Human Question: Sonia Gandhi Speech / Unni Krishanan Interview
Duration: 00:52:51; Aspect Ratio: 1.366:1; Hue: 11.366; Saturation: 0.148; Lightness: 0.322; Volume: 0.120; Cuts per Minute: 4.275; Words per Minute: 108.432
Summary: Tracing the story of the global struggle to make HIV/AIDS drugs more affordable and available, A Human Question raises key questions of whether private ownership of knowledge can be at the costs of human life?
interview with dr. unni krishanan
Sonia : ...the passions of his beliefs, the intensity of his commitment has been a beacon to all of us, and most of all, his fortitude in extreme adversity, his light-heartedness, his compassion, and his statesmanship continue to inspire all of us in public life. And though his birthday is tomorrow, let us all wish him a very Happy Birthday today.
Today we close a conference devoted to an issue that dominates world headlines everyday. I am sure that all of us will go back reaffirming our resolve into combat this most dreaded scourge - a disease that is not a medical or a scientific subject alone, but a poignant social and human issue as well. We talk of strategies, of programs, of paths, of priorities, but let us not forget that ultimately, we are talking of men, of women, of children, of brothers, of sisters, whose suffering has to be felt, has to handled with great sensitivity and with great ___. (applause) even to say of suffering caused by HIV AIDS epidemic, it is to be expected that doomsday scenarios of its spread are commonplace. My country figures prominently in all these projections. While I do agree that there is no room for complacency, I would like to take this opportunity to categorically assert the determination and the ability of the government and the people of India to meet this challenge just as effectively as they did in the campaign for eradication of smallpox some decades ago.
We have ____ to meet socio-political and economic challenges in the past, and I am more than confident that we will do so again in the present context. India faces numerous public health challenges. We are meeting these challenges in the framework of growth, faster economic growth as well as social welfare, and human development intervention. AIDS control accounts already for about 10% of our national health budget. Many in my country believe that we are paying disproportionate attention to AIDS at the expense of malaria and TB. But the present government does not ___. In fact just last week, it s budget increased the allocation for the national aids control organisation for this year, although we do recognise that the amount still needs substantial increase. In the very first articulation of these priorities, on assuming office, a little over 50 days ago, the new government drew full attention to the need for strenthening our AIDS control effort, and this will be accomplished through a variety of means, including increased funding, greater involvement of NGO's, more widespread education and better health facilities. We seek the sustained understanding and support of the international community, multilateral and bilateral financial agencies, as you all know, have been very generous and so have some private philanthropic organisations. And we welcome these corporations since it is only through such partnerships that we will be successful. India therea are distinct dimensions to HIV AIDS and our national ids control programme has to take into account a regional, as well as a number of other, variations. Also you may be aware that some Indian companies have gained global recognition for developing inexpensive generic drugs. (applause) And some of these are used in many parts of the world, I believe
For the past few years, India has not included ART in drug control program, and this was making for a shortage of resources at the highest cost of price. But things, I'm glad to tell you, have begun to change. The ART has made a beginning as far as the government's program, and is being phased up (applause) in the last few years, our national aids control program is has quite a number of success stories. The entire chain for blood supply has been made safer, condom use has spread and could have a significant impact on HIV AIDS prevalence in ____. Vaccine development initiatives have been launched with international collaboration. We are aware that vaccine will not be available for quite some time, but we do recognize their enormous potential, and I do hope that we will be in a position to launch field trials very soon. Indian businessmen, political leaders, sports icons and filmstars are spearheading an extensive campaign to heighten public awareness, to speak up forcefully against ____ stigma and apathy, and to remove the misconceptions of HIV AIDS patients that still exist in the public mind. NGOs are involved in a variety of areas including public information, education and communication, disease ___, counseling and care of patients, especially women and children. The suffering of children particularly has come into sharp public focus in recent times. And here I would like to acknowledge the NGOs - all NGOS and activists, their invaluable role, and I commend their dedication and their sincerity.
