Re: The writing is on the wall for UNAIDS

[Guest guest]

Dear All,

Re: /message/8832

As a person who has been in the " HIV industry " (as the author of this

article calls it) for all of his working life, I must say that I have

benefited enormously from it, and therefore I feel a moral obligation

to jump up in its defense. This is not withstanding the fact that the

de facto status of 'chamber of commerce' for this particular industry

bestowed on the UNAIDS by the author is a wee bit misplaced.

Shorn of the footnotes, references, and rhetoric, lets face it, this

article is a polemic for the moolah by the late risers in the health

'industry?'. The author lets the cat out of the bag, maybe

inadvertently so, in the very last line of the article, when he speaks

of tripling of health care workers salaries. Speaking of which, it

ties into my first point, my own benefits

from the industry.

Being in the industry from my pre-college days I must say that today I

can lay claim to serious upper-middle-class-dom, at least by Indian

standards. I have a low end diesel small car, I have rent to pay for

an apartment, I can support the periodic fancies of a boyfriend who

lives with me, I have acquired a dog, and I can often take a day off

in a place I am visiting on work and pretend that it's a vacation I am

making.

The only problem is that if I had not stayed in the industry and

instead concentrated on developing a legal career, as most of my

classmates from law school did, I would probably today be buying a

house of my own and driving a high end saloon, not to speak of those

real holidays spent in uninhabited exotic beach resorts. Well, the guy

who was the worst performer in class and who shall remain unnamed in

this article for fear of libel (I was in the top end of scorers, just

in case it's of any import) recently bought his third car, his second

house (a beach one in Pondicherry) and had his third child from his

second wife. I must surely be prospering in the industry, given my

potential, no?

And this is the crucial point that the author totally misses. Yes,

there is more money in HIV compared to other diseases. But that has

not happened because of any largess that various funding sources

suddenly discovered one day. It happened because of mobilisation over

years by those that were being treated as outcasts by society at

large. HIV was and continues to be a disease that disproportionately

affects those who are considered the dregs of society. The author

should try and do a bit of research to find out the last time someone

was accused of being a faggot or a whore, simply because s/he had

pneumonia or diabetes. But it is a daily occurrence with HIV, almost 3

decades after the onset of the epidemic.

And because it disproportionately affects people like us, hundreds

like me took a decision to forgo that big car for a bigger stake at

dignity. HIV gave us the perfect opportunity to do so. Here was a

disease that could not be tackled unless you tackled these other

uncomfortable questions and dealt with these other uncomfortable

people whom you thus far had refused to even acknowledge. Some of the

best brains (even if they were faggots or whores) got mobilised behind

a disease, probably for the first time ever in human history, and

claimed a seat at the table. And they were successful. This success is

not a competition with other illnesses for resources. It is

mobilisation for a dignified treatment, period!!

The above is the real 'proposition of exceptionality' of HIV. It is

not material poverty as the author has made out, it's the poverty of

the human race in treating some amongst themselves with dignity and

respect. And almost all those that the author has quoted in this

article to emphasise the point of 'less money for HIV, more for

others' are those whose governments (if not they themselves) believe

that homosexuals should be stoned to death. For them this argument is

a good bogey to challenge the relative success of the HIV movement to

attract some resources, which in turn go to 'undesirable' people.

Look at the blood safety situation in India and you would see how HIV

has strengthened and reformed certain parts the health sector from

which everyone has benefited. One can claim this success as the

exception that proves the rule, but I would say that this is the

compass that shows the direction it should take. With care and support

becoming ever more important, with ARV roll outs in many parts

becoming ever more possible, this compass should be clutched even more

firmly. The areas of compatibility with the mainstream health sector

are increasing and the opportunities this provides to strengthen the

overall health sector should not be lost out on.

The fact should not be missed that most of the HIV funds available

today are not part of budgetary allocations that governments and

ministers make. In other words they have not enough control over

these. No wonder they are miffed, if not outright pissed. That much of

these funds go towards meeting the health needs of and for serving

communities of undesirables is again a matter of outrage. So, the

simple question is what is stopping these esteemed governments from

allocating more funds in their national budgets to the health sector?

