In my younger days, decades upon decades ago, we were consumed by the
threat of nuclear annihilation. The forces of darkness, East and West,
seemed in the ascendance. The Doomsday clock inched its way to
midnight.

And then there arose, across a spectrum ranging from the scientists
and engineers writing in the Bulletin of Atomic Scientists, through to
the Physicians for the Prevention of Nuclear War, a loud clamouring
cry of protest, accompanied by marches, banners, polemics, statements,
press conferences demanding, in the name of humankind, that the
madness end.

And it did, at least for a time at the end of the Cold War. And the
scientists and doctors won Nobel Peace Prizes and showed the power of
scholarly activism for the whole world to see.

Two weeks ago, just prior to the meeting of the G8, a full-page ad
appeared in the Financial Times, with the headline ?Scientists Call on
World Leaders to Take Action on Climate Change?. It was signed by
twenty-five of the most renowned climatologists and earth scientists.
They didn?t get all they wanted by any means, but they jolted the
political leadership into the recognition that the scientists are
mobilized, are watching, are keeping the rest of the world informed
and will not be silenced.

I was immediately reminded of the letter, signed by eighty-one
acclaimed medical clinicians and researchers right after the Toronto
AIDS conference, demanding the resignation of the then South African
Minister of Health for reasons everyone in this audience understands.
It was an important moment in the accelerating, cumulative pressure
for a change in policy, a change now underway.

In truth, there are many in this audience who fought for that change.
This is an audience that has devoted itself to making the world a
better place, so I hope that what I?m about to say will comfortably
resonate.

No one should underestimate the power and influence of science when it
decides to take a stand. The two co-Chairs of this Conference are
striking examples, amongst many, of the extraordinary impact
scientists can have. And never has the exercise of power and influence
been more imperative than at this moment in the fight against the AIDS
pandemic. Your individual and collective voices are needed ? sure, you
have the technological and laboratory acumen, you know about vaccines
and microbicides and triple combination therapy and viral loads and
CD4 counts and pre- and post-exposure prophylaxis ? the entire panoply
of sophisticated scientific discovery and? intervention.

And that?s your work, and it?s of inestimable value. We need you to
unravel the secrets of the science, to make all of that elusive and
mysterious information accessible to the untutored rest of us. But we
need the scientific community as well to speak clearly, and
unequivocally, boldly and evocatively to the power-brokers of this
world, telling them of the risks and the benefits, and what will
happen if they make the wrong choices.

Somehow, along with the science, we need the activism. They are inseparable.

So when, as now, there?s a backlash against funding for AIDS, with
mindless charges against AIDS exceptionalism, you should find a way,
collectively, to shoot down the pinched bureaucrats and
publicity-seeking academics who advocate exchanging the health of some
for the health of others ? who propose robbing Peter to pay Paul
rather than arguing, in principled fashion, that money must be found
for every imperative, including maternal and child health, and sexual
and reproductive health, and environmental health as well as all the
resources required to turn the tide of the AIDS pandemic.

It can never be an either/or. We?re talking about human lives for
God?s sake, not about the phony parsing of balance sheets. The
Treasuries of the western nations are very artful at the divide and
conquer route. We must never allow them to play one part of the health
sector against the other. HIV/AIDS, for all the horrendous human
consequences, has objectively strengthened health systems, has brought
together all the sectors of government from agriculture to education,
has integrated private and public initiatives, has exponentially
raised awareness of the consequences of gender inequality, has spawned
remarkably novel ideas for raising resources ? all of it inevitably
improving human health overall.

Believe me, if we could have back the lives we?ve lost, I?d relinquish
in a heartbeat the institutional gains that flow from AIDS. But we
can?t, so at least don?t undervalue or dismiss the gains.

It?s so easy for the detractors to coddle specious arguments. Rather
than asking for more money, they have this punitive spasm to ransack
resources for AIDS. You must not let them get away with it.

And when the G8 won?t renew its 2005 commitment to universal access;
when the G8 cynically uses the financial crisis to threaten cutbacks
to AIDS funding; when the G8 once again, yet again, always again
subverts its own promises and in so doing compromises the health of
millions, then it?s time for science to speak with one powerful voice
of accusation.? And when the Global Fund faces a shortfall of several
billion, you would do the world a tremendous service by simply
finding a way, collectively, from your positions of authority, to
remind the political leadership of how they used precious public money
to bail out the banks, so that Goldman Sachs could make a profit of
$3.4 billion in the second quarter of 2009, JP Morgan Chase could make
a profit of $2.7 billion in the same period, and with obscene contempt
for the human condition, pay bonuses, yet again, beyond the dreams of
hyperactive wealth.

