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Nelson Mandela, South Africa's former president, closed the 13th international AIDS conference in Durban last week saying that poor people in Africa, “who would carry a disproportionate burden of the AIDS epidemic,” would wish that “the dispute about the primacy of politics or science be put on the backburner and that we proceed to address the needs and concerns of those suffering and dying.”
He followed this with a call to action. He said that to challenge the “grave threat” posed by HIV and AIDS, we have to “rise above our differences and combine our efforts to save our people.” He added: “History will judge us harshly if we fail to do so now, and right now.”
These words rescued the atmosphere of the conference, over which an air of desperation had settled earlier when South Africa's current president, Thabo Mbeki, opening the conference, failed to deal with the impression he has created internationally that he has doubts about the aetiology of AIDS.
Many scientists, non-governmental organisations, international agencies such as the World Health Organization, people with HIV and AIDS, and others had expressed their despair at the lack of inspired leadership to guide conference delegates. Some were angry that a group of scientists who contest the origins of AIDS was present at the conference, having been given new respectability by Mr Mbeki's flirtation with them.
Mr Mandela's speech, which pulled the morale of the conference back from the brink of that despair, also highlighted the major issue of the conference: the need to confront the fact that 90% of those with HIV and AIDS were in poor countries, mostly sub-Saharan Africa, and could not afford available treatment for the disease or the opportunistic infections associated with it.
Much of the science at the conference was also devoted to these issues, with the presentation of promising results from a South African team lead by James McIntyre and Glenda Grey of the University of the Witwatersrand. Their trial showed that when nevirapine was delivered to HIV positive pregnant mothers in two doses (one during labour, the other between 24 and 48 hours later) and to newborn infants shortly after birth, it could reduce the incidence of HIV in the babies to 10
The manufacturers of the drug, Boehringer Ingelheim, had earlier announced their willingness to donate it free for five years to countries in the developing world to reduce vertical transmission of HIV.
This trial, and several others reported, showed the need of the conference to focus on the accessibility of treatment globally. The conference focused on this issue with the help of AIDS activists, who emphasised that pharmaceutical companies needed to address how their drugs could reach those who most needed them.