ACW Interview: Mr Mark Heywood
At the 2nd South African AIDS Conference recently held in Durban, South Africa, June 7-10, AIDS-Care-Watch spoke with Mark Heywood, National Treasurer of the Treatment Action Campaign (TAC)and lawyer with the AIDS Law Project in South Africa on access to HIV/AIDS care and treatment and his hopes for 2005 and beyond.
ACW: Can you comment on current progress in scaling up antiretroviral (ARV) provision in your local context?
MH: Well, it’s significant that we’ve got to 45,000 people. If you put together the public with the private sectors that’s over a 100,000 people, which means that South Africa has one of the biggest programmes in the world, possibly the biggest after Brazil. But 100,000 people out of 700,000 who would probably clinically benefit from antiretrovirals (ARVs) is clearly a drop in the ocean.
So the reality is that most people are not getting appropriate medical treatment and therefore we do need to have care strategies for people who are not getting treatment because they live in a province that is tardy, slow and not committed or because it’s difficult to access a site because they don’t have money or for whatever reasons. And our general position is that there still lacks an unambiguous political commitment and that with that political commitment it would be possible to scale up significantly.
ACW: Aside from ARVs, which are other care and treatment options do you think are likely to add years or quality to someone’s life?
MH: I think a starting point is proper counseling at the time of diagnosis. It’s a massively under-resourced area and I hazard to say, anecdotally, but I believe this is true, that most people are diagnosed without appropriate information and that if there was empowering and generally informative counseling then it would be a start point that allows people to understand their medical diagnosis and consequently to take a range of decisions that would better their health or prolong their health generally.
And then after the issue of counseling, there are questions of ongoing psycho and social support, because one post-test counseling is clearly not going to be enough. If there’s access to proper information about HIV which allows people to monitor their own health, and by that I mean what TAC calls “treatment literacy,” frankly the more information the better and the more scientific information the better, and that doesn’t mean in complex scientific language, but it means explaining scientific concepts of resistance, of decline of immunity.
And then there’s access to social security and grants, which is an important issue, and appropriate treatment prior to ARVs; so early diagnosis of tuberculosis (TB), proper management of other opportunistic infections, whether it’s skin disease or candida, all of those things would prolong life. And of course nutrition is important.
ACW: What do you think might be the reasons for this difference [between rich and poor regions] in relation to HIV/AIDS?
MH: Poor people obviously have less access to clean water, food and medical services. If you put all those things together you have a more rapid progression from HIV to AIDS.
ACW: Is adequate or appropriate attention being given at the national or international level to preventing and treating these conditions [diseases such as TB and meningitis]?
MH: Today we’re actually launching a paper on TB. Obviously TB is the main cause of death for people with HIV and our TB programmes are in a mess and really what we’ve seen is that the same approach that we’ve tried to develop for HIV needs to be developed to TB, it needs to be popularized, it needs to be taken down to communities, there needs to be advocacy, early diagnosis, there needs to be much more hard information about TB and so on.
Our approach should be the same as for all other HIV-related problems; they are in the best position themselves frequently to determine at what point thrush becomes severe, at what point medicines are necessary and so on. There’s no inherent reason why people can’t recognize skin conditions and know the medicines that are necessary to treat those infections. So if they go into a clinic and they’re fobbed off with something that doesn’t work they know to ask for the right medicine.
ACW: In what ways do you think affected people can be empowered to take more control of their own health? What impact do you think this would have on their day-to-day lives?
MH: It really follows on from what I was saying now, which is that particularly in developing countries, there’s not enough doctors and there’s not enough nurses and there isn’t going to be enough doctors and nurses for a hell of a long time unfortunately. It’s far better to empower people and not doing away with the need for proper medical care, but it’s far better to empower people and empower communities about health and about medicine than to do nothing waiting for systemic changes which potentially could be a long time coming.
And then there’s just the obvious things, I mean if you have strategies to mitigate the burden of orphans, strategies to mitigate the various areas where we know HIV impacts then you allow people to remain functional. If people become too burdened by HIV, and not just by the illnesses of HIV but by mismanagement of its social consequences, then they are decapitated if you like, I mean they can’t respond because they’re too besieged by problems.
ACW: Do you consider 2005 to be a significant year? What are your hopes?
MH: 2005 has had the potential to be a significant year but I think what we’re seeing is that on many of the key fronts we’re not getting the progress that may have been latent in the year. I’m not confidant of G8 outcomes for a moment; the Blair Commission for Africa proposals seem to have not disappeared, but they’re not getting the prioritization that they need; WHO’s 3 by 5 is under attack by our own government and by a range of other organizations.
So it’s not a particularly good scenario frankly. It’s not to say we all must despair but as usual there’s sluggishness around the response which is to do with the general paralysis of the world in dealing with a poor people’s problem and a problem that is invisible to the mainstream of world affairs because it knocks out poor people. We know people are dying, that communities are being disrupted, that households are being disrupted, but its marginal people.
This interview was conducted by an HDN Key Correspondent, June 2005.
To contact the HDN Key Correspondent team, please email correspondents@hdnet.org)********For more information about Treatment Action Campaign, go to http://www.tac.org.za/For more information about the AIDS-Care-Watch campaign, go to http://www.aidscarewatch.org/For more information about WHO 3 by 5, go to http://www.who.int/3by5/en/For more information about the G8, go to http://www.g8.gov.uk/servlet/Front?pagename=OpenMarket/Xcelerate/ShowPage&c=Page&cid=1078995902703For more information about the Commission for Africa, go to http://www.commissionforafrica.org/.