You spend every day of your working lives to make life possible, and
the power brokers devalue your work with the fraudulent plea of
destitution. Don?t let them get away with it.

But funding isn?t the only issue; the issues proliferate. When the
Government of Senegal jails eight gay AIDS activists for no reason
except homophobia, setting back the fight against AIDS, where are the
scientific voices of condemnation?

Right now, in the Caribbean, every country save the Bahamas, has laws
that criminalize homosexuality. We tiptoe round this twisted form of
racism. We submit to ridiculous claims of cultural relativism. The
Prime Minister of Jamaica, in the safety of Parliament, makes the most
contemptible statements about gay men, leaving every elemental
component of human rights in tatters, and he?s never called to account
... not by the UN Human Rights Council, not by the G8, not by the G20,
not by the Commonwealth ? only by the gay activists themselves. What
is wrong with the international community? If this is how it behaves,
it doesn?t deserve the name ?community? at all. And if the political
leadership lacks the courage to confront such outrageous slander, you
shouldn?t lack the courage. You?re scientists. You know that it?s a
scientific reality that a certain percentage of the world?s people is
gay. So tell the political philistines to get over it and stop
wrecking such damage. More, you know that an ugly homophobic culture
is a threat to public health that inevitably serves to spread the
virus ? I beg you to say so. The majesty of science is its influence.

Then there?s the issue, commonly known as PMTCT --- prevention of
mother to child transmission. This should have been the easiest
intervention of all, instead we?ve had a panorama of unnecessary death
for both the mothers and their children. So-called PMTCT has been a
colossal failure, subjected to twisted linguistics, lousy science,
governmental chicanery, and astonishing delinquency on the part of
United Nations agencies. Only now is the political establishment
coming to its senses. But it needs your help so that it never goes off
the rails again.

What help? Let me count the ways. First, never again should it be
called mother-to-child transmission. It should better be called
vertical transmission. How is it that we so casually, mindlessly
demonize the mother by naming her as the vector? Second, even now a
dreadful double standard prevails: in the industrial world we use full
HAART; in the developing world we still use, in the majority,
single-dose nevirapine. You?re scientists: you know what that means in
terms of unnecessary infant infection and death. Third, we abandon the
mothers. In 2007, only 12 per cent of pregnant women living with HIV
identified during antenatal care, were assessed for their eligibility
to receive ARV treatment. That?s an unconscionable neglect of women
that smacks of vestigial misogyny. Fourth, the WHO/UNICEF/UNAIDS
guidelines on breast-feeding, and the use of breast-milk substitutes
are widely ignored. To this day, the value of exclusive breast-feeding
for six months in stemming HIV infection and providing the infant with
the strongest possible immunity to other diseases is still caught
between conjecture and disavowal. Sometimes I think that every
Minister of Health should be required to take a mandatory course from
Dr. Coovadia. Failing that, the UN, and primarily UNICEF, should do
its job, and mount a massive global education campaign to replace
myths with facts about infant feeding. Political and cultural
influences can be dead wrong where infant feeding is concerned; the
scientists here assembled have an indispensable role to play in
setting the world straight.

And there?s one other matter I must raise. The epidemic of domestic
sexual violence that lacerates the soul of South Africa is mirrored in
the pattern of grotesque raping in areas of outright conflict from
Darfur to the Democratic Republic of the Congo, and in areas of
contested electoral turbulence from Kenya to Zimbabwe. Inevitably, a
certain percentage of the rapes transmits the virus. We don?t know how
high that percentage is. We know only that women are subjected to the
most dreadful double jeopardy.

The point must also be made that there?s no such thing as the
enjoyment of good health for women who live in constant fear of rape.
Countless strong women survive the sexual assaults that occur in the
millions every year, but every rape leaves a scar; no one ever fully
heals.