I myself head an NGO, which is the Rajiv Gandhi Foundation, and it has been active in Mumbai ___, and it is a matter of some person satisfaction that USAIDS has included in its program for ____ toolkit of local responses to HIV AIDS, and it's one of the best practices. So much is being done, but it is equally true that we need to do a great deal more. First, I believe there is a great need to target stigma and discrimination and to safeguard the rights of people living with AIDS to with regards to access to information, services, and treatment. We in our county are holding countrywide consultations for drafting legislations to address these. Second, greater insight and commitment are needed to deal with the social issue that prevents proper recognition of the scale and nature of the problem. There is need to integrate ___. Third, the fight against AIDS is intrinsically connected with the effort in achieving gender equality.
Fourth, public health systems have to be made more effective and sensitive to the people they serve. Traditional healthcare providers, especially at the community level, need to be empowered with more accurate information and to be appropriately regulated. Fifith, the world, including my own country, needs to spread awareness and information through education and other means so that prejudices that harm individual and social health can be removed. Now clearly the government has a major major role to play. But communities also need to take initiative to care for those who suffer, to rid themselves of the social ills and individual habits that cause the spread of the epidemic. My own interaction with HIV AIDS patients has brought home to me the heartbreak and trauma that is wreaked not just on those directly affected, but also on those in the families. Through the years, I have seen the terrible emotional toll that HIV AIDS can extract part from its huge physical ravages. I have seen people who have lost their jobs, who are ostracized by their community, who can no longer hope to raise and bear healthy children, infants in orphanages who no one wants to adopt because they were struck by the disease even before they were born. I have met families who suffered the agony of watching their loved ones slowly fade away and found themselves helpless, isolated and shunned in their grief. Today, therefore, let us all renew our commitment to work together to find new ways of reaching out with compassion, with empathy, with understanding, to the millions and millions of men, women and children who are tragic victims of the physical and social devastation caused by HIV AIDS.
I would like to finally once again express my gratitude to the royal Thai government for giving me this unique opportunity to be with all of you today. My country India and Thailand share a close cultural, political and economic relationship, and our Prime Minister will be here in just about a fortnight. We in India have much to learn from this country in many areas, not the least being in HIV AIDS management itself. Thank you.
UNNI INTERIVEW (Q : Your name and designation, and what you do..) I'm a medical doctor. I work as a volunteer with the People's Health Movement, which is a large grassroots movement, which has got presence in nearly 100 countries. I also work as a staff, as a team member with Action Aid International, which is an international development and humanitarian organisation that works in about 45 countries.
(Q : What is the PHM Charter?) we are here in this conference primarily because we would like to amplify the voices of people in nearly 100 countries where we work. And in large conferences like this, the voice of ordinary people never reaches the ears of decision makers, politicians, policy makers and others. So we are here to amplify people's voices.
(Q : you believe that has happened successfully in this conference?) it's very difficult to say that, because if you look at the last... the actual test to see whether the people's voices are actually making an impact will not always be in conferences like this. Let's look at the scenario. Two years from today, exactly today, there will be another conference that will be happening in another part of the world. 2 years. For many of the politicians, the pharmaceutical companies, and the big private corporations who are here, everyday might mean 24 hours, but for us, the frontline workers who are often dealing with people living with HIV AIDS, the families who are finding difficulties, everyday is not just 24 hours, everyday is actually 8000 deaths. 8000 lives that are lost every 24 hours because of HIV AIDS. One of the efforts that we,ve been putting in the last 24 months is to work towards a much more broad based approach to deal with the difficulty of HIV AIDS. it's because we find that HIV AIDS is no more. HIV and AIDS is no more a medical issue, not just a social issue, it's more of a political issue that calls for much more of a broad-based, a solidarity as well as an alliance response, an alliance across communities, an alliance across countries, an alliance across organisations, philosophies, politics - that's one of the efforts we have been putting. We have been involved...the PHM has been involved in developing the People's Charter on HIV AIDS, and this Charter is perhaps the political manifesto of grassroots workers and solidarity groups to demand health as a right and care for those who are affected and infected with HIV and AIDS, as a right. That is, care, treatment, and access as a right.