And if there is nothing to stop them, and yet they are not doing so,

then the so called competition for resources that the author avers to

is nothing but a false debate.

Yet these venerables do not stop spouting about the competition for

resources and how more need to be available for 'health sector' and

they even know the source of that more, take it from what is available

for HIV. Shorn of rhetoric all they say is that they should be the

ones spending the money now available for HIV, not some collective of

faggots, whores, or shooters. In case their designs are realised, I

cannot say much about the 'health sector', but the one sector that

would surely benefit are those of Swiss Bankers managing numbered

accounts.

So where does that bring us to as far as the real writing on the wall

is concerned? Simply this, WHO is a great organisation, so are all

other UN organisations. But all of them collectively have either never

exercised their minds, or have not had the occasions to expressly

state that faggots and whores are human beings that deserve human

dignity and respect. UNAIDS have done so, and in the process have

carried the burden of the failings or

omission of the entire UN system on their back. That they have also

done a competent job of managing and controlling HIV along the way is

just an aside. That they would continue to do so is a given.

Till diabetics organise enough to stake a claim to their own UN body,

not to speak of an entire stream of parallel funding to meet their

needs, let UNAIDS continue as the UN agency for faggots and whores. In

the process if Swiss Bankers manage a wee bit less business, it's

really their loss.

Best regards to all

Aditya Bondyopadhyay

e-mail: <adit.bond@...>

[Guest guest]

Dear All,

Re: /message/8832

I agree with Aditya and i feel that the author has based the article on several

assumptions. The article reminds me of the current South African President

Thabo Mbeki, who believes that it is poverty that causes AIDS. And if it is not

amongst poor people it is not a disease.

Well it is proven beyond doubt that AIDS is caused by the HIV virus and not

poverty. So to bring an age old rhetoric back seems that this " anti HIV " lobby

has run out of steam. They completely forget that the linkage between HIV and

poverty is from the perspective of impoverishment and affordability of treatment

and prevention measures. It is the poor people earning less than a dollar a day

that cannot afford a simple prevention measure like female condom that costs a

dollar. And yet if we feel that poor people have access to all prevention

methods it would be laughable.

To ignore the poorest and the most marginalised in an infection control means

that we have not learned the lesson from other infectious diseases. We are

facing resurgent Polio today just because we neglected very marginalised

sections of society. It is a dangerous trend where a lot of scientist are

saying that with the infection under control amongst women and children let us

cut the budgets for AIDS control.

They forget that without having to deal with most marginalised and invisible

sections of the society like the MSM, Sex workers, Transgender and IDU wishing

away the epidemic solely on the indicator that it is going down amongst women

and children, would be a public health disaster.

On the issue of spending more on health systems and strengthening them, I think

there has never been a problem. But my question is that why compete with HIV

and AIDS resources. The solution lies not in fighting for the small pot but in

increasing the capacity of the pot.

Are lives of MSM, Sex workers, IDU and Transgender any less valuable than that

of women and children? The articles smell of an underlying homophobia and

phobia of sex workers and IDU. An attitude than only a fanatic religious

perspective brings in. It is definitely not based on scientific reasoning.

And to say that strengthened Health Systems would be able to address issues of

the populations mentioned above would be turning a blind eye towards the way the

health system are structured.

The Health systems in most developing countries are highly bio medical in

nature. The perspective of Public Health is often flawed and confused with

Preventive and Social Medicine (PSM).

Participation in design and functioning of Public Health system has little or no

participation from the Affected Communities, Civil Society and Private Sector.

For the first time in the history Global Fund provided for participation of

civil society, affected communities and private sector in health programmes even

if they are limited to the three diseases. It would be challenge for the author

to give an example of one low-income developing country where such a model has

been tried.

It is this model that has prompted many governments to re-look into their

strategies and start involving communities in planning and implementation albeit

not in true sense of partnership.

NRHM in India is an example of half hearted attempt to implement that model.

