It was a time of crippling AIDS denialism in South Africa. Anti-retroviral treatment was available but prohibitively expensive. Few in the developing world, where the epidemic was at its most vicious, could afford it.
AIDS 2000 launched a global campaign to bring treatment to all those who needed it, with civil society groupings such as the Treatment Action Campaign at the forefront.
On the periphery of the 2000 conference the Treatment Action Campaign, a South African HIV/AIDS activist organisation, was finding its voice. It was highlighting the fact that focusing on the science at a conference like this was not enough; that we also had a responsibility of “breaking the silence”, as the conference was themed – to speak up about the injustices of those times.
I had come to the conference on the back of a trip to Nigeria, where I had carried out a small study to expand access to AIDS through physicians in private practice. It was an exploratory survey of knowledge and practices in two Nigerian states. At the time, the talk of the town in Nigeria was of “Dr Abalaka”, a surgeon turned immunologist who claimed to have developed an HIV vaccine.
In one of the worst periods in Nigerian journalism, newspapers went to town extolling his virtues.
But out of the darkness of the reportage on Abalaka rose journalist and activist Omololu Falobi, who was one of a kind. In 1998, he formed a coalition called Journalists Against AIDS in Nigeria. His group became the most credible source for stories and policy advocacy on HIV/AIDS in the country.
Like most good things and people in Nigeria, we lost him too soon when unknown gunmen shot him on his way home from work in Lagos in 2006.
It was the norm in all the early years of the international conferences on AIDS that there were meetings called for all Nigerians attending or those working on HIV/AIDS in Nigeria. The meeting at the Durban conference in 2000 was chaired by Professor Ibironke Akinsete, the then chairperson of National Agency for the Control of AIDS, which was still a committee at the time.
Nigeria was one year into its new democracy, with an HIV prevalence that had just crossed the 5% mark, and Nigerians were enthusiastic about defining the way forward.
A wide variety of issues were discussed on the day – a plan to place the first 10,000 patients on anti retrovirals, a new strategic plan, negligence of non-governmental organisations, poor research capacity and the pervasive “Abalaka issue”.
In Nigeria there has been progress, but it’s been painfully slow despite the enormous resources thrown at the disease. There is a response programme that is still almost completely donor-funded. Less than 20% of those infected with HIV are on treatment and Nigeria has the biggest burden of mother-to-child transmission of HIV, leading to about 50,000 new infections in children every day. Yet despite all of this, there is no sense of urgency and it seems to be business as usual.
Things have changed but remain the same
This year we will return to Durban, 16 years after the first conference in Africa for only the second International Conference on AIDS held in Africa.
Globally, we still do not have a cure, but it is no longer the death sentence that it was in 2000. The discovery of highly active antiretroviral drugs has made HIV/AIDS more of a chronic disease, and is beginning to have an impact on prevention.
The cost of antiretrovirals has reduced significantly, to about $100 per patient per year. This has been driven by the aggressive advocacy of the 2000s and the roll-out of the biggest public-sector antiretroviral treatment programme in the world in South Africa in the years after Thabo Mbeki’s presidency, during which the government refused to roll-out antiretrovirals.
By 2013, an estimated 24.7 million people were living with HIV in sub-Saharan Africa accounting for 71% of the global total. In the same year, there were an estimated 1.5 million new HIV infections and 1.1 million AIDS-related deaths.
A lot has changed in 16 years and much has stayed the same. But there’s still lots to talk about. Join the conversation.
This is an edited version of a blog that appeared on Nigeria Health Watch. The blog will also be providing updates from the conference.