And we are here also to redefine access - one of the key themes of this conference. Access is not just about medicines, it's about access to food, nutrition, employment, job security, shelter, livelihood, and of course access to medicine as well as medical and health care. that is how we look at the case of...access in its holistic form.
(Q : What is you interest in this conference?) This is a huge conference. On the one side, it has given an opportunity for people to connect with each other, but on the other hand, this conference has been dominated by patents, politics and profits. But we believe that putting people first is extremely crucial in winning the battle against HIV/AIDS. That is one the things that this conference has not been able to achieve, that is, how do we put people first? Straight from the beginning if you look at how much money you need to pay to register yourself to get access to some of these deliberations, plenary sessions, and the meetings. Perhaps if there is one lesson the conference organizers must take from this conference to the next conference, it's the fact that to ensure people's participation , you cannot put a fee of 1000 dollars, the battle against HIV AIDS can only be won by involving people at all levels, including the involvement of ordinary people in conferences like this. They will not be able to be involved in this if the registration fee continues to remain 1200 dollars, with which, one of our colleague from Nepal today was saying, we could actually have built a small shelter, a small house, for a family who have been affected and infected with HIV AIDS. So this is the dynamics of money that is involved with that. On the other hand, should people based organisations, should NGO's expect really much from this conference? Till this is going to be dominated and dictated by pharmaceutical companies, who are one of the key players in this conference, the agenda of people will be missing. It is going to be again profit that will definitely dominate, unless there is going to be a paradigm shift in the way in which we look at conferences like this. And we,re definitely clear - we wanted to be here, at least we,re here in small numbers because it is this conference which is going to decide, and which is going to set the agenda for the world, how HIV AIDS should be looked at, and how it should be responded to, in the next 2 years time. We definitely want to influence that agenda, even with whatever great difficulty we might face, because it is this agenda that is going to decide what is going to happen to those 8000 lives that are lost everyday because of HIV AIDS. We believe that by influencing that, we may be able to reduce, in fact we should be able to stop all these deaths. That's the reason why we are here.
(Q : What about the presence of various governments?...) long political statements and shallow promises - that is what this conference has been repeatedly showing one after another. What has happened to this 10 billion dollars they had promised long back? Which is a very small money, which the world has not been able to get. And this 10 billion dollars, let me remind you, is a small fraction of the amount that is need to fight HIV AIDS, at the same time, the same world dictated by the politicians who have been here and the politicians who have been influencing this conference in many ways, the world spends about 960 billion dollars as military expenditure. So this is the contrast you see. And it is time for soul searching for the politicians who are here and the politicians who are involved in the fight against HIV AIDS. It is time for soul-searching at two levels, one, if you do not have money it's time that you identify why you don't have this, and where is your money going. In order to cut expenditure which is wasteful, like military expenditure, and to put it for the life that should be saved from the grip of HIV AIDS, and this is one lession the politicians have not been able to actually learn. It is actually time to act. We believe that short sentences, and short promises...Let me say it again, what we need is not just slogans and commitments, what we want from the political leaders and the leaders of national governments is action, because time is running out.
(Q : So many people are making money and careers out of HIV. In your experience, what is influencing such behaviour?) HIV AIDs epidemic, which actually reached pandemic proportions, is actually located in the larger context of what is happening in the field of health and medicine. Today, especially in the era of globalisation and liberalisation, we understand that the role the TNC's, pharma companies, food companies, cosmetic companies, etc. are dictating how the world should be responding to the health emergencies. We do not find much progressive responses coming in such a situation. What I mean to say is, there is an absolute anarchy that is existing when it comes to HIV AIDS. This is dominated by some of the...HIV AIDs actually has become a hostage in the hands of powerful drug companies, a few international NGOs with dubious questionable distinction and credibility, like especially those promoted by the multinational drug companies , and especially the international financial institutions. So HIV AIDS is a hostage in their hands. It is time that we take it way from their hands, so unless we broad base the fight against HIV AIDS by taking it to more and more trade unions, student associations, youth groups, and above all, people-based movements and organisations, the fight against HIV AIDS will not be a winning battle. It will be alosing battle. So if you look at that case, because of the liberalisation and the globalisation policies dictated by the international and financial institutions, there is an absolute anarchy that exists in the pharmaceutical sector today. So I mean to say that anarchy exists even in the graveyard today. I mean to say that, for example fyou take the case of a country like India, there are more than 60000 brands that is available in the market without much idea what are these products about. And most of these so-called medical products are products which are badly looking for diseases, not the other way around. So there is no mechanism involved to inform and educate, doctors to begin with, what is the protocol involved in the new medicines that are coming into the market. So the only source of information often is what the pharmaceutical companies give as their sales promotion literature. So that's the case with some of the older products, and some of the newer products, including ART medicine, medicines that are required to treat HIV. So in this absolute anarchic situation, it is too much to expect to happen from the pharmaceutical scenario alone. Because the case of HIV AIDS is much more rooted not just in the medical sector, definitely in the social sector, definitely in the other sectors that define politics, and social indicators like education, healthcare, food and nutrition and several other disciplines. So this is what we need to see - the several broader dimensions of HIV AIDS.
