Africa has been the poor relative with too few representatives at global HIV/Aids conferences. But things are changing, writes Mia Malan.
Aids is a mirror that reflects how we think about society. It displays whether we judge those different from us harshly or embrace them in their diversity, whether we have faith in modern science or are deeply suspicious of it and whether we view those with less education and more disease as our equals or as lesser beings.
HIV, in all its intricacies, reveals the state of societies around the world. It exposes dysfunction, from racial and gender prejudice to political inaction and homophobia. It highlights the ever-widening gap between rich and poor – those who can afford medicine and those who cannot – as well as the cracks in countries' governing structures and the role, or lack of it, civil society plays in trying to seal those fissures.
Every two years, the International Aids Conference melds all this together under one roof in a steaming cauldron of chatter, banter and serious debate. Thousands of people (rich, poor and in-between) interact. Research studies of varying quality leave a paper trail kilometres long. Opposing views fly across rooms like scud missiles.
By the time the gathering reaches its conclusion, the few days spent in the cavernous venue feel like weeks – or mere seconds, depending on whether you feel that your particular field of expertise has received the attention and achieved the results you desired from the event.
At the conference, delegates take stock not only of how much progress scientists have made in their attempts to save the world from a devastating epidemic, but also the levels of discrimination against those infected with a virus that continues to rage.
Whether the world is getting life-saving treatment to those who need it is always a hot topic. Mention that you are South African and thus a citizen of the country with the most people living with HIV in the world, its biggest antiretroviral drug roll-out and the homeland of "that man Mbeki" and his health minister whose name they still cannot pronounce, and things get hotter.
About 25 000 people (including more than 1 000 journalists) gathered last month at the 19th International HIV Conference in Washington DC. Even the media rooms of such conferences reflect the state of the world. Sub-Saharan Africa, the world's poorest region, where HIV infection rates are often 10 times higher than those in the developed world, had the fewest reporters present.
In the conference's media room, the Western world still ruled (China, it seems, had little interest in trying to dominate an HIV meeting). Super-confident American and British journalists were on first-name terms with leading scientists; they live in the same countries. These reporters have had considerable time and resources to cover a specialised topic consistently, unlike journalists in less developed countries, who must cover a briefing by the health minister in the morning, a political protest at lunchtime and rush in the afternoon to the zoo to witness a rhino give birth.
News organisations from developed countries had entire teams of reporters covering the conference. Almost all African journalists at this year's gathering had been awarded scholarships or sponsorships to attend. They were all one-person teams, rushing from panel to panel, from demonstration to demonstration.
But they were fortunate to be there because most African media houses – including some of the continent's most powerful – were absent, even though it is Africans who are the most affected by HIV.
Absent African representatives
It is the Western journalists who often act in the interests of the developing world and interrogate the issues affecting Africans. Such reporters, particularly those from the big wire services, were able to attend sessions focusing exclusively on HIV in Africa when sometimes not a single reporter from the continent was present.
Perhaps even more shockingly, African representatives were also absent from many of the conference's media panels. Despite such panels addressing issues that are unfolding in Africa, often not a single one of the experts lives, works or hails from the continent. Some have never even visited Africa (that Seychelles holiday cannot be counted). One panel focusing on the media and HIV did include an African delegate – me. Of a panel of 10 international journalists and scientists, I was the sole representative from Africa.
Not surprisingly, the dialogue was dominated by HIV in the developed world. Some kind soul did, however, take pity on me when he threw a question my way. It was: "How did it feel to report on HIV under the rule of Thabo Mbeki?" I should have been irritated at having to regurgitate ancient history. Instead, I did my best to answer, happy to be involved, finally able to free lips that had become stuck to my teeth owing to prolonged silence.
The question and my answer did, however, give me the opportunity to reflect just how radically the sphere of HIV has changed in South Africa in recent years.
Being a South African journalist at an HIV conference between 2000 and 2008 was an almost comical, but also incredibly sad and embarrassing affair. Comical, because all you did was run after former health minister Manto Tshabalala-Msimang to report on her latest ridiculous, unscientific comment. Sad, because the South African media should have been busy reporting new research on HIV to their listeners, readers and viewers back home. Embarrassing for obvious reasons.
Good HIV governance
However, at this year's conference, South Africa was on several occasions elevated as an example of good HIV governance. We have the largest antiretroviral programme in the world. Our mother-to-child infection rates have decreased by more than half. HIV testing has increased dramatically. And Health Minister Aaron Motsoaledi and Deputy President Kgalema Motlanthe were keynote speakers. Their comments were praised by everyone I spoke to.
But also highlighted at the event was that our HIV programmes are not perfect. Drug shortages, tender fraud and unpaid suppliers are all negatively affecting our anti-HIV efforts. But finally there is good leadership on the issue and the world has noticed.
And just as change has swept South Africa in the field of HIV, it seems that things are changing at the International Aids Conference as well. Although there is much room for improvement, several conference sessions focusing on prevention and treatment issues this year did include African voices.
In one United States government and champions for an HIV generation session on medical male circumcision, all the panellists were African. They were former presidents, chiefs and men who had been medically circumcised.
Africans broke new ground in other ways at the gathering. Specioza Wandira, Uganda's former vice-president, took an incredibly bold step for an African woman by publicly declaring on a podium that she enjoyed sex. African males who shared the panel with her supported her. Wandira's declaration is rare in Africa, where discussing sex in public is mostly considered disrespectful to one's culture.
The Aids looking glass continues to sparkle. But at this point in history, as the world continues to confront Aids with ever more success and scientific optimism grows that we are on the verge of defeating the disease, that looking glass is beginning to reflect a glimmer of hope.
Mia Malan works for the Discovery Health Journalism Centre at Rhodes University