“There is another moral imperative in this world, and it’s called: ‘Treatment as Prevention’, and it deals with HIV and AIDS,” Stephen Lewis, co-founder of AIDS-free World

Transcript of Welcoming Remarks by Stephen Lewis at HIV Treatment as Prevention Workshop, Vancouver 2013

Moderator, Stephen Lewis:
In order to exercise incomparable compassion I’m going to speak for a few minutes so that David Wilson can finish eating, which is unusual for me to be vaguely decent on platform.

I’m glad to open this session on Global Solidarity.

We’re making the assumption I think that the panelists, who have the advantage of being able to speak into the mike rather than holding the mike, will give some sense of how ‘Treatment as Prevention’ has permeated their various activities and organizations and parts of the world.

If you will permit me I thought I’d like to use the prerogative of the chair by saying a couple of things before this session actually begins – and the things I want to say flow directly from the discussion of the panel this afternoon, I have four points to make:

Number one, there seems to be a consensus in the room – almost ‘full-throated’ in it’s fervor – of moving from what was a contentious theory to what Michel Sidebé called: A Human Right. And I think Julio [Montaner], at the end of that panel, made an argument about the scientific evidence which was unanswerable. And certainly from the panel in the person thinking of the beleaguered countries, of the minister of health from Malawi, there was an extraordinary rendition of what Treatment would mean. As would be the case if for example you had heard from Swaziland where there is a very insistent ‘Treatment as Prevention’ programme taking place. I think for what it’s worth that we should all take this moment as a cause célèbre and move the mountains that are necessary and see this as a clarion call meeting for ‘Treatment as Prevention’.

Number two, this CD4 count stuff has been bedeviled us long enough I think. Personally I with Bryan Williams, I recycle all of them undoubtedly and put them out to pasture. Tomorrow you will hear from the World Health Organization – I’m not sure what they will say, and I’m certainly not one of those people whose privy to the Guidelines, which will emerge in the middle of this year, but I would bet that it will be 500 or 550 or something of the kind, surrounded as always by the World Health Organization with caveats which serve to liberate and strangle simultaneously. I suspect that ‘B-Plus’ will not receive the kind of support that 500 will receive, but that will eventually be shown. But what is important I guess is to point out what all of us understand, that when you move it to 500 – and ultimately down the road, not far off, remove the nonsensical CD4 count entirely – then you really are opening the floodgates for treatment, and the target of ‘fifteen million by 2015’ becomes an ephemeral target because it will be twenty million or twenty-five million or more. And that will be felt and seen immediately.
So despite whatever circumspect cautious and tentative things are said by the World Health Organization – if the leadership comes from the top of that organization, then we will have taken tremendous strides.

But that brings us to the third point I want to make which is about resources: I notice that Eric Goosby was very very careful in his parsing of the availability of resources. And the Global Fund of course has asked for fifteen billion dollars between 2014 and 2016 in order to do the job. I noticed in an off-air today in the ‘Guardian’ that Kofi Annan was asking for 5.5 billion dollars for polio – the number of cases of polio in the world so far to this date in 2013 are 18 in three countries: Afghanistan, Pakistan and Nigeria. 5.5 billion dollars for 18 cases thusfar, which may rise to 50 or 60 during the course of the year. We’re talking about money to save millions of lives – I don’t diminish or depreciate the effort to remove poliomyelitis as a scourge from the earth. But I do say that there has to be a balance of priorities here, and as we ask for the funding for one we ask for the other.

