PHA-Exch> Piot: a good organization man ? (3)

[Claudio Schuftan]

From: Alison Katz <katz.alison at gmail.com>


   Bravo to Garance Upham for this spot-on, urgently-needed reply to the
news that Peter Piot will be leaving UNAIDS.

*My additional comments below apply to the entire AIDS establishment, not to
Piot alone. He **served as Executive Director in the **era of servility of
UN agencies to **powerful entities: **the USA, the UK, the G8, the World
Bank, the IMF, the WTO and the transnational corporations which govern **them
all. *

We now learn that the AIDS epidemic is going to be less serious than we were
lead to believe. Serious enough given 25% prevalence in rather a lot of
sub-Sarahan African countries. And certainly *serious enough to have merited
thoughtful, open minded analysis.*

WHO and UNAIDS and indeed the *entire AIDS establishment spent 30 years
strenuously promoting responsible individual behaviour*, firstly on the part
of African people in general and then in deference to a fashionable,
apolitical, "gender perspective" (a betrayal in fact of serious feminism) on
the part of African men.

S*erious analysis of the remarkable coincidence between miserable living
conditions and high transmission rates** was ignored*. There are plausible
explanations and mountains of evidence for biological vulnerability to HIV
infection in terms of malnutrition, under-nutrition and chronic co-infection
with other diseases of poverty. See for example Eileen Stillwaggon's book *AIDS
and the Ecology of Poverty*, Oxford University Press 2006. This evidence
implies a radically different approach to HIV/AIDS which goes way beyond
condoms, IEC and other interventions aimed at individual behaviour change.

Racist assumptions about African promiscuity certainly contributed to
the almost
exclusive focus on individual sexual behaviour in the response to AIDS - and
predictably, the imperceptible impact of international and national efforts
to control the epidemic.  Despite the rhetoric, the social and economic
determinants of all diseases of poverty including HIV/AIDS were never
seriously addressed either by UNAIDS or by WHO. *

Victim blaming - which is a pillar of the neoliberal approach to health -
predominated in AIDS discourse (albeit disguised in the pseudo-respectful
language of "sexual networking") from 1981 until now, despite scientific
evidence available already in the 1990s (from WHO and UNAIDS own studies!)
that sexual behaviour varies very little between communities, countries and
regions and that sexual practices appeared to have no clear relationship to
HIV prevalence. The perverse refusal to acknowledge the evidence and modify
the discourse and the practice accordingly has meant that insult has been
added to injury.

*Never was it acknowledged that HIV infection (like all infections,
bacterial, viral or parasitic) needs the fertile terrain of compromised or
non-functioning immune systems that are the inevitable result of miserable
living conditions.* The essential message,  respectful of human rights and
human dignity, should have been that the particular behaviour of people in
Africa does not account for the high transmission rates. The same behaviour
in places on earth where people's immune systems function because their
basic needs for health are met, does not produce high transmission rates.

The essential concept to explain the epidemic spread is biological
vulnerability. Real primary prevention would address such vulnerability (for
example through population-wide control of parasitic infection).
 Examination of the implications of biological vulnerability would have led
to dramatically different policy, strategy and discourse.

*The single most important fact*

Finally, in 2006, WHO acknowledged that "*There is a misperception that
there is a great deal of promiscuity in Africa, which is one of the
potential reasons for HIV/AIDS spreading so rapidly . . .  But that view is
not supported by the evidence*  (Dr Paul van Look, Director, Reproductive
Health Research, WHO, reported in Lancet 368, 2006).

This is perhaps the *single most important, most overdue statement that has
been made in relation to HIV/AIDS in 30 years* but its implications appear
to have been entirely ignored. Indeed the statement does not appear to have
stimulated any discussion at all despite the fact that it represents an
indictment of the international community's approach to HIV/AIDS over three
decades. That approach is and always was unscientific. It is also
insultingand anaffront to human dignity. An appalling tragedy and a
crime - as are all the
diseases of poverty today in a world of plenty.

*Alternative voices are invariably vindicated in the end*

The most important lesson to be retained from the AIDS debacle is that *in
the era of corporate science and capture by private interests of our public
institutions, it is vital (literally** it is a matter of survival**) to
listen to the independent and the alternative view.* It will have an
excellent chance of turning out to be correct. I challenge anyone to
identify a single warning emanating from environmental or social justice
researchers and activists, ridiculed, vilified, and silenced by the
establishment as eccentric and dangerous, that has not proven to be correct
20-30 years later. Remember that corporate science on climate change has
brought us to the brink of destruction.

*Can we afford 20-30 year delays in the acquisition of reliable,
independent, serious science? *

We, in the rich countries, will probably survive to observe and deplore the
next revelation of wrongdoing or neglect. But for those who die of AIDS,
diarrhoeal disease or acute respiratory infection, in other words those who
die of poverty, the answer is "no", we can't afford corporate, privatized
science and we can't afford a corporate, privatized UN. And for those of us
who recognise *our responsibility in **opposing **the construction of
poverty and inequality* - the answer is also "no".

Next time round, let us have the courage of our convictions. Always remember
that if a position is being put forward by the establishment, which today
emphatically includes the UN and its specialized agencies, it is unlikely to
have as its first priority the wellbeing of the world's people but rather
the maintenance of the status quo of the powerful minority.

The threat of redistribution of resources is nothing compared  to the threat
of permanent war and insecurity from ever growing, intolerable inequalities.
If Health for All had been achieved through a New International Economic
Order, the AIDS pandemic might have been contained. People would all have
food, water and primary health care and the fertile terrain for a pandemic
(mal- and under-nutrition and chronic co-infection with other diseases of
poverty), would not have existed.

If civil society including PHM has any role to play in the appointment of
the next Executive Director of UNAIDS, let us all insist on a person with
the strongest possible Health for All credentials and a thorough grasp of
social and economic determinants of disease. That person must have the
courage of his or her convictions to assert that pandemics of diseases of
poverty result from identifiable structural inequality and poverty and that
until and unless we are prepared to challenge those powerful forces, as the
People's Health Charter states, these problems will continue.



Alison Katz



*Incidentally, WHO also censored the "disease of poverty" approach. I was
isolated for 18 months and then removed definitively from any HIV/AIDS work
after being ordered by my director NOT to debate this subject in an internet
discussion. I published the censored perspective in "AIDS, individual
behaviour and the unexplained remaining variation". International Journal of
AIDS Research, 1:125-142, 2002.
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