Mark Heywood: “AIDS is about deeply-rooted social issues”

Mark Heywood was the most eminent speaker at BTC's AIDS conference on 30 November in Brussels. This South African activist sued President Mbeki's government in constitutional courts when the government failed to distribute free AIDS inhibitors.

Heywood won the case. He proved an enthusiastic speaker, who cannot agree with the UNAIDS statement that the end of AIDS is in sight.

The latest UNAIDS report speaks about great progress – even about 'the end of AIDS’. May we be optimistic?

Over the last decade progress was made indeed: 8 million people worldwide get treatment, including many in poor countries; the price of medicines has fallen, whereas quality has risen. In South Africa the transfer from mother to child has fallen from 30% to 2.5% - this means 409 000 rescued lives. In this respect, we live in a different world compared with 10 years ago.

But exactly such positive messages and that success are a danger. Danger for those who use AIDS inhibitors, and feel better, and therefore do not use the medications as prescribed any more, and so forth. Danger that the waning health systems and budgets weaken the distribution of medications. Danger that public opinion is relaxing and thinking: "Right: That problem is solved". While this is not the case at all. Chances are real that things deteriorate as the attention, commitment and budgets for AIDS are shrinking. Besides, the AIDS epidemic spreads in some countries. So, the fight is certainly not yet won.

But AIDS attracted a lot of money and attention, more than other health problems.
Yes, but we need to get rid of that aversion for AIDS's so-called 'exceptional' status. The extra attention for AIDS was not to the detriment of other issues, quite on the contrary. Extra doctors, nurses and budgets also benefit other health domains. Efforts to reduce AIDS-related child or mother mortality, for example, led to better follow-up of pregnant women. Campaigns for AIDS testing also cover testing for diabetes and TB.

In the past we have often responded badly to diseases in developing countries. It is not because AIDS constitutes an exception, that we should stigmatise AIDS. On the contrary, we must try to get other issues at the same level as AIDS. And the money is there. Just look at the state setting aside its largest budgets for... It all boils down to political will and priorities.

Is there a link between AIDS and development?
AIDS is definitely a cause of underdevelopment: breadwinners are killed and orphans are left behind, AIDS takes up most of the household budget for the medicines, and so on. It has consequences for practically all sectors in society: education, agriculture, infrastructure...

But also vice versa, shortcomings in other areas are risks for AIDS. Everything is linked. To give an example: If a school has no good sanitation facility, this may deter menstruating girls from going to school. They are behind at school, have nothing in their hands to enter the regular job market and get involved in prostitution and its risks.

But AIDS is also a matter of development in the positive sense. AIDS has strengthened civil society, the social fabric. And, above all, it has set the democratisation processes in motion. Citizens ask their government for a well-functioning health system; they ask for accountability; they ask for good governance. And it does not stop with AIDS. Those who learned to ask for AIDS services, also use that capacity in other situations. This side effect of the AIDS issue also comes in handy in other areas.

The AIDS issue is about more than a virus; it is a 'social disease': It denounces social ills. It is about gender equality, violence against women, how medications are developed and sold, about child abuse, drug users and sex workers. How do we deal with this in our society? We know how we can reduce AIDS among drugs addicts, but if we treat this group as outcasts and do not provide medication or prevention to them, we would still have a long way to go. To what extent are we interested in the fate of poor people? These are not Europeans who die, so there is no sense of urgency. This is all about deeply-rooted social issues and human rights.

Mind, a minimum level of democracy must be present. South Africa has a properly functioning legal system, which makes it possible to enforce one's rights in court. In other countries, which lack such basis, things are harder to achieve.

What are spearheads for the future?
We need more accountability. There are huge budgets available while there's definitely been corruption and mismanagement. We need to look into that more. Mind: Better management does not mean we need to deliver more complex reports. Complex procedures only complicate the work.

We must increase quality, quality in information, in monitoring AIDS, in access to health care, in medicines. And we need to watch out for new forms of discrimination: Good advice or good information is not always available for the poor among us.

And we must continue to see AIDS as a major threat, in particular for health and for development. If we do not do that, it will come back to us and hurt.