped that the Health Ministry will adopt nationally the treatment regimen used by Sant'Egidio "so that no children are born with HIV".

After all, this was already the case in western countries.

Since treatment is available to ensure that no western child is born with the virus, "there is no reason for African infants to be born HIV-positive. We have treatment that can prevent the transmission of HIV to children".

"Why is the life of an African child worth so much less than the life of a western child ?", he asked. "This is absolutely impermissible".

Lewis believed the rapid training of staff would prove an important factor. He approved of the Health Ministry's programme for "vigorous training of medical assistants to help with treatment - you don't need doctors and nurses to give out pills".

"What has been missing is capacity, human capacity", he added. "The government has not had enough people to roll out the treatment".

The problem was not essentially financial. Health Minister Ivo Garrido "told me that for many AIDS projects he has the money, but not the staff".

From the various international initiatives, and from bilateral donors, there was "probably enough money to do the job", Lewis added. "But you can't do the job without human capacity, and that's where the money must be used".

Nonetheless, it was worrying that the Global Fund against AIDS, Malaria and Tuberculosis was a billion dollars short for this year. A problem for all African governments, Lewis said, was that "the West, and the G8 (the group of most industrialised nations) always betray the promises they make to Africa".

"If western countries deliver on their promises, then something will be possible", he concluded. "If they default on their promises, then African governments are in trouble".