I am registered at the conference as a physician delegate. They are anticipating 12,000 delegates in attendance. I will be primarily participating in the clinical track. The clinical track looks a little different from Geneva or Vancouver's presentations. There has been a lot of effort made to bring clinical relevance to the realities of HIV in developing countries, lacking the resources of the 'West'. In Geneva, the basic and clinical sciences were quite evidently skewed toward the developed countries, while the social sciences and human rights tracks were skewed toward the developing countries.
Another immediate contrast between Geneva and Durban is that this is the first AIDS conference to be held in a country experiencing the AIDS epidemic on the scale of a national disaster. The United Nations revealed last week that South Africa now has the largest population of HIV infected people in the world. And the province of KwaZuluNatal, where Durban is located, has the highest incidence in this country. What a contrast from Switzerland! Geneva in 1998 presented a model of excellence in HIV Care and prevention. South Africa's response has been clearly inadequate, to such a degree that there were voices that called for a boycott of the conference. This was intended to punish the South African Government for its AIDS policies. This viewpoint has dissipated mostly, as proponents of this view came to realize that being here and witnessing the epidemic and the power of international media focusing attention here has more potential for promoting greater progress in Africa.
A glimpse into how the future will evolve for South Africa,in regard to AIDS, will be seen at the opening ceremony on Sunday night, July 9th. The President of South Africa, Thabo Mbeki will be providing a welcoming address. He has received alot of criticism for the stance he has taken which provided an opportunity for naysayers who deny HIV virus as the etiological agent of AIDS to appear to have some credence.
Last week, the Durban Declaration was delivered by many prominent respected Nobel Prize winning scientists. This has been endorsed by thousands of other scientists, researchers, and physicians. The Declaration attempts to state clearly the etiology of AIDS and the proofs there of. It should be quite interesting to see how President Mbeki responds to this in his welcoming address. Press leaks say that he will make his position on HIV clear this week. In anticipation, security is quite tight.
It was quite an adventure to get David through security to the volunteer registration site which was deep in the convention center. He was successful in the end and, because he is an artist, he will be working with the cultural programme, which is titled 'Amasiko'. This word means culture, tradition, and social values. Amasiko promises to be a dynamic exhibition and interaction between different forms of art and performance to create an ethnic tapestry that reflects Durban, South Africa, and the world. It aims to give artistic reflection, translation and presentation of the theme of the conference, 'break the silence.' The cultural programme has expanded on this theme, 'Break the silence, lets the Drums roll.!" Tomorrow, David will begin coloberating on a mural, expressing the conference theme. He is quite excited about this opportunity to lend his artistic talent to this global art form. Prior to arrival in Durban, David had envisioned painting as his ideal medium to participate in the Conference. Today, he was asked if if he would like to participate in the mural project. He was thrilled!
Driving in Durban has been a harrowing experience. Not as crazy as Bombay, I wouldn't even try that, but unnerving would not be too strong of a word. Driving on the left side of the road, shifting gears with the left hand, traversing freeways torn up by construction,with narrower lanes than we are accustomed to, and pedestrians walking on the shoulders of the freeways, around broken down vans with 15 plus persons piling out of these vans onto the road.
This morning, David and I made it to Victoria Street Market. This is the center of the Indian District, the largest population of Indians outside of India. Aromatic scents of spices for curries filled the air! I never knew that there were so many types of masala, including one labeled, Guaranteed to get rid of the mother-in-law Marsala. I settled for 10grams of Chicken Marsala for 20 rand, approximately $2.50.
Tomorrow, the Treatment Action CAmpaign (TAC) has organized a global protest march to Durban City Hall to demand cheaper treatment for the pandemic. The march has been endorsed by 230 organizations from 33 countries across the world. TAC blames the acceleration of the disease in South AFrica on inefficent Government policies, lack of management of the diseas and unaffordable treatments.Globally, TAC estimates that only 5% of the worlds HIV sufferers can afford treatment! It is expected that Mrs Winnie Madikizela-Mandela and Anglican Archbishop REv. Njongonkulu Ndungane will participate in the march. A tght security net has been placed over Durban in preparation for tomorrow's march and later, President Mbeki's opening address.
It's getting late and I have not recovered from jet lag. I am going to close now and shall send this to you tomarrow from the conference site.
Yusuf Erskine D.O.
Today, we visited Shepherd's Keep, a home for abandonned babies in Durban. It was a heart-warming expereince. They have 15 babies under 6 months of age. They are the only 24 hour open orphanage for AIDS babies in 400 kilometer area around Durban. 80% of the babies are HIV positive when they are tested on arrival at the orphanage. They are often found tied up in black plastic garbage bags by the local police. They are brought here and open medical evaluation, social worker creates a file and they get to stay at the orphanage until they are placed. I hope to be able to download pictures from Shepherd's Keep soon, but certainly upon our return to California, we will get them on our web page. Dr.Erskine.com. The house is up on the bluff, looking down onto the harbor. It is a beautiful view of the harbor, but also shows the industrial nature of the port. According to Cheryl. the prostitutes actually go onto the boats to do their sex work. The babies reflect the multi-ethnic diversity of the population.
