Insights from ICASA: “This Epidemic has been a long agony”

"Death is still present on this continent." –Justice Edwin Cameron

James Pursey/Swaziland

The morning plenary on the last day of the 17th International Conference on STIs in Africa (ICASA) conference was worth the wait. Professor Ashraf Coovadia gave an excellent overview of pediatric AIDS in Africa, citing the progress and challenges. After a review of the global numbers, Coovadia pointed out that adolescents are the only age group where AIDS-deaths are increasing, and identification and treatment of HIV-positive adolescents is a huge priority.

I finally had the opportunity to hear Justice Edwin Cameron speak. In his compelling remarks, he pointed to the continuing inability to close the AIDS epidemic in Africa, saying, "Death is still present on this continent." He emphasized that it is only on this continent where the heterosexual generalized epidemic remains untamed and that stigma is at the core of this epidemic in Africa. Stigma prevents people from testing, prevents them from accessing treatment. Cameron said, "AIDS is a medically manageable disease. ART turned my life around!" He talked about "too many dark figures" in the numbers on the epidemic on the African continent and said that we have no reason to feel triumphant. Half of those on the continent don't know that they are infected. AIDS causes unnecessary suffering, anguish and death.

At its base is the stigma that has been intractable. It is the source of blame and silence, and has led to very damaging policies in many countries. Cameron said that we are working toward the wrong zeros: we need to get to zero stigma so that we improve access, legal protections and compassion, which will get to the causes of HIV spread. Cameron called the punitive laws that exist in many countries a 'disgrace' that we should work to repeal and told the audience that protecting the health of all requires protecting the rights of all. He called for social compassion and acceptance.

"This epidemic has been a long agony." We can end the guilt and suffering. Our biggest effort should be to normalize this disease, which is actually less scary than Type 2 diabetes and other chronic conditions. Stigma is irrational, hateful and harmful. It is not a physical reality but a state of mind. At a conference where many are talking about the 'end of AIDS' and saying that we have taken care of mother to child transmission (MTCT), the voices of reality that point to the battles that still remain to be fought are persistent and important to hear. These voices are not naysayers, they recognize our progress but want to focus us on the challenges and the opportunities that they present to actually get to the end of the epidemic.

Dr. Mark Dybul, head of the Global Fund, picked up on this theme in this remarks. He called HIV and TB 'one epidemic' that could be defeated. He said that we have an historic opportunity to defeat three pandemics - HIV, TB, and malaria - and turn them into low level, endemic diseases, ending them as public health threats. He talked about progress, citing the advances from the early days of the epidemic when the best thing that we could do was reverse the deaths. He called for us to allow the science to be used, to provide compassionate care and effective treatment, as well as to take a new approach to prevention. People are at risk for HIV throughout their sexual lives, 40 or 50 years! During these years, the prevention needs change and we need different tools at different times.

We must meet people where they are, respect them and give them options. (This remark drew loud applause from the audience.) He said that we must stop looking for silver bullets for this epidemic; they just don’t exist. Dr. Dybul called for a new era of partnerships to replace the paternalism that has existed in development and health. He called for a focus on women and girls, and for openness in talking about special populations in need, such as sex workers, men having sex with men (MSM), drug users, and prisoners.

Remarking on the passing of Nelson Mandela, he called for a new openness for new ideas and to each other, for human dignity and respect, and to work together to advance the human spirit.

Mary Pat Kiefer is EGPAF’s Senior Director of Technical Leadership Development
Insights from ICASA is a blog series featuring the stories and thoughts of EGPAF experts and staff participating in and attending the 17th International Conference on STIs in Africa.