UN HIV/AIDS Envoy Stephen Lewis on two-year anniversary of antiretrovirals in Arua, Uganda
29 August 2004
"It is heartbreaking if some people can get treatment and other people cannot get treatment."
I was appointed the envoy on HIV/AIDS by Kofi Anan back on June 1, 2001. So I've been doing the job for a little more than three years. Ever since I began the job, the cry that we hear everywhere in Africa, from every country, is the cry for treatment. The cry is for treatment because there are very powerful voices coming from groups of people who are living with AIDS.
There is a widespread recognition that we have the drugs that can do the job. And there is an increasing recognition that the world is slowly beginning to provide the resources. So everywhere, people who want to live have been demanding that their government provide treatment. But, unfortunately, in most parts of Africa, those treatment breakthroughs are very few and very small. And we've all been looking - you can't imagine how we have all been looking - for a model which can be used throughout the continent. And coming to Arua Regional Hospital, I have found the model. And what I have learned, in finding the model which the hospital staff and all of you and Médecins Sans Frontières have fashioned together, is that there are six basic principles.
Number one: All of the drugs and the services related to HIV and AIDS must be free, must be universal and must have equal access for everyone. It has to be free because even the smallest amount of money as a charge, even the smallest user fee, will deter people from getting the treatment. It has to be universal because, as the Minister of Health leaned over to me and said just a little while ago, "It is heartbreaking if some people can get treatment and other people cannot get treatment." So it must be universal. And there must be equal access - urban and rural, and men and women, because women, women in particular are disproportionately infected and they must have special and additional access to treatment.
And I stand before you ashamed. I am profoundly ashamed at the negligence, and the delinquency, and the failure, even up till now, of the international community to provide the resources which were necessary to fight this disease. I want to tell you that the international community has allowed millions of Africans to die unnecessarily. And I will never forgive them for that.
Number two: What I have learned is that treatment is best offered in these generic drugs at very low prices where you have to provide them only twice a day. They're called by this fancy name, fixed-dose combinations. But they're very inexpensive, and they provide excellent quality treatment as all the studies show. And because you only have to take them twice a day, there isn't as much resistance, there aren't many side effects, and it is fairly easy to adhere to the treatment.
Number three: I have learned from watching this project in the last day or so that it makes sense when everything is integrated. I've never seen a project that is so integrated. VCT [Voluntary Counseling and Testing], PMTCT [Prevention of Mother-to-Child Transmission], all of the preventive work, all of the lab work, all of the treatment itself, involving the community caretakers, the community-based organizations and the faith-based organizations; the Nacwolas, Admachas, and Muslim women's organization, and the UN family, and TASO, everybody working together so that fundamentally it is all community based, flowing from the hospital and eventually, as MSF says, decentralizing into district health units so that everyone will have access in Uganda.
Number four: I have learned that the toughest thing we have to deal with is human capacity, human resources. And there, it's necessary, as I know the minister and the government agree, to invest a great deal of time and attention to developing the people, particularly the counselors and the community health workers, as well as the doctors and the nurses and the midwives and the pharmacists - everyone - so that we have the people who can provide the treatment and the services over time, without interruption to the additional numbers who should be treated.
Number five: I have learned what is perhaps the most important thing of all: all of this integrated commitment should be funneled though one channel, and that channel should be the government and the Minister of Health in the way they want to do it through this hospital. That's why what MSF is doing today is so remarkable. They're turning over facilities, they're making the commitment. And I agree with the Director General completely: if there are others who want to get involved, they may find other places to get involved, but we have to use the public system for what is an emergency, to which the government appropriately responds.
Now the sixth point has very little to do with your government. It has much more to do with me. The sixth point is that the international community has to provide the resources in order to give the government the financial support it needs to purchase the drugs and provide the treatment.
And I stand before you ashamed. I am profoundly ashamed at the negligence, and the delinquency, and the failure, even up till now, of the international community to provide the resources which were necessary to fight this disease.
I want to tell you that the international community has allowed millions of Africans to die unnecessarily. And I will never forgive them for that.
But finally... finally, the international community is beginning to provide the resources. And we will not again have to have Rose come to this microphone and lay her quilt out before her and talk about the people who have died, who should never have died. This is a dreadful disease. It's taken a terrible toll on the continent.
The government of Uganda is celebrated everywhere as the government which, through President Museveni and his colleagues, has done the finest job of prevention. Now you have the opportunity as a government and as a society to set the model for treatment right across the continent. I salute you for that, and I believe you will achieve it.
I have one last thought before I surrender the microphone to the minister who is tremendously excited as he sees me slowly retreating toward my seat. Africa knows how to do treatment. Africa knows how to do prevention. Africa knows how to do home-based care. Africa knows how to handle support. What we're all struggling with now is the question of orphans. And we understand in country after country that one of the most effective ways to deal with orphans is to keep the parents alive.
I was at Mulago Hospital not very long ago, at the PMTCT program. The have PMTCT 'Plus', where the plus represents treatment for the mother who is HIV positive and whose CD4 count is below 200. I met a woman whose CD4 count when she came into treatment was one. One! And there she was, sitting in front of me, two months later, looking strong, entirely happy, and her two young children were playing at her feet. And I thought to myself: this is what all of this work really means. It keeps people alive.
And then as I was walking in the area this morning and looked at the marchers, I noticed the banner that the Omoja women's group was carrying. It said, "Why die soon? Life must proceed." And I thought to myself again, that's what MSF is doing, that's what the government is doing, that's what all of you are doing. May life proceed for everyone.
Thank you for having me.