8th August, 2008
The issue of gay and lesbian rights has taken unprecedented prominence at the International AIDS Conference going on in Mexico City, with a few ugly incidents, including the pulling down by pro-gay activists of a stand belonging to a Ugandan exhibitor. While acknowledging the need for programmes that catered to the needs of all vulnerable groups, Dr Festus Ilako, AMREF’s Deputy Country Director for Kenya, has cautioned delegates against allowing their focus to be derailed from the issues and agenda of the communities they work with.
“Africa has specific priorities, including weak health systems, shortage of health workers, gender inequality and disease burden.” Dr Ilako was speaking at an informal gathering of delegates from Kenya who were meeting daily to share information and exchange views and ideas on issues arising from the conference. The gatherings are convened by the Kenya National AIDS Control Council led by its director, Dr Sobbie Mulindi. NACC chair Prof Miriam Were said there would be a post-mortem meeting in Nairobi for all delegates to the conference to discuss what they had learnt and how those lessons could be used to improve HIV programmes in the country.
Rights issues of men who have sex with men (MSM), drug users and sex workers have indeed dominated the conference. In a keynote address during the conference, former American president Bill Clinton stressed the need for inclusion of all groups in the war against HIV, including gay men and sex workers. Continuing stigma and human rights problems continue to keep services from vulnerable populations, he said, fuelling the epidemic. Nevertheless he noted that there was still a lot more to be done to expand prevention, treatment and care of people living with HIV (PLHIV).
Mr Clinton’s William J. Clinton Foundation supports AIDS treatment programmes in several countries around the world, including Africa, with particular focus on lowering the cost of drugs and tests needed to be in treatment. “We must determine what each of us can do,” the former president said. “The theme of this conference, ‘Universal Action Now’, calls on all of us to make the best us e of the weapons at our disposal. We need to strengthen underdeveloped health systems, which limit the reach of life-saving strategies. We must integrate the fight against AIDS with the conversion problems of TB, malaria, other infectious diseases, and the lack of maternal and child health care. We need to evaluate what works and make better use of expanding our still limited resources. And we need to support scientists in their research and inquiries.”
The relationship between HIV and the overall condition of national health systems has been a heated topic of a debate at the conference, with one side questioning whether funding of HIV programmes boosts health systems or actually weakens them by focusing only on one disease. Mr Clinton said he believed that funding for HIV programmes can be a starting point to building stronger health systems that could provide universal treatment and care.
“There is an incredible opportunity to do so in the design and delivery of HIV services by taking into account the need for TB diagnosis and treatment at the same time. In some African nations, nearly three or four people who have TB are also infected with TB. It does not make sense for us to continue asking these people to go to two clinics with two doctors and two pharmacies and two strategies to treat one person who has got enough problems as it is.”
AMREF’s director for community partnering, Dr Daraus Bukenya, agrees that health systems need to be responsive to all the needs of the communities, but stresses that unless the communities themselves are part of the health system, they will not function effectively.
“Health systems strengthening must include communities. Programmes should be designed, implemented and evaluated in partnership between the formal health system and the communities to ensure that they are responsive to the needs of the people, and to guarantee sustainability,” said Dr Bukenya.