The PEPFAR Conference

Where to start when describing this conference?

Firstly its been a ground breaking meeting since for the very first time the US-funded PEPFAR conference has invited in other agencies such as the WHO, UNAIDS, GFATM etc ....... given USAID's terrible reputation for engaging only in bilateral programmes and never contributing to basket-funded projects - this has represented a huge step forward ... its also meant that we've been graced by experts from all these different groups moving the emphasis away from toeing the PEPFAR line (abstinence good/condoms bad etc) .... and so the conference has been reinvigorated from mere forum where the various PEPFAR organisations show off their results and are suspicious of sharing"secrets of success" .... into a meeting where issues are being properly debated, difficulties and challenges openly aired and strategies that work highlighted ....

Secondly its also been amazing to be at such a diverse gathering - although it is a little ridiculous to be a British Indian representing Africa interacting with a Ugandan representing the US government and a Yank speaking for India .... but its great to see such a mix .... and i have revelled in meeting people from Cote d'Ivoire or Nepal or Djiboutie ..... it does however make me feel a little pity for poor white people with no decent national costume to bring colour to such an event ....

Thirdly its also been a conference where Africans have been given their place and time alongside american or european "experts" to present their experiences .... all too often we hear western academics lecture to us - setting standards and dispensing lofty advice ..... so its seems this forum has finally spawned true "south-south" cooperation as we share thoughts on the problems we face .... and debate how we should implement guidelines as best for own own contexts .... and i have been humbled by the courage, motivation and innovation shown by colleagues battling the epidemic with limited funds in areas bereft of all infrastructure .....


Fourthly - the conference was opened by Paul Kagame, the Rwandan head of state (and ex-RPF leader whose military tactical brilliance is credited with having ended the genocide) and was attended by the whole of the Rwandan parliament emphasising the political will behind efforts to control HIV in country where it was spread primarily as a result of the rape and torture carried our during the genocide. Last summer in Toronto - the Canadian Prime Minister refused to attend the International AIDS Conference (the gays aren't in line with his christian beliefs) ... and in South Africa - not only does our President not believe HIV causes AIDS and our Health Minister the laughing stock of the world but she also snubs all HIV conferences in the country and bans her staff from attending .... So it was really heartening to see that there are leaders on this continent who are prepared to confront this challenge ... the prevalence rate here in Rwanda is around 3% - just imagine if the South African government had shown this leadership when we had such low rates ....

Finally the main issues discussed have also been different to previous conferences i've attended .... the activists shouting for access to treatment and rights for health workers/prostitutes/one-armed lesbians etc are thankfully absent .... western buzzwords such as pre-exposure prophylaxis (essentially the morning-before weekend wonder pill for people that want to go out and have unprotected sex) and hot-of-the-press new drugs have rightly been disregarded as irrelevant to us .... instead the topics have ranged from how to responsibly implement male circumcision across our countries and cultures and how to improve our prevention of mother to child transmission (a real tragedy: a simple method exists yet is somehow shockingly poorly implemented) .... to the value of opt out (ie mandatory) HIV testing and how to integrate malaria and TB into HIV programmes or how to reach orphans and vulnerable children ....

I won't bore you with a litany of facts and figures ...... it suffices to say that we seem to be losing the battle with the current lip service that is being paid to properly funding and supporting the efforts so desperately needed .... over 25 million people have died from HIV since the early 80s and conservatively over 20 million currently live with HIV today .... that means that at present over 45 million people have died or have been condemned to die (and thats not counting the 3 million infected each year) .... 45 million people ...... that's more than 7 times the number of people that died in the Holocaust .... the majority of whom live in Africa ...

And so its appropriate that this conference has taken place in Rwanda - where 13 years ago - whilst it burned like hell on earth - the world turned its back and navel gazed in embarrassment ... after which Bill Clinton and Tony Blair amongst others pledged that we would never let it happen again .... Today however we see the same apathy and disinterest and i'm-sorry-but-what-can-i-do face making - and its not just AIDS .... tragedies have unfolded in Iraq, Afghanistan and Darfur ....

Kevin de Cock from the WHO gave a rousing plenary address yesterday urging western donor nations to honestly commit funds and honour promises made ... but also impressed upon us the importance of all of our roles and contributions to these efforts .... and he floored the whole audience by ending with a quote Martin Luther King:

History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people .....