This business of discrimination against and oppression of women is the
world?s most poisonous curse. Nowhere is it felt with greater
catastrophic force than in the AIDS pandemic. This audience knows the
statistics full well: you?ve chronicled them, you?ve measured them,
the epidemiologists amongst you have disaggregated them. What has to
happen, with one unified voice, is that the scientific community tells
the political community that it must understand one incontrovertible
fact of health: bringing an end to sexual violence is a vital
component in bringing an end to AIDS. The brave groups of women who
dare to speak up on the ground, in country after country, should not
have to wage this fight in despairing and lonely isolation. They
should hear the voices of scientific thunder. You understand the
connections between violence against women and vulnerability to the
virus. No one can challenge your understanding. Use it, I beg you, use
it.

When I said at the outset that this was the most critical moment, I
wasn?t indulging in rhetorical flourish. As has been pointed out time
and time again, 2010 is the anointed year for universal access. We
have but seventeen short months. If ever the scientific community was
to engage in public activism, that time is now. Not only must we save
every life we can in that seventeen months, but we have to create such
energy that the tide of intervention is irreversible, and neither
financial downturns nor the feckless caterwauling of the critics of
AIDS funding will compromise our goal.

Make no mistake about it: that means taking on the development
aristocracy and those who advise and influence it ?? for example, DfID
in the United Kingdom, and the World Bank and the IMF and even the
World Health Organization.

Pause for a moment to think what we?re dealing with. AIDS
exceptionalism is a perfectly defensible and descriptive concept. Why
do you think the world created an organization called UNAIDS? AIDS was
exceptional. AIDS is exceptional. I tramped the high-prevalence
countries of Africa for more than five years; if I wasn?t viewing the
most exceptional communicable disease assault of the twentieth
century, then the word ?exceptional? needs to be re-defined.

As a consequence of that exceptionality, and the tremendous
campaigning of grass-roots advocates, AIDS received funding, a lot of
funding ? never enough to be sure, but enough to recognize the
exceptionality.

Then along come the detractors, driven by resentment, resentment at
the success of the AIDS movement. These arithmetic arguments alleging
that AIDS is getting too much money at the expense of other health
imperatives ? this is simply naked academic and bureaucratic envy. I
know I?m not supposed to say that, but it?s got to be said.

Why? Because the critics know that it?s not a matter of pitting one
aspect of health against another. The critics know that it?s a matter
of measuring the resource needs of global health against the crazy
expenditures that the world makes on other things. But the seething
resentment that pulsates beneath the surface creates this false
argument.

I urge the scientists and activists here assembled not to fight on the
terrain of the poseurs. Your whole life is in the world of AIDS. You
know the legitimate resource requirements. You just can?t permit an
intellectual contrivance --- an argument in favour of accepting the
size of the pie and slicing it differently, rather than demanding a
larger pie --- you can?t allow that to be used to justify a terrible
reversal in public policy. People infected with HIV or at risk of
infection, are suddenly tossed onto the landscape of treatment
ambiguity, and the gains we?ve made and the momentum we?ve achieved
are put at risk.

Is my naivet? showing? Why is it not possible to allocate sufficient
money for every aspect of global health, of which AIDS is but a part,
and in so doing, meet the Millennium Development Goals ? money which
is but a fraction, a miniscule fraction of all the public dollars that
have found their way, in one short year, into the bottomless pits of
greed and avarice?

No one dies from a surfeit of money. People die when poverty and
disease are the twin ingredients of life.

Madiba turned ninety-one yesterday. I strolled down to the waterfront
here in Cape Town where people were singing and dancing and
irrepressibly celebrating the life of their national treasure. This
country has been through tough tough times. The numbers of deaths, the
psychotic denialism, the political betrayals; it?s taken an incredible
toll. And yet, in the liberation and its aftermath, and the
constitution, the law, the courts, the phenomenal culture of community
activism, most sublimely exemplified by the Treatment Action Campaign
? in all of that, there lies hope. I saw hope everywhere yesterday.
And if that tumultuous passage from despair to hope can happen here,
it can happen anywhere.

But to take it to a global scale, requires the collective will of
people like the people at this conference? people who speak with
unimpeachable scientific authority, and if they so wished, and brought
advocacy to bear, could move the mountains of resistance and inertia.

You could strike a fatal blow against the pandemic. I salute those of
you who have already risen to that challenge. I leave it with all of
you.

www.aidsfreeworld.org