TARGETING AIDS
June 26, 2001

After a back ground report, an international panel discusses AIDS and the U.N. conference in New York. The NewsHour Health Unit is funded by a grant from The Henry J. Kaiser Family Foundation.

 

Health Spotlight: The AIDS Crisis Health Spotlight: AIDS In Africa June 25, 2001: AIDS in India March 15, 2001: The Price of AIDS in India Feb. 21, 2001: AIDS Drugs in Developing Countries May 14, 2000: U.N. Secretary General Kofi Annan May 2, 2000: National Security Advisor Samuel Berger Aug. 31, 1999: The National HIV Prevention Conference. Browse the NewsHour's Health coverage   United Nations Coverage Kaiser Network UNAIDS CDC Division of HIV/AIDS Prevention	GWEN IFILL: Joining us now are four participants attending the UN conference this week from around the world. Dr. Denzil Douglas, who's worked as a family physician, is the prime minister of St. Kitts and Nevis in the Caribbean. Pitak Intravityanunt is the deputy prime minister of Thailand, and heads the country's national AIDS prevention and control committee. Joy Phumaphi is the health minister of Botswana. And Dr. Paulo Teixeira is the director of Brazil's national program on HIV/AIDS. Welcome, everyone. Mr. Prime Minister Douglas, how important is this meeting going on in New York this week?
	Extremely important meeting
	DR. DENZIL DOUGLAS: I think this meeting is of extreme importance because it has been used to bring full political support to the fight against HIV/AIDS. For us in the Caribbean, specifically in St. Kitts and Nevis, it also demonstrates to the entire international community that though we are far removed in the Caribbean region, though we are not spoken of as much as in Africa, we nevertheless have a very, very serious problem. In fact, the infection rate in the Caribbean region is second to sub-Saharan Africa in regional terms. And so we use this opportunity to sensitize the international community that the problem exists seriously in the Caribbean region and that there is need for our assistance and there is need for assistance from the international community. GWEN IFILL: Mr. Pitak, let's go around the world to Thailand where you hail from and tell me, do you agree with the kinds of issues we say… that Prime Minister Douglas... Denzil Douglas, just mentioned; and do you think that this is the sort of thing that Thailand also has to address? Are those kinds of questions properly being addressed this week at the UN? PITAK INTRAVITYANUNT: Yes, I do. I believe this is the first time that have such a high level inter-governmental conference to discuss the issue of HIV/AIDS. And it's a good opportunity for the world community to be able to make the commitment, on both political commitment and financial commitment, to tackle this serious issue of HIV/AIDS. GWEN IFILL: Dr. Teixeira, of course, as we have heard, there is an incredible pandemic in Africa, but also in other countries. You're from Brazil. Give us a sense... when Kofi Annan says this disease is spreading at a frightening speed, what does that mean in your country? DR. PAULO TEIXEIRA: Well, for us, the epidemic is a very important question -- even when we identify less than 0.5 percent of infection among the adult population. But exactly observing what's happening in many countries in other regions, we can know that... we know that the infection can spread very, very quickly if we don't have good control, particularly talk about prevention and also about treatment. So since the '83 Brazil is very concerned about the question, and for these 18 years we established and we are running a strong program, trying to maintain, to contain the epidemic and to support affected people. GWEN IFILL: Mr.… I'm sorry, Minister Phumaphi, there is such an incredible rate of AIDS and HIV on the African continent. Certainly there's been a lot of attention. What can the international community do in this case to address this, more than is being done already? JOY PHUMAPHI: Well, I think Africa has learned the hard way that it does not pay to concentrate on rhetoric, and commitment -- whether it be political or otherwise -- is not enough without action. And I think this is the most important message that we can give to the rest of the world. And also, the fact that the HIV epidemic is not a threat to Africa, but is a threat to humanity, and humanity exists on every planet, on every continent on the planet. And it is therefore the responsibility of everybody to move away from rhetoric, move towards action-oriented programs and assist humanity to survive because we are under threat as the human family.
	The question of rhetoric
	GWEN IFILL: Let's talk about that question about rhetoric. There are those who say that this United Nations meeting is about passing texts and drafts and having a lot of talk, but that there won't be enough action. How do you respond to that? JOY PHUMAPHI: Well, we are hoping that the world will learn from our experience. We are hoping that by communicating more with the world, by exposing the world to the tragedy that we are experiencing in Africa, the rest of the world will learn that we not only need to assist Africa to not to be annihilated, but we also need to assist the rest of the world from finding itself in the same position that Africa is. I think that alone, that wake-up call, if it is adequately achieved by this assembly, then this assembly will have been successful. GWEN IFILL: So Prime Minister Douglas, in the Caribbean, has the wake-up call that she just mentioned, has that happened? Has that arrived? Are people... are you on the cusp of the issue, or has the curve passed you by? DR. DENZIL DOUGLAS: I think that we are presently on top of the issue in the sense that our populations in the Caribbean have been sensitized to this disease. We are also at the point of developing national strategic plans. Some countries have already developed such plans. Some countries need to develop those plans. Even those who have developed the plans, there is need for technical and financial assistance in order to finance the implementation of those plans. We are trying to move this from just being a matter for the Ministry of Health or the public sector to one where the private sector, the NGOs, the community on a whole must become fully involved. Of course this is going to require additional finances. For example, in my own country, St. Kitts and Nevis, 10 percent of the health budget has been dedicated in 1999-2000 for HIV/AIDS alone. But we need to advance this to about 15 percent. How can we do this in a small, developing country, which continues to be seriously affected by developmental issues? Especially the challenges of globalization, and trade liberalization. How can we devote much more revenue to this kind of financial activity for HIV/AIDS programs, when it is not there? And that is why we are here. We are here to emphasize that the global fund, that the international financial institutions, that donor countries generally must come forward in order to assist us in the Caribbean if we are to survive; if humanity on a whole is to survive in the Caribbean and beyond. GWEN IFILL: Dr. Teixeira, part of the question that's been raised