The solution lies in not merely strengthening the health system but in

restructuring them with involvement of affected communities, civil society and

private sector as partners and not as recipients or contractors.

Only when this starts happening we shall see that the need for special vertical

programmes and bodies will slowly cease to exist.

Regards,

Rajiv

Rajiv Dua

E-MAIL: <rajivdua@...>

[Guest guest]

Dear freinds,

Re: /message/8832

I agree with Aditya and Rajiv. UNAIDS needs to live as an exceptional response

to an exceptional epidemic. Much as HIV 'normalisation' is getting increasingly

discussed worldwide and getting frightfully close to being accepted, there is

hardly anything normal about significant numbers of people getting infected by

the virus everyday, and significant numbers of people dying from the virus

everyday.

This despite the fact that after 25 yrs of the we now have many more tried and

tested answers to the epidemic.

If the HIV normalisation debate has anything to do with the availability of ARV

treatment, let none of us be misled; life with ARVs may stop deaths, but its far

from a picnic.

Living with HIV, with or wirthout ARVs, continues to be an exceptional

challenge.

Similarly, as a sex worker, MSM or IDU, being significantly and routinely

vulnerable to HIV, violence, discrimination and indignity - is undoubtedly an

exceptional challenege.

Being a young person embarking on a sexually active life in an age of HIV and

high levels of HIV related stigma, is an exceptional challenge.

Being a dis-empowered woman in the age of HIV is an exceptional challenge.

UNAIDS' existance is a manifestation of our collective acknowledgment of this

exceptionality.

However, every dissenting voice adds value to our response to HIV.

And when England, makes a rather well argued plea saying 'the writing is

on the wall', we need to think harder rather than shoot the messenger.

To me its worrying that he postulates the following: " The proposition of

exceptionality is now under stress. " If this is indeed the public perception,

explicit or implied, we need to reflect on whether we the AIDS community can do

more to continue to argue for AIDS exceptionality, and how.

AIDS advocacy is a continuous challenge, and here is another one.

Thanks and regards,

Mona Mishra

New Delhi, India

E-MAIL: mona.poslife@...

[Guest guest]

Dear All,

Re: /message/8847

We have to appreciate that a humongous development challenge like the pandemic

of HIV/AIDS ,necessitates a multi-pronged response with an extremely strong

component of effective communication built into it.

I cannot agree more with Mona,Rajiv and Adidty on the issues mooted and cogently

articulated in the forum.

The uniqueness and strength of the systems developed with lot of pains and

collaborative efforts of myriad stakeholders definitely need to be strengthened

..

It would be far from prudent to wish away the need of invigorating the

preventive measures just because of the ARV roll out.

Any attempts ,deliberate or inadvertent, for 'over medicalizaton of the

" prevention and control of AIDS " activities have to be actively discouraged.

While strengthening the care, support and treatment endeavours,all efforts must

be made to sustain and support all the pursuits,institutions and mechanism which

have been extremely effective in generating an evidence based robust response to

the challenge.

The writing on the wall is very clear ;-

WE NEED TO HAVE AN EFFECTIVE MAINSTREAMED RESPONSE TO HIV THROUGH ACTIVE SUPPORT

OF ORGANIZATIONS LIKE UNAIDS AS A PART OF COMMUNITY LED INTERVENTIONS WORKING IN

COMPLETE SYNERGY WITH GOVERNMENTAL AND NON GOVERNMENTAL PARTNERS.

LET US REDEDICATE OURSELVES TO A CONCERTED COLLABORATIVE ACTION TO STRAIGHTEN

ALL THE MECHANISMS AND PURSUITS FOR THE CONTAINMENT OF HIV/AIDS.

Best wishes,

Dr.Rajesh Gopal.

Dr. Rajesh Gopal, MD

Joint Director,

Gujarat State AIDS Control Society (GSACS),

O/1 Block, New Mental Hospital Complex,

Meghaninagar, Ahmedabad, Gujarat. PIN 380016

Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

e-mail: <dr_rajeshg@...>