And I would say to some of my colleagues and friends that we have to stop the groveling and the begging and scraping before the political potentates. Just because Barack Obama and Hillary Clinton have used the phrase: “AIDS-free Generation”, doesn’t mean that we should wear our knees threadbare in their presence and applaud with unseemly adoration because the ‘phrase’ is offered. The 1.65 billion dollars that is in the budget for next year for the Global Fund is frankly compared to the possibilities of the United States, pretty paltry. And the fact that the PEPFAR monies receded last year – and receded again this year – is not a terribly welcome signal. And if you will allow me to make the observation, official development assistance has declined in 2011 by 3%; in 2012, by 4%: A loss of over ten billion dollars internationally. And the United States of America, adjacent to which Julio and I live and, naturally, are steeped in reverence, the United States of America has spent two trillions dollars on two wars in Afghanistan and Iraq and the recent Harvard Study suggests that they will spend a total of four to six trillion dollars when the debt has been paid down and when all of the military personnel have returned and been treated for physical and mental illness. And when you compare those sums of money for two individual wars with countless human suffering and uncertain results against the struggle for Global Public Health, I would simply put to you that it’s time for all of us scientists, activists and others together collectively to put the kind of pressure on government – which has subsided. These extraordinary G8 Governments pretending to have terrible economic hardship can almost always find money for other priorities, beyond the human priorities – and it’s time for that I think to be bestirred again. A very close colleague of mine was reminding me of what is spent in the sports arenas alone around the world, and the amounts of money that that – and that serves largely men – the amounts of money that we spend on other things when there are so many human priorities.

And the fourth and last point I wanted to make is that Africa is growing, as has been said, but I beg that we do not get carried away. The World Bank released a report last Wednesday showing the state of extreme poverty in the world – people living on less than a dollar and a quarter per day, still amounting to 1.2 billion – and every single region of the world has experienced an astonishing reduction in poverty from 1981 to 2010, except sub-Saharan Africa. In sub-Saharan Africa poverty has declined from 51% to 48% – a microscopic decline in over 30 years; and worse than that, the numbers of people in poverty have doubled to over 400 million. And those millions are located in significant measure in the countries which are dealing with high prevalence rates. So let us not kid ourselves about the resources that are required internationally – they’re desperate, and countries can’t get off the hook.

I was thinking to myself as Michel Sidebé finished today, when he reminded us of the extraordinary gains in South Africa in the last couple of years moving to nearly two million people on treatment at roughly ten US dollars a month for one pill a day which has just been introduced, and I thought to myself – you’ll allow me this:
– Of all the people who died during Thabo Mbeki’s deniability:
– Of the slowness with which we introduced the prevention of ‘Vertical Transmission’ over the years;
– Of the slowness with which we moved on ‘male circumcision’, when we knew earlier what the studies would portend – as Julio said graphically at the end of his remarks; and
– How much women have never been fully attended to, in any respect, at the heart of this pandemic!

There is a tremendous fight still to wage! And there is a good feeling in this room that we have the vehicle called ‘Treatment as Prevention’ in order to do it. So along with gender equality, and the rights of key populations there is another moral imperative in this world, and it’s called: ‘Treatment as Prevention’, and it deals with HIV and AIDS.

Thank you

This was transcribed by treatmentsciencewriter.com’s Lance Sherriff.


1 thought on ““There is another moral imperative in this world, and it’s called: ‘Treatment as Prevention’, and it deals with HIV and AIDS,” Stephen Lewis, co-founder of AIDS-free World”

  1. While this talk has as its focus the very important need for effective as treatment as prevention strategies in resource-limited nations, I think it would be very useful to have a comprehensive review of the literature on viral transmissibility on ART, with reference to gay men. A number of western governments have made statements in recent years to the effect that viral suppression on ART reduces the risk of transmission to negligible levels. Most notably the government of Switzerland stated in 2008 that HIV could not be transmitted by a person who had maintained an undetectable viral load for greater than 6 months and had no other STIs. Recently the UK government added more weight to this, stating that sustained suppression of viral load is “as effective as consistent condom use in limiting viral transmission”. However, the vast majority of the studies on which these statements are based were conducted with heterosexual couples. Conversely, the amount of data on the effect of ART-induced viral suppression on risk of transmission in gay men appears to be much more limited. While I understand the critical need for effective prevention strategies for heterosexual vaginal intercourse, which accounts for the vast majority of HIV transmission globally, we must also not neglect the issue as it effects gay men, who remain a very high risk group. There is a danger that without attention to the relative significance of these studies for gay men, it may be erroneously assumed that anyone on ART with an undetectable viral load is statistically non-infectious regardless of whether the sex they are having is vaginal or anal. Do we know this is true? I would love to see a comprehensive article discussing this, as I think it is badly lacking and urgently needed. Anyone up for the job?

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