in these first few early days of this conference has been about the cultural questions surrounding AIDS, the stigma surrounding AIDS. Brazil has not had that same problem. How do you view that? Is it an impediment to widening awareness of the disease and getting the kind of financing that Prime Minister Douglas was referring to? DR. PAULO TEIXEIRA: Well, it's real that in Brazil it did not face a big problem to consider and to talk about all the aspects that relate to HIV and AIDS. Brazil is a very tolerant country when you talk about sex behavior, and when you talk about sex workers or even about drug users. And our experience is that even if it is very difficult, we have to consider and we have to put on the table all the questions and all the aspects. That's the only way that we have to provide people with the good information so that the necessary information about how to prevent themselves from infection and how to support... and how to support HIV- affected people also. GWEN IFILL: Mr. Pitak, how do you respond to that? The United States... the United Nations in its first few days has been struggling with itself about whether gays and lesbians should be represented in the councils of power on this issue. How do you get past that cultural stigma?
	Treatment and prevention
	PITAK INTRAVITYANUNT: Well, when we talk about this HIV-AIDS issue, it's not about the differences of sex behavior; it's about a sickness, about a disease that seriously affects the world, affects the people. In Thailand, we consider it... you know, an Asian country, we are very shy on this kind of sexual issue. However, Thailand is the very first Asian country to openly admit that there's a crisis, and the government from the highest level to take this action openly, discuss this action openly. That's why we introduced this prevention and control program along with a treatment program. That's how Thailand be able to contain this spread of epidemic. And so, therefore, I think this issue regarding the seriousness of disease, not about other issue. Of course, we have to take all the issue concerns, whether it's culture, whether it's humanity, or whether it's economics. I think all must be addressed together in order to be able to combat this very serious sickness. GWEN IFILL: Minister Phumaphi, the deputy prime minister of Thailand just mentioned a very interesting point, which is the debate between treatment and prevention. Treatment and prevention, how do you sort that out? Is it a debate that you even have to have? JOY PHUMAPHI: I think it's rather unfortunate because debates and prevention are two sides of the same coin. It is impossible for us to adequately and effectively combat this epidemic without introducing both. You need a multi-sectional approach because this is a multi-dimensional problem. In Botswana, we have a national AIDS council, which has got every sector because first of all we believe every sector has to be involved; it is chaired by the president. We have a program that targets every group within society. And we have intervention programs that target prevention and behavioral change, that target protecting the new generation like mother-to-child transmission program. We have to have treatment as well because people need to have hope. How are you going to give people hope without treatment -- by telling them that some medication is available that can alleviate suffering, that can prolong the quality of life and allow them to contribute towards the development of the economy -- but that you aren't going to give them access to it? I mean, that is going to destroy any effectiveness that you can even achieve from the preventive strategies. So you have to have both. We feel there is no choice. GWEN IFILL: Well, Dr. Teixeira, let's talk about this access to treatment and the availability of drugs. In Brazil you've taken matters into your own hands. In fact, the United States has backed off a little bit on its objection to the way you took matters into your own hands by manufacturing generic drugs and making antiretrovirals and making them available for free. Is that something other countries should be doing: Following that example?
	Producing drugs
	DR. PAULO TEIXEIRA: I think so. I think that we have many developing countries with the technical capacity to produce some drugs, ARV -- even... It's important also to remember that the Brazilian government is offering to order developing countries the technology we achieve to make these drugs if they consider adequate for their country. But I think that this is not the only aspect. What we really need is low prices or differential price for the drugs necessary for the treatment of HIV patients. And I think that we don't have to expect on the other side that all the countries develop some kind of capacity of production. We have to insist on a kind of global agreement that could include all these strategies, all the possibilities and all the good experience you have seen in all the world. This means general production, local production, this means differential prices, this means transference of technology and so on. So I think that all the aspects, all the... have to be considered to provide ARV for everybody, how we think that we have to do. GWEN IFILL: Prime Minister Douglas, from your outpost in St. Kitts and Nevis, where you are a small country watching a big problem, how optimistic are you after talking with your colleagues from around the world this week that you are going to come out of this fight ahead, or that you at least have a handle on how to approach it? DR. DENZIL DOUGLAS: I think that we are fairly confident that we will be able to arrest this problem and to overcome the challenges that it poses. We are very confident that we have made the necessary contact while we have been here. In fact, yesterday I had the opportunity to chair the first roundtable session on prevention and care. And we have been able to point out very clearly as the minister from Brazil just indicated that the drug companies have a particular responsibility to assist those countries who can ill afford to purchase those drugs. But apart from the political-legal problems that exist with patients and so forth, we think that they have a particular responsibility to provide assistance in other ways. For example, they should help in building up the infrastructure, the lab infrastructure in the various countries so that patients can be properly monitored, so that the treatment, the care could be of the highest standard and the quality of life improved dramatically as a result of use of these drugs. There is also the question of the opportunistic diseases that they should provide maybe free of cost -- the various drugs to treat fungal infections, et cetera, which we know will always develop in patients who are taking the treatment and those who are suffering normally from the HIV/AIDS. These are some of the fundamental questions that we have put forward in the discussion while we are here. And so, you know, it's a situation, we believe, that drugs at lower prices would be made available to us and that the drug companies will come forward. GWEN IFILL: Okay. Thank you all very much.