KristofDecosterThe Icasa conference isn’t over yet – tomorrow is the final day – but I thought I’d already give some of my impressions. This is the first time I attend an Icasa conference, or even an HIV conference. It’s good to be here, for a number of reasons.

I understand better than before why the fight against HIV is so important on the global health agenda, and especially in this area in the world. Even if people are saying that there is now increasing HIV fatigue linked to the general donor fatigue, I also witnessed the enormous energy of civil society, activists, and inspiring people here in sessions and in the corridors. ‘Miss Condomize’ for example, Bidia Deperthes, blew away the audience in the plenary on Monday while talking about the new Campaign ‘Condomize’. Thousands of people just shouting out aloud ‘sex’, in the plenary, is something unimaginable at, say, the Health Systems Research symposium in Beijing last year (even if some people were uttering the word rather reluctantly). The sex workers are also a very noisy bunch, arguing for decriminalization of their work.

I also understand better why the phrase ‘Now more than ever’ is such an evergreen in global health. The needs are indeed huge, hundreds of thousands of people are still dying from this disease, and moreover, there is a sense that these few years will be crucial in the fight against HIV. Having said that, it was obvious that the ‘Ending Aids in this generation’ discourse polarizes people. Some people, like the dynamic Michel Sidibé from UNAIDS, embrace it and see it as a great mobilizing goal post-2015, others, like Mark Heywood think it’s irresponsible and that UNAIDS should drop the goal altogether. I find myself situated somewhere in between. I hope the slogan ‘we can be the generation that ends Aids’ won’t suffer the same fate as the ‘we can be the generation that ends poverty’ which already has been declared decades ago, and we’re still nowhere near last time I checked. But I do think, for example, that HIV/AIDS should be at least a regional post-MDG goal (I’m not sure about a global goal, I think it would be good if post-MDG goals were made up of a number of global goals, like UHC or education for all, and then a few continent-specific goals). HIV definitely requires to remain on the agenda in SSA, and probably in a few other regions in the world as well. But for the West, for example, it’s much more urgent to change unsustainable consumption and production patterns. A combination of universal and regional goals seems to me the way forward.

As my colleague Raoul Bermejo noted, the conference offers an interesting mix of human rights based approaches and ‘smart’ investment approaches so far. I also attended an event yesterday evening in one of the coloured slums in the area – the première of the third season of the MTV series  Shuga on young African people, struggling with life and with HIV related issues. Mark Dybul spoke briefly at this event as well. It’s great to see that when donors fund a cool series like this, which is then taken up further by local communities, so that people in slums start talking about these difficult issues which are still surrounded by a lot of stigma, great things can happen.

A recurring theme here was the fact that domestic revenue for HIV is increasing in SSA, and rightly so. Many other things, like co-morbidity, are also being discussed in detail. And I have to say that hearing all these stories from committed people and sometimes actions from desperate people – like a number of Nigerian patients yesterday in the session on the ‘End of Aids: myth or reality’ who confronted their Minister of health about substandard ARVs that are killing people in Nigeria as we speak – say so much more than reading about HIV statistics and trends in Lancet articles. From an institute that tends to emphasize the holistic, health systems lens – and rightly so – I understand a bit better now the dire mood in the early 2000s when the disaster was unfolding in this part of the world and why disease-specific approaches have taken off. I also understand the stigma around HIV better, even if it has somewhat improved. Some people say the stigma around homosexuality is far worse now than the stigma around HIV in SSA. The brave testimony of the gay activist on the opening plenary was a highlight for me, in this respect. Incredibly courageous.

There’s one concern I have, though. The sessions provide relatively little on the global political economy, the urgent need to develop in a sustainable way, the need for global financial justice, …  the big picture so to speak. Even in the session on the ‘End of Aids: myth or reality’, where projections were made till 2050, this bigger picture was strangely absent, by and large. That is a shame, as it will and should have massive consequences on the HIV fight and the position of HIV on the global agenda (as can be seen in the ongoing post-MDG negotiations). For example, if part of a future climate deal  requires that fossil fuel resources are left in the ground, this will have major repercussions on the fiscal space of African countries. Or, on financial global justice, as a colleague told me, ‘I don’t understand why the West hasn’t been dealing with tax havens the way the US deals with Cuba’, so that the financial sector and multinationals can at last be properly taxed. The HIV community should join other groups fighting for this. For some reason, although there’s quite some emphasis on social determinants in some sessions, these debates are avoided, at least in the plenaries, which is a shame. The difference with the People’s Health Movement Assembly from last year, which also took place in Cape Town, and started from a very in-depth analysis of the state of the world, is profound. Still a bit silo-mentality thus, in spite of all the talk about integration and ownership, although there were some exceptions in sessions.

Let me also offer a remark on the framing of the HIV struggle: especially at the opening plenary, I got at some point the impression that the main roles for heterosexual men are confined to ‘being condomized, circumcised and refraining from sexual violence’. These are, of course, key, but why is it that you hear so often here ‘Nations are built on women’ while it should be ‘Nations are built on women AND men’? Men need to be involved in different ways, in this fight. Shuga seemed a great entry point.

Finally, of course, Nelson “Madiba” Mandela is all over the place here. Everybody is saying they’re not mourning him, but rather celebrating his life. People all over the world are admiring the man for what he has been for his country, and he will rightly become an icon of humanity, if he isn’t so already, just like Mahatma Gandhi for example. One of my ITM colleagues even is a bit of a ‘Mandela groupie’, she watches hours and hours of documentaries on Mandela on tv; the man still seems to attract women, even now that he has passed away. I have to admit he’s a far better role model than Jacob Zuma, the man who is totally ignored here, unlike Mandela and the South-African Minister of Health, for obvious reasons. Having said that, I think all of us should read this Guardian Op-Ed by S Zizek on the legacy of Nelson Mandela. Zizek provocatively wonders whether Mandela would still be seen as a universal hero, if he really had won. For his people in South-Africa, without any doubt, yes, but what about the likes of David Cameron and other neoliberal capitalism proponents who now unanimously praise ‘Madiba’ as if they have much in common….

When one passes the slums around Cape Town, you just feel sad and even bitter about the enormous inequality in this country, twenty years after Nelson Mandela came to power, and the toxic legacy of Apartheid in GINI terms and in terms of crime and violence, including sexual violence. If I can offer just one advice to South-Africans: I would bring in the Chinese, to ensure social housing. The social housing situation is improving, apparently, but it’s going way too slow. Trust me, if you bring in the Chinese, things will go faster. Much faster. The question on individual versus collective freedom arises then, obviously… The world is a complex place.

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