At the opening ceremony tonight that launched the HIV/AIDS Implementers’ Meeting, two noteworthy events (outside of a wonderful acaplella performance of the Namibian national anthem by the local band Vocal Motion 6 (VM6)):
- Hifikepunye Pohamba, President of the Republic of Namibia, led a long delegation of senior political leaders that included the top officials in his Cabinet as well as many members of the National Assembly.
- And one speaker, Kevin M. DeCock, head of the World Health Organization’s HIV/AIDS program, delivered a speech that looked at all the scientific developments in the last year. And he also laid out challenging ethical and political questions for those working in AIDS programs, warning that others “no matter how unfairly’’ may draw comparisons between AIDS treatment in the developing world today to the infamous Tuskegee study in which researchers failed to appropriately treat syphilis among poor, mostly illiterate African-Americans between 1932 and 1972.
Pohamba underscored the political commitment of Namibia to the fight against HIV/AIDS by spending several minutes saluting national leaders who were in the audience. Then he made strong use of numbers:
“The HIV/AIDS pandemic still remains one of the biggest global threats to mankind,’’ he said. “The number of people living with HIV continues to rise, as does the number of deaths due to AIDS. The year 2009 marked 28 years since HIV was discovered; in 28 years, the world lost more than 25 million people to AIDS.’’
“Remember,’’ he said, “Namibia has only 2 million people.’’
DeCock, who is leaving his WHO job in two weeks to return to one of his former jobs, head of the Center for Disease Control and Prevention’s office in Kenya, swept over a range of scientific developments in the last year, drawing special attention to two – providing antiretroviral treatment to those in the developing world and expanding coverage to prevent HIV transmission from mother to child.
On preventing HIV transmission from mother to child, he noted that 90 percent of HIV infections in pregnant women are found in just 20 countries, “highlighting the need to focus prevention efforts.’’
The “most pressing issue’’ involving WHO guidelines on the issue, he said, concerned how to prevent breast-feeding transmission. Some 40 percent of all pediatric infections pass through breast milk, he said.
On whether to start treating patients earlier – several studies have shown strong benefits in either treating upon diagnosis or when a patient’s CD4 count is 350 or lower, compared to 200 today in the developing world – DeCock noted the tension between following evidence and coming up with the money.
“Changing starting criteria has major implications for cost and choice of drugs,’’ he said. “Starting at 350 CD4 in countries like Kenya or Zambia will double treatment need, and there will be the communication challenge of explaining an apparent decline in coverage because of the expanded denominator.’’
He added: “We are entering perilous ethical and political waters, and current practice for poor people of color in the global South will not be judged well by history if it does not evolve with science and practice in the richer North. As a long-term CDC employee currently with WHO, I do not raise the memory of Tuskegee lightly, but cite it to warn all countries that others, no matter how unfairly, may draw an analogy between earlier and today’s events. The world cannot allow a permanently two-tiered system of global AIDS treatment with late initiation of outmoded drugs reserved for the South.’’
When DeCock finished, the audience cheered loudly. When the clapping stopped, Namibian Health Minister Richard Kamwi, the moderator of the event, said simply: “Wow. That was it.’’