ACW: Can you comment on current progress in scaling up antiretroviral (ARV) provision in your local context?
MH: Well, it’s significant that we’ve got to 45,000 people. If you put together the public with the private sectors that’s over a 100,000 people, which means that South Africa has one of the biggest programmes in the world, possibly the biggest after Brazil. But 100,000 people out of 700,000 who would probably clinically benefit from antiretrovirals (ARVs) is clearly a drop in the ocean.
So the reality is that most people are not getting appropriate medical treatment and therefore we do need to have care strategies for people who are not getting treatment because they live in a province that is tardy, slow and not committed or because it’s difficult to access a site because they don’t have money or for whatever reasons. And our general position is that there still lacks an unambiguous political commitment and that with that political commitment it would be possible to scale up significantly.
ACW: Aside from ARVs, which are other care and treatment options do you think are likely to add years or quality to someone’s life?
MH: I think a starting point is proper counseling at the time of diagnosis. It’s a massively under-resourced area and I hazard to say, anecdotally, but I believe this is true, that most people are diagnosed without appropriate information and that if there was empowering and generally informative counseling then it would be a start point that allows people to understand their medical diagnosis and consequently to take a range of decisions that would better their health or prolong their health generally.
And then after the issue of counseling, there are questions of ongoing psycho and social support, because one post-test counseling is clearly not going to be enough. If there’s access to proper information about HIV which allows people to monitor their own health, and by that I mean what TAC calls “treatment literacy,” frankly the more information the better and the more scientific information the better, and that doesn’t mean in complex scientific language, but it means explaining scientific concepts of resistance, of decline of immunity.
And then there’s access to social security and grants, which is an important issue, and appropriate treatment prior to ARVs; so early diagnosis of tuberculosis (TB), proper management of other opportunistic infections, whether it’s skin disease or candida, all of those things would prolong life. And of course nutrition is important.
ACW: What do you think might be the reasons for this difference [between rich and poor regions] in relation to HIV/AIDS?
MH: Poor people obviously have less access to clean water, food and medical services. If you put all those things together you have a more rapid progression from HIV to AIDS.
ACW: Is adequate or appropriate attention being given at the national or international level to preventing and treating these conditions [diseases such as TB and meningitis]?
MH: Today we’re actually launching a paper on TB. Obviously TB is the main cause of death for people with HIV and our TB programmes are in a mess and really what we’ve seen is that the same approach that we’ve tried to develop for HIV needs to be developed to TB, it needs to be popularized, it needs to be taken down to communities, there needs to be advocacy, early diagnosis, there needs to be much more hard information about TB and so on.
Our approach should be the same as for all other HIV-related problems; they are in the best position themselves frequently to determine at what point thrush becomes severe, at what point medicines are necessary and so on. There’s no inherent reason why people can’t recognize skin conditions and know the medicines that are necessary to treat those infections. So if they go into a clinic and they’re fobbed off with something that doesn’t work they know to ask for the right medicine.
ACW: In what ways do you think affected people can be empowered to take more control of their own health? What impact do you think this would have on their day-to-day lives?
MH: It really follows on from what I was saying now, which is that particularly in developing countries, there’s not enough doctors and there’s not enough nurses and there isn’t going to be enough doctors and nurses for a hell of a long time unfortunately. It’s far better to empower people and not doing away with the need for proper medical care, but it’s far better to empower people and empower communities about health and about medicine than to do nothing waiting for systemic changes which potentially could be a long time coming.
And then there’s just the obvious things, I mean if you have strategies to mitigate the burden of orphans, strategies to mitigate the various areas where we know HIV impacts then you allow people to remain functional. If people become too burdened by HIV, and not just by the illnesses of HIV but by mismanagement of its social consequences, then they are decapitated if you like, I mean they can’t respond because they’re too besieged by problems.
ACW: Do you consider 2005 to be a significant year? What are your hopes?
MH: 2005 has had the potential to be a significant year but I think what we’re seeing is that on many of the key fronts we’re not getting the progress that may have been latent in the year. I’m not confidant of G8 outcomes for a moment; the Blair Commission for Africa proposals seem to have not disappeared, but they’re not getting the prioritization that they need; WHO’s 3 by 5 is under attack by our own government and by a range of other organizations.
So it’s not a particularly good scenario frankly. It’s not to say we all must despair but as usual there’s sluggishness around the response which is to do with the general paralysis of the world in dealing with a poor people’s problem and a problem that is invisible to the mainstream of world affairs because it knocks out poor people. We know people are dying, that communities are being disrupted, that households are being disrupted, but its marginal people.
This interview was conducted by an HDN Key Correspondent, June 2005.
To contact the HDN Key Correspondent team, please email correspondents@hdnet.org)********For more information about Treatment Action Campaign, go to http://www.tac.org.za/For more information about the AIDS-Care-Watch campaign, go to http://www.aidscarewatch.org/For more information about WHO 3 by 5, go to http://www.who.int/3by5/en/For more information about the G8, go to http://www.g8.gov.uk/servlet/Front?pagename=OpenMarket/Xcelerate/ShowPage&c=Page&cid=1078995902703For more information about the Commission for Africa, go to http://www.commissionforafrica.org/.
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