(Many feel that the HIV AIDS conference, and HIV AIDS programs, remain outside of other social movements, Why? ) HIV AIDS has been a very slippery issue, among social movements. Because despite the fact that this has been wiping out a generation in Africa, social movements have not really been able to get a grip of the issue. On the one hand, you see the genuine issues relating to HIV AIDS slipping out from our hands like an eel. Amongst UN organisations, among other international financial institutions, so you see on the one side, the real issues of HIV AIDS getting slipped out of the hands of...BREAK FOR SETTING CAMERA...
So, on the one hand, the dominant constituency today ...on the one hand the dominant players like the very few UN organisations, international financial institutions, and the powerful drug multinationals have not been addressing the real issue, the real issue has always been slipping, or they,ve been conveniently been ignored by this constituency. On the other hand, the constituency that could actually make a difference, are the large social movements, the political movements, who could actually make the difference, and for them HIV AIDS...they,ve not been able to capture the real issues of HIV AIDS as a social and political issue. So unless we cross the artificial walls that have been created by these financial institutions, UN institutions, and drug companies, where it has been more and more confined as a medical issue, and as a health issue, unless we are able to articulate it as more of a social and a political issue, we will not be able to win the fight against HIV AIDS.
On the one hand, death is actually happening. But this is one place where we see the limited role the media has been playing. The media has not been playing a very progressive role when it comes to HIV AIDS. The images of people who are dying, cremations that are happening in cemeteries and in graveyards, have actually been powerful images. But we also need to inform the larger constituency - ordinary people that, on the one hand it is wiping out the generation; on the other hand, positive interventions, and joining hands with other movements, joining hands with people and their families, the people living with HIV AIDS and their families, have been able to make some inroads in the fight against HIV AIDS, especially in the case of Africa, and parts of Asia. It is these messages, also the positive messages that the media needs to carry to the rest of the world.
(Q : Health officials and NGO activists agree that India faces a big problem. Yet it doesn't form part of the mainstream campaign...) India is a ticking time bomb when it comes to HIV AIDS. Earlier there were lots of allegations that some of the figures that has been coming out about the prevalence of HIV AIDS are not correct, there is something wrong, etc. But today, the country has slowly started waking up to the fact that the time is ticking away, and this is going to cause a major devastation in the country. This is a new development that has actually happened. But if you look at the case, the number of people who have been infected, or at least the figures that have been rolled out by the UN organisations, is actually a very large number. But we must also remember that India is a country where stigma and discrimination has been playing a major negative role. What do I mean by major negative role? The negative role to such an extent that people have not been able to come forward and say that I am infected, I am a person living with HIV AIDs, it has not been easy at all for such people. So it is quite logical to think that the number of people who are already registered, and who have already been identified as infected, will be a small number compared with the actual problem that we should be dealing with. And this is going to be a major problem in the coming years, especially when the tide is going to turn against the people who are already infected. it's time the politicians actually wake up, and come out with much more progressive, much more inclusive, and much more, I would say pragmatic, approach to deal with HIV AIDS.
