AFRICA: Interview with AIDS activist Milly Katana
Milly Katana, founder of the Pan African Treatment Access Movement
MAPUTO, 31 March (PLUSNEWS) - Milly Katana is a members of the Commission on HIV/AIDS and Governance in Africa, which was established last year by UN Secretary-General Kofi Annan. A long-standing AIDS activist and founder of the Pan African Treatment Access Movement, she spoke to PlusNews on the need for accelerated treatment programmes.
QUESTION: A whole raft of treatment initiatives is underway, but they seem to be quite small scale. Are there significant challenges in the scaling-up that concern you?
ANSWER: I think, as far as HIV is concerned, we have very little evidence that small pilot programmes scale up to massive activities. That's why we're advocating for government to get involved, because in Africa it's only governments that have the capacity to do things [nationally]. The NGOs have good intentions, but their capacity just cannot match the needs; day by day the scale of HIV is bursting the banks. A country like Botswana is hitting [an infection rate of] 40 percent, South Africa 25 percent. The magnitude is so huge, we should no longer be thinking of pilot, small-scale programmes; we must be starting large-scale initiatives that are intended to reach all the population.
Remember, the way HIV spreads, if you arrest it in one place and don't arrest it in the other, in a matter of a few days we'll have cross-infections from one community to another. So, in a nutshell, we [should] no longer [be] trying things at this point in time; we know what works; we know what doesn't work. When you talk about treatment, we know that generic drugs work - cheap and simple regimens - just give them to the people."
Q: And yet, it's not happening - why?
A: It's not happening. I think we have many reasons: one of them is the different priorities between the different stakeholders; between the donors and the governments on the one hand, and also within governments. Our African governments have completely failed the people; they have failed to set the right priorities. Somebody said that in Africa we spend billions each year on weapons, but we cannot buy ARVs, which are now costing 50 US cents.
Q: The argument of a lack of capacity - is that a bit of red herring?
A: No, that's very genuine, but we cannot just moan about it; we have a problem with capacity - try and fix it and move on.
Q: What do we need to do to push the treatment process forward?
A: I think, first of all, we need to take a stand as African people, as leaders of African people. We need to decide, and get our choices right. Do we want to save the lives of our people, or play games at the expense of our people? If our stand is to save our people from HIV and AIDS, then we must say, 'we shall do whatever it takes'. If it means sweet-talking the donors into putting money into sustainable programmes ... then we can do that.
Q: Are you sometimes upset or disillusioned that much of the pressure for treatment seems to come from outside? As African people we don't seem to be demanding treatment as a right and using it as a political weapon, except for, perhaps, in South Africa?
A: I think we just have different ways of working. In my country [Uganda], if I went to the streets with my friends living with HIV, we can be shot at, and I don't want to take that responsibility. In South Africa it's different. People can go and toyi-toyi: a few of them maybe are put in police cells, they sign papers and they're released. We do things differently. Not that the voices are not there; the voices are very much there, [but] in some of our countries we don't have access to media, but the voices are there. People are desperate - they know treatment is there; treatment can save lives, and they're waiting to be treated.
Q: Obviously, gender is a vital, crosscutting issue. Are there special steps that should be taken that helps empower women?
A: For sure! We all know HIV in Africa wears a woman's face, and if we are to overcome HIV we must address the challenges that face women. If we're talking about prevention, we must empower women. If we're talking about treatment and care, we must empower women and children. We are seeing, now, substantial numbers of children being born to mothers living with HIV, and therefore have HIV.
To me, the magic bullet here is providing free access to care, prevention and treatment. Then the ... social issues - we can go slowly and mop them up. Of course, there are some men who won't allow their women to go to clinics because they've not authorised them; some women don't have transport money to get on a bus to go to a health centre. But if they know that 'where I am going to go the treatment is free', then they can do whatever they can: sell their cassava; sell their millet, to get the money to get to the clinic.