terça-feira, janeiro 03, 2006

O fim de 3x5

By Gregg Gonsalves
23 de Dezembro de 2005

What we're seeing now is the "return of the repressed," that is, instead of an activist WHO under Bernhard Schwartlander (who came up with 3x5) and Jim Kim (who implemented it), we're getting a public health traditionalist at the helm of the organization, Kevin DeCock, sometime in March (the interregnum, where the HIV/AIDS Department sits headless is notable in itself in terms of indicating the importance or lack of it that HIV/AIDS really enjoys at WHO).

I think it's fair to call Kevin a traditionalist, as he invokes Thomas Parran, US Surgeon General under US President Franklin D Roosevelt and Parran's book, Shadow on the Land, published in 1937, in which the Surgeon General outlined his plan to combat syphilis, as a clear model for himself as he muses about AIDS in Africa, in his famous 2002 Lancet article, Shadow on the Continent.

We are also seeing a return of the Blob of the WHO's bureaucracy, which like the star of the eponymous 1950s horror flick, consumes everything in its path, turning programs into jelly.

Let's be clear: 3x5 wouldn't have happened without the groundswell of grassroots support for treatment access from the Treatment Action Campaign, from HealthGAP, from MSF, from many, many other groups outside the mainstream of global public health.

Now, we have G-8 leaders, mostly the English, and UNAIDS trying to placate the outsiders, by telling us, 3x5 isn't over, it's now Universal Access by 2010. This would have been a credible sequel to the 3x5 initiative if some new goals had been announced with an analysis of why the previous effort failed to achieve its own targets and a call for us all to move ahead together with a spirit of renewed purpose and determination.

What we've seen instead is that Universal Access by 2010 is universal access to HIV treatment, care, prevention, human rights, stigma reduction, etc.---yes, it's heaven on earth in four years' time and I have nothing to wear to the party!

Moreover, there will be no "global" targets for the new Universal Access Initiative, which is to be country-driven. Of course, there will be no global targets. Global targets are scary. Eeek! The UN system, bilaterals, national governments get judged on outcomes with global targets. Targets might have to come with a plan to achieve these goals, with milestones and timelines. How much better to sit in Geneva and not have to feel responsible for reaching any target---whew, I have a lovely, well-paying job, in a lovely city by the lake, I already sweat enough during the summer here to have to sweat and worry all year round about reaching millions of people with AIDS treatment by 2010, 3x5 was bad enough...

And countries, yes, the countries, which complained loudly about targets in the first place: how dare anyone suggest to sovereign nations that they actually should try to treat 50% of their citizens dying from a treatable disease, it's outrageous. Only death will separate African politicians and elites from their Mercedes. In East Africa, they are called the wabenzi — men of Mercedes Benz — in Swahili, writes George Ayittey, in his Africa Unchained: The Blueprint for Africa’s Future. Only HIV/AIDS (tuberculosis, malaria) will separate African children from their parents, parents from their babies, husbands from their wives, wives from their husbands. So, let's see what 2006 brings.

Perhaps, I am too cynical and this series of meetings both on the international and country level on universal access will bring us detailed plans of actions, with specific measureable goals, milestones and timelines (e.g. 3 million on treatment by 2006, 4 million by 2007, 6 million by 2008....). I doubt it -we're slipping backwards in time now- on December 1st of this year, while our brave colleagues in Zimbabwe were getting thrown into jail for daring to demonstrate about access to treatment and the rights of people living with HIV/AIDS, back in Geneva, 3x5 was getting airbrushed out of the UN agencies' World AIDS Day festivities.

How different is this from 2000, when in Durban at the AIDS conference, the Treatment Action Campaign began to galvanize the world about the right to treatment. Zackie Achmat was once talked about for a Nobel Prize, but this December, it's Bill "I don't do treatment, I do prevention, and sometimes shiny new health toys" Gates and U2's ''drop the debt" Bono on the cover of Time magazine... HIV/AIDS is getting "mainstreamed to death" now--AIDS, everything about it, is being put into a big pot called All the World's Troubles, in which it's hard to pick out individual issues at all anymore, let alone organize a response to them.

Yet millions of consultants and officials (some rich men and rock stars) stand around the pot having meetings, giving a big stir to the pot once in a while to show they are earning their salaries or their accolades. When we say something, they remind us they are the experts, they are our leaders, and if we insist on claiming our rights, they dump us in a prison in Harare, Douala, Kaliningrad....

I think I know what we have to do in 2006-as labor organizer Joe Hill said as he was being put to death in the USA many years ago, he said, "don't mourn, organize." Well, we need to organize. Let's stop trying to out-expert-the-experts, showing them we know as much as they about diagnostics, health systems, intellectual property, procurement, tuberculosis. Let's politically organize wherever and whenever we can and help our colleagues in other countries to do so. This isn't about meetings and reports, this is about organizing a world-wide political campaign, with messages and media, a level of discipline and coordination that other successful political campaigns have had.

Most people I know now aren't doing political work, if they are, they are not in the USA, where we meet with each other and our opponents, where we criticize them and they criticize us, but unlike them, we have no political base of power any longer in the USA, we are talking heads without bodies. The advances we did secure early in the epidemic in this country were when there were people on the streets in San Francisco, New York, thousands of people, not dozens or hundreds, and millions marched on Washington to demand our rights.

So, it's time to go back to basics, and many of us remember how to do this, but somehow have drifted away from this kind of work. Yes, it's difficult, in the 1980s and 1990s, this kind of political organizing happened spontaneously and as the movement began to die at the beginning of the first Clinton Administration, we were tired and were all too glad to believe that finally we could get what we want from our leaders.

The Campaign to End AIDS is a noble attempt to revive the activist spirit, but why has it failed to catch fire, pull in significant resources, though it did give hundreds of new people a way to tap into the work. It now has to be brought to scale here in the US, were thousands and millions are demanding our rights once again. If we could put our collective brain-power together to figure out how to bring activism back to scale, well, that would be a critical task.

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