(Q : WHO is starting a 3/5 programme. But what happens when (unclear)) The 3 by 5 initiative of the WHO is a very welcome sign. We feel that it is a very important initiative. But the problem with the 3 by 5 initiative is, it is not often located in the social and political realities in which we exist today. It is absolutely necessary that the world makes a commitment and implements the 3 by 5 programme. At least about 3 million people will be getting the benefits out of it. We are keen that the programme survives and becomes a success. But the problem with this promise and this commitment is more or less similar to the commitment and promise which the WHO made 35 years ago. In 1978 the WHO made another promise - it promised health for all by 2000. It is time the WHO does some introspection why that dream actually failed. It failed because the WHO did not look at the social and political determinants of health, and today it is a very important factor. So the 3 by 5 is almost like putting the seed without actually looking at the weed. Unless the initiative looks at the negative determinants of health like the role of pharmaceutical corporations, the military expenditure involved in that, the weak public health system, 3 by 5, like any other initiative, is doomed to fail. So this is a very important lesson.
There has been some positive signals coming from countries like Thailand, India and Brazil in terms of their capability and ability to produce ARV medicine, the medicine that are required to deal with, respond to HIV AIDS. In the recent past, we have been getting positive signals from India, Brazil and Thailand, and these countries havebeen able to demonstrate their capabilities to produce medicines against HIV and AIDS. But the major problem we,re going to face now, and the disaster we,re going to face now, is when there are going to be changes in the patent as well as the intellectual property directions. Where the prices, cost of medicines are going to shoot up. And the other thing that has been happening in Thailand, in some of the South East Asian countries is the very negative and devastating impact of the free trade agreements. It has been understood very well, from the countries that has agree to free trade agreements with US, with Australia, and some of the northern countries, the rich countries is that, the poor countries actually lose out in this unfair trade deal, that is the free trade agreement. The impact of free trade agreement, and WTO directions on the patent issue, will not be limited only to the case of medicines. It is going to have an impact on food, it is going to have an impact on essential services. And when food sector is going to be affected, nutrition is going to be a major problem. And for people, medicines, even though it's one of the most important determinants of deciding how long they will live, whether they will be able to deal with HIV AIDS in a positive way, will also be influenced by how much food they will have, how much nutrition they,re going to get, and how much basic essential services they,re going to get. So this is where the definition of access becomes extremely important. Access for people should be, and will always be, defined by access for anything, access for everything, access for all, and access everywhere. And if there is one lesson that we,re learning when we talk about patents, politics, profits, and HIV AIDS, the most important lesson is that we,re witnessing the disappearing of a generation in Africa. If there is one thing which we should remind ourselves, and which international communities should remind themselves everyday, is that the lives that have been lost in Africa shouldn't go waste. They must learn lessons from Africa, and we should see that we honour those lives that were lost in the last two decades.
(Q : A lot of the media in Asia really don't know what's been happening wrt HIV...) Asia is a large continent with a variety of cultures and a variety of politics, and a variety of other push and pull factors that have always been influencing. Let's look at the case of Central Asia for a moment. Central Asia is emerging as a major flashpoint as far as HIV AIDS is concerned. There the factor that are influencing, in Central Asia, are the increase in number of intravenous drug users. The use of intravenous drugs is a major amplifying factor in Central Asia. The second one being impact of conflicts, conflicts leading to forced migrations and trafficking of human beings, and when people are really pushed out during conflicts, and are pauperised by conflicts, they often tend to cross either the boundaries of countries or they end up in other situations, and poverty is a major influencing factor in HIV AIDS in Central Asia. If we move on to South Asia, there are other factors like stigma and discrimination. That is playing a major role in South Asia. Move on to South East Asia. You see other factor like economic factors, and to a great extent stigma and discrimination as well. Then the questions relating to human rights violations. And the complacency in certain countries to say, look we don't have a problem. At the same time we know very well you scratch the paint, you see the problem really exists. On the other hand there has been a willingness from the political leaders, at least from some countries in south-east asia, willing to come to the front and open up and say that we,re now realising and now we,re actually getting a feel of what is going on, and we would actually like to respond, and it is that positive message that other leaders, or the leaders of other countries in Central Asia and South Asia could actually learn. And this is a very important signal that is coming from South East Asia, especially countries like China.
