The International AIDS Society's (IAS) Governing Council reads like a Who's Who of the HIV world. Robert Gallo, Tony Fauci, Luc Montaigner and the late Jonathan Mann all at one time served on the Council. Today, the IAS leadership is still composed of leading scientists and physicians including Scott Hammer from the University of Columbia, Souleymane Mboup and Elly Katabira, both respected and established HIV advocates from Africa, and Helene Gayle, formerly of the U.S. Centers for Disease Control (CDC) and now with the Bill and Melinda Gates Foundation.
While the IAS may lack the gravitas of the World Health Organization (WHO), the resources of the National Institutes of Health (NIH), and the high-status prefix of UNAIDS, from an activist perspective, the IAS is respected for its world conferences and for making itself amenable and accessible to the activist community in Europe. Stefano Vella, the former IAS President, before and during his presidency, was no stranger to European AIDS treatment activists. His engagement with AIDS activism has been a personal commitment and has helped to establish an important liaison between advocates operating at pan-European and international levels.
Joep Lange is the recently appointed President of IAS. While his demeanor may be brusque and disarmingly forthright, his intellect, integrity and dedication to fighting HIV on all its geographical fronts, is without reproach. Lange is a rare individual who understands the business of governance but does not respect the insidious imposition of power. Entrenched positions of power, and abuse of it, he has long claimed, have the potential to bring nations to a halt. Whether the abuse of authority is the result of political machinations, business greed or personal lethargy, it is always reprehensible.
Professor Lange, how would you describe the HIV situation in the developing world?
Well, I would begin by describing the scale of the situation. HIV has devastated individuals, communities and populations on a proportion that can only be expressed as a human tragedy. The suffering, misery and total lack of hope that I witness when I travel to Africa is beyond description. I would also illustrate the toll of HIV against the stark reality of economics -- since that is, and will continue to be, the great motivator for many nations.
What specific efforts do you feel are essential to contain and adequately address HIV in the developing world?
Treatment. All our breast-beating is futile. And our efforts to date -- 50 patients here, 50 patients there -- are negligible. Let's look at the figures, 28 million in Africa, 7 million in Asia. We are told that 30,000 people are being treated in the developing world. Well, that must be a lie -- it is actually less than this. Our commitment, no matter how well meant, has been fragmented. We have not even begun to consolidate our own actions. What is needed is concerted, responsible and sustainable intervention. Let's look at it like this -- we will need treatment, yes. But we will also need to devise effective strategies for speeding up drug supply, drug delivery, identify key players, develop clinical and technical expertise. The Global Access Initiative launched here in Barcelona is one way of sharing and building upon our resources and commitment. We organized ourselves against smallpox eradication. Let's do it for HIV.
Who is responsible for addressing this global tragedy? Who are the key agents whose contribution will make a difference -- African governments, western governments, WHO, scientists, physicians, pharmaceutical companies, international NGOs, activists?
There is so much to be done. So much intellect, resource, capital and commitment is out there, yet no one seems to be playing together. I have often said that we are fighting over Africa and Asia for our own political and career interests, duplicating efforts and obstructing real potential. Instead, let's divide the world amongst those who have the resources and thus the responsibility to treat. I proposed earlier that the NIH could be responsible for some part of the world, the ANRS for another and so on. The WHO does have a role. It's role is to lead -- but it cannot deliver alone. Bad governments impede our efforts. I have always been vocal on this issue. People under a bad government are punished enough -- let's not punish them anymore by making them suffer a disease for which we have treatment. There are operational issues and supply issues to be addressed. Let's work positively and responsibly with those who have the treatment resources -- the pharmaceutical industry and those who make generics. NGOs will remain essential in this process. They can support, empower and vocalize. As Paul Farmer so rightly said, "the community is part of the infrastructure."
What is your personal vision and aim as President of IAS?
To be an advocate. To take the lead. To overcome the issue of infrastructure as an obstruction to treatment. Infrastructure is used incessantly as an argument for not treating HIV. We have the WHO treatment guidelines as a starting point. Let's establish treatment, scale-up and work with countries to improve existing health care delivery systems now.
The Vice-Chair of the EATG said in a press conference "scientists are turning into politicians" and "activists are getting angry again." How do you respond to that?
Unfortunately, scientists can't just stay scientists. Their resources and skills are needed to mobilize treatments on a global scale. Scientists and physicians have delivered astounding achievements in this area. But we need to push them and their talents so that research and clinical care are available and made meaningful to those who need it the most. And yes, I have observed the community getting angry again. That is a good sign. We need strong advocates from both the developed and the developing world. Activists emerging from Africa have already established historical landmarks.
My message to European treatment activists? Partner up with activists and networks in the developing world, share with them what you know, learn from them about their experiences of HIV, and build alliances that will be supportive, challenging and formidable.
Our thanks to Professor Lange for sharing with us his candid comments and views.
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