George Strait: Today’s plenary sessions began with Dr. Paul Farmer of Harvard University. Given the experience of his work in Haiti, he showed how to implement drug treatment in resource-poor areas.

Paul Farmer: …learned from our experience in Haiti, and I will start by asking a couple of general questions. Why would we want to introduce antiretroviral agents to settings of great poverty? And there are several reasons, and they become, I hope, less and less important to debate each year. First of all, they may not be highly effective, as we sometimes call them, but they’re effective, and they will reduce suffering and mortality, and they may even help us in our prevention task. Number two, because there is an ever-growing outcome gap, whereby the rich world has more and more and the poor world less and less. Into this growing outcome gap, all of our efforts as a scientific and public-health community are now becoming enmeshed. We can’t avoid taking on these issues, these larger issues of social justice. Third, because we can reinforce our HIV prevention efforts by paying attention to people living with HIV and that paying attention to their families, and then, fourth, and most importantly, because we should introduce these agents in resource-poor settings because that’s what we’re being told by people living with both HIV and poverty. This is the inside of the house of a woman who, during pregnancy, received AZT to prevent mother-to-child transmission. Her child will very, very likely, and looks to be by now, seronegative. But unless we’re going to have this child be a seronegative orphan facing terrible conditions, we have to pay attention to this baby’s mother. It’s not as if poor people are a different species. These drugs work for everybody. The purpose of the global fund is to remediate inequalities of access to proven strategies. It is not to advance new research. We need to do research, but it should be operational research, and we should also have other partners helping us instead of hindering us to deliver these services if we know they’re effective. In other words, the job of the global fund is to do a better job bringing the fruits of science and public health to those who need it most. Some people say, “Well, we can’t use antiretrovirals, because the stigma is so great.” Others say the stigma is reduced by using antiretroviral therapies in poor communities. Well, let the people with HIV speak. This is Samuel, who asked me to use his name and his images in this meeting. This is Samuel the day he started therapy and Samuel two months later. And as he put it, “Now my children are not ashamed to be seen with me in the street.”

George Strait: Dr. Julio Frenk, the Health Minister of Mexico, made the case for more investment in the fight against HIV by all countries.

Julio Frenk: HIV is not just a virus. It is not just the top public-health priority of our time, but also, as the Secretary General, the Director of the World Health Organization, and many other international leaders have stressed, it is, indeed, the main threat to global development and security. I think we’re arguing in an increasingly convincing way that health, apart from being intrinsically valued, is also a key means for achieving development goals. And these are not contradictory. I think we need, always, to stand up and say and state and restate that access to high-quality health care is an intrinsic right. But in addition, we’re finding that this is also what makes economy’s growth. It is also what generates global security. And in all of this, AIDS has been clearly, clearly a key topic and the focus of many of this commitment. Obviously, there are still many challenges to face, and clearly, the most glaring inefficiency and inequity is in the field of purchasing. In my own region of Latin America and the Caribbean, it is really a painful part as Dr. Himien Zappula (MS?) has called it, that countries with a greater buying power actually pay less for antiretrovirals than countries that have less buying power. And this means that drug prices are not being driven by a market logic of market segmentation according to purchasing power, but really, they’re being driven by the negotiating power of the purchasers. Now, if this is the case, then we do have a solution in hand, which is joint purchasing. Such a mechanism has been suggested by Dr. Zappula that recently, for Latin America and the Caribbean, at the recent meeting of the International Development Bank, it would make even more sense for Africa, and this could be one of the new goals of the new African Union. It would also help to change the presentation of drugs to make them more suitable and more adapted to regional countries.

George Strait: Dr. Paulo Teixeira, the director of the AIDS program in Brazil, then explained the country’s long-standing program of free and universal distribution of antiretroviral drugs.

Dr. Paulo Teixeira: We have also managed to achieve a significant reduction in the rate of incidence, particularly within more vulnerable populations as men who have sex with men, sex workers, and intravenous drug users. The consistent use of condoms has been brought to new grounds. You observed a dramatic increase in the proportion of condom use in the first sexual intercourse levels of much wealthier countries. The schools have been a major factor behind such an increase. Currently, about 70% of all public and private schools have a lot of activities related to HIV/AIDS prevention, reaching about 30 million students. In the meanwhile, the number of new AIDS cases has dramatically dropped. The number of deaths from AIDS has also fallen dramatically, especially after the adoption of highly active antiretroviral therapy. I started to present (MS?) in this conference by a colleague from Brazil, Dr. Ricardo Marins, has shown that survival has increased substantially. The immediate survival time before availability of combined therapy was less than six months and now is close to five years, a twelvefold increase. More than just survival, quality of life has also improved extensively. Most of the patients were, one, working normally and interacting with their friends and families. Such gains must not be underestimated. The Brazilian policy has also managed to keep the average longevity of the Brazilian population nearly at the same level while (MS?). Truly, the key lies in mobilizing a new Marshall Plan to stir up national responses in poor countries as it was done by the United States to Western Europe right after the Second World War.

George Strait: Graca Machel, educator, child advocate, and the wife of Nelson Mandela, also spoke. She challenged the delegates to be as aggressive against HIV as the virus is against society.

Graca Machel: HIV/AIDS has proved itself to be an incredibly aggressive and comprehensive virus. It attacks the humans individually, and it attacks physically, emotionally, mentally, psychologically, spiritually, it attacks the friends and the well-being of the whole. It never leaves behind the same situation as before. But what I want to talk about is, I don’t think that all of us, in spite of the good efforts we have been making, I don’t think we are attacking the virus epidemic as aggressive and as comprehensive as we can. You’ll be disappointed because I know many of you are doing a very good job. You are very committed people. But in terms of results of what is happening, if you look back home, you’ll realize we are not attacking it as aggressively, as broadly, as comprehensively as to deal with that. We are sending a message which addresses practice. We are not sending a message which shakes the value system behind which, articles and behavior and practice are such. That’s why the weight of the value system of what children hear at home in society is such that although they know it doesn’t shake them to be able to change, my message is we have to revisit the message of prevention. To make sure that it goes deep into the value system, which put girls and boys in a situation where they are accepting themselves as equal to equals. We have to change the balance of power within our families, within the education we give to the young generation so that they will face the (MS?) in a completely different basis of what they do today.