(Question inaudible) Let's look at where we were last year exactly, and let's say the last six months of momentum that has gone into the AIDS conference. Exactly the same time from last 2003 January to May there was a major build-up for a different issue which is very closely linked to HIV AIDS. We saw millions of people marching in hundreds of cities protesting against the war on Iraq. That was not a major mobilisation before 2003. The antiwar movement actually existed in the world. But we saw the willingness of the people, people who are not just part of the peace movement coming out more and more on to the street. And as an optimist, I believe that when millions of people march in hundreds of cities, it will definitely have an impact on the decision which the political leaders like the Presidents and the Prime Ministers make in the countries that often define the agenda for the world. This is an important lesson which the people who are working on the issue of hIV AIDS should learn, that is, when you broadbase your constituency, when you approach the issue more from a solidarity angle, and more from an alliance approach, we will get more and more people to be with us, to be with us on the streets, in hundreds of cities to demand for more access, and to claim health as a fundamental human right. In order for that to happen, the demonstrations should...public demonstrations must happen in the streets, but also there must be negotiations in boardrooms like the conference, like here, and this will be possible only when we broadbase the campaign, and that is going to be the calling for a more and more broadbased appoach. (I'm not getting specifically on what you said about what is going to happen)
In this conference, again we have seen numerous promises that were being made. Excellent promises, realistic promises, and promises that can actually decide life and death. We want to see that these promises are fully implemented. In order for these promises to be implemented, we need to put the pressure on the government, we need to continuously put the pressure on the government, we need to challenge, and hold international financial institutions, the pharmaceutical companies (a very important player in this) accountable. And in order for that thing to happen we need to be vigilant, we need to be alert, and we need to be proactive. Only with this we can ensure that at least some of these promises that were made here in various stages and various platforms, is fully implemented by the time people meet for the next conference.
I think one of the key strategies that the PHM and the nearly 100 countries who are here working, will be using, will be to broadbase our campaign, to take the fight against HIV AIDS also to the other arenas, to be more inclusive and a greater involvement of other social movements, other political movements, and most importantly, the people who are infected, people who are living with HIV AIDS and their family members and their communities. It is going to be one of the greatest challenges we are going to face, but this is exactly one of our focuses. And we hope that by the time the next conference happens, there will be much more amplified voice of the ordinary people that we are committed to ensure will be heard during the next conference.
On the one hand, we have a limitation of the international aids conference being organised by the International Aids Society, which is actually a consortium or a formal outfit for the leading multinational pharmaceutical companies. So it will be too much to expect from such a forum how they will address the real concerns of the people. It will be too much to expect. On the other hand, there are avenues available like the WSF, European Social Forum, Asian Social Forum, Latin American Social Forum, and variety of other people- based movements. It is extremely important that such forums understand the importance of HIV/AIDS, and start addressing HIV AIDS on an emergency basis. And there are several groups who are working as anti-war, peace initiatives, and several other social mobilisations, like people fighting to reclaim their lands, and several other things. Unfortunately HIV AIDS has not emerged as a key agenda for them. It is our responsibility to see that HIV AIDS becomes a number one agenda, along with other crucial social issues like other epidemics, the public health issues, and the impact of WTO, and the impact of wars and conflicts. Along with that, we should ensure that HIV AIDS is being placed as a number one agenda.
There is a possibility, there is a possibility - that was one of the things that was pushed today - that in Bangalore, as a symbol, that we invite everyone who have come here to Bangkok for just a quick catching up on what has happened. But we are also trying to invite the politicians who have been here, and it is extremely important, especially when we spend lot of money, energy and resources to be in conferences like this, to do a reality check. What have we actually been able to achieve out of this? We'd have been able to achieve some, but how do we actually find our strategies by the time the next conference happens? So there will be a small meeting in Bangalore which will definitely be - invitations will be extended to all the people who have come here - plus whoever is interested to know what is going on here. That will happen soon in 10-12 days time, at least within a month's time from now.
Shots of workers clearing up area, Ronald Macdonald figure being taken away, etc.