By 4 months, about 30% of the babies are truly HIV infected. They do not have access to medications to treat HIV, or lab testing of immune status such as CD4 counts or viral loads. They do have access to Bactrim, which they require alot for pneumonia. DEspite the horrific beginnings that these children have, they seemed very happy and peaceful; they definitely felt loved by the staff at the home. It costs about$225 US dollars a month to care for each child.
Cheryl and Collin who founded Shepherd's Keep were truly moved by the postcards that we brought from SEbastopol. These greetings card with spontaneous heartfelt greetings from patients, friends, staff and humanitarians who heard about our intention to visit children orphans, were truly a big hit. I could tell that at times, their work is quite bleak. but the card were an infusion of support and caring that will carry them in their work! They are hoping to create a collage with the cards to display at the home.
Today's lectures focused on REsistance Studies with current HIV medications and the debate about access to some medications (1-2 drugs ) versus treatment with HAART, highly active antiretroviral therapy with 3 or 4 medications.. IT was a very passionate discussion from both sides. Any treatment is better than none said the representatives of the undeveloped countries. Waiting may result in death. The problems with resistance and transmission of resistant virus were cautionary warnings from the developed world. It won't be resolved this weekend.
Representativies from the world bank, WHO, UNICEF, UNFPL spoke today about their concerted efforts to improve conditions in the world. They were greeted with appreciation and a demand for more action and less talk now. ACT UP PARIS broke into the symposium and demand access to all and medications for all in the world.
It is late now and I must get off. I do not have a phone where i am staying so i must borrow the owner's phone.
BE in touch soon.
Be grateful for your health!
Yusuf
I am having trouble accessing the internet from the bed and breakfast. So it will be difficult to email any attachments such as pictures. Hower, i can log on at the conference via this side and we can correspond.
During the day, the internet access line is always busy, at night, i don't get back from the conference till after 9pm and the owner's don't always make them selves available to use the phone. However as i said above, i can send and receive via this email address.
The conference is chocked full of information. It takes a half hour daiily to just organize my schedule as to what venue and what lecture, symposium or debate i will attend.
I missed some good lectures this am for the orphanage but it was quite worth it. The energy was beautiful and felt blessed. They were very, very moved by the tenderness of the postcards. They are thinking of putting them on in glass and having them visable from both sides as a display.
It was a beautiful experience. Thank you for inspiring it, Mimi!
They ar so hungry for information and skills for treating HIV, it would be wonderful if we could link them up with the San fRancisco, recycling program for hiv drugs.
Promising news about the effect of Viramune in preventing HIV transmission to infants from their mom. Two pills per event! It could sl;ow down the incredible infection rate here in South AFrica. In Durban alone, 1500 new infections daily.
I will stay in touch, but tomarrow David and I are off to the Nature reserve for an experience of non urban South AFrica, i will check on thursday, so please send an email Hope that Mitch is feeling better and say hi to all!
Yusuf
Earlier in the day, there was a march to Durban City Hall calling for access to treatment for People all over the world. Current estimates are that only 5% of people infected with HIV in the world have access to treatment! Mandala's daughter, Winnie addressed the crowd of a few thousand.
A large AIDS memorial was dedicated yesterday, it is the Red Ribbon Monument. I shall try to attach it as my first email attachment from South AFrica.
It is late and I am tired.
As the first international AIDS conference in the developing world, it was unlike any prior AIDS conference. What seems to have emerged is a powerful tribute to the strength of human will. In South Africa, where apartheid was abolished, the question arose, if we can stop apartheid and that was thought to be impossible, how can we not join forces and solve this huge problem of HIV/AIDS. The thought took form, this epidemic can be stopped if we work hard and join forces. Seeing how people maintain their dignity in the midst of an epidemic of stupendous proportions, unleashed a sense of power which was fueled by the development of a consensus. Health is a human right.
While the circumstances seem very different is Africa than in the USA, it would appear that everywhere in the world, this human right is being challenged and usurped. I could not help but think of the many struggles over the past few years that we have had over osteopathic manipulative medical care; denials of care, limitations in access to care, primarily in the realm of HMO managed care plans. Patients are being denied the care that they need!
It is time for the right to health to be raised in the consciousness of humanity and for laws and public policy to be revised to encourage health for all human beings.
Business, scientists, clinicians, politicians need to come together and find the way to provide the means necessary to stop this AIDS epidemic in a humane way.
Hope that you are well, attached is picture of Cheryl and Michelle from Shepherd's Keep, the home for abandonned babies in Durban.
Sincerely, Yusuf