Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 24141-24146 469

Project: With data on costs and expenditures on AIDS in Mexico, we analyzed
their broad impact on different levels: on Gross National Product (GNP), on Public
expenditures and on health expenditures. Estimation of resources needed at 3
different scenarios was also performed; the first one taking into account current
trends of market prices, the second one, by using government purchases, and
the third one, projecting the fall of protease inhibitors prices, due to the entrance
of new drugs into the market.
Results: According to our estimations, Mexico spent $90.2 million US on AIDS
medical care on one year (Sept. 1995-96); however, neither that expenditure nor
the $350 million needed by year 2000, are enough to be big players and affect
the Mexican GNP of more than $300 billion US (1995), not even in the worst
scenario projected. For the public budget of $46 billion US, in 1995, the impact of
AIDS care was also a minor issue and not something that can not be absorbed
by the overall expenditures considered for the social sector. However, Inside the
health care system, with a budget of $10 million US for 1998, resources needed
for AIDS patients will have to compete with several other health care programs.
Lessons Learned: The cost of AIDS medical care, mainly the prices of antiretrovirals, are probably not a major treat for the overall economy of a middle
income country like Mexico with a population of more than 92 million inhabitants
and realtively low prevalence rates of HIV. Nevertheless, the microeconomic
impact of costs in affected families can be disastrous, if not provided free or with
high subsidies by the government, mainly when an affected person will need to
spend more than 250 daily minimum wages to cover a 30 day triple combination
cocktail.
24141 No content without process: factors influencing the
implementation of AIDS policy in South Africa
Helen Schneider, J. Stein. Centre for Health Policy, Johannesburg, South Africa
Background: In 1994, the new South African government adopted a unique
and wide ranging National AIDS Plan. Yet by 1997, little of the Plan had been
implemented and a study was conducted to assess the reasons for this.
Methods: A policy analysis framework, as proposed by Walt and Gilson, was
adopted in which the context, actors, processes and content of AIDS policy
implementation were assessed. The research methods included interviews with
key national and provincial stakeholders (governmental and non-governmental),
participation in committees and workshops across the country, and a review of
documentary sources.
Results: Despite the presence of adequate financial resources, an active NGO
sector, and clear national consensus on the content of an AIDS programme,
there have been major constraints to AIDS policy implementation. These include
a context of public sector restructuring with the absence of adequate structures
through which to implement activities; the lack of credible leadership which is able
to unite people across many divides; unresolved conflict, particularly between
NGOs and government; the absence of initiatives to ensure mechanisms for
widespread participation in developing strategies; and a retreat into technicist
approaches to AIDS programming.
Conclusions: The analysis suggests that an AIDS Plan and the mobilisation
of resources are necessary but not sufficient conditions for AIDS Policy implementation. A wider approach to building implementation capacity is proposed,
which pays greater attention to process-oriented dimensions such as leadership,
vision-building and participation.
24142 Spreading the load: Reports of the death of AIDS
activism have been greatly exaggerated
Geoffrey Woolcock', D. Stephews2. 125 Mary Street, Kew Victoria 3101;
2APCASO, Melbourne, Australia
Issue: The changing nature of AIDS activism accompanying plateauing new infection rates and enhanced treatments in western liberal democracies significantly
impacts the global response to HIV/AIDS.
Project: The diminishing capacity of ACT-UP (AIDS Coalition to Unleash
Power) to provide a platform for radical AIDS critique is viewed by many as
symbolic of a widespread decline in AIDS activism itself. Such analysis ignores
rapidly shifting modes of activism and, in particular, the prominent role of people
living with HIV/AIDS across the global pandemic. Drawing on research interviews
with activists in Australia, Canada, New Zealand and the United States, and
the authors' experiences as members of regional activist networks, this study
pinpoints the contemporary terrain of AIDS activism.
Results: Where AIDS has historically offered fertile ground for dissidence
through soaring infection rates and relatively open political systems, these two
characteristics now rarely accompany one another. Activism has become less
stereotyped but more institutionalised through networks of diverse sectional interest representatives. An accent on principles of universal empowerment and
community has been superseded by pragmatist goals specific to local cultural
contexts.
Lessons Learned: The rise and fall of AIDS activist movements in the west
should not detract from the plurality of forms of activism emerging in the global

pandemic response. Still reliant on western resources, formerly effective models
of protest have had to be strategically adapted to fit markedly different regional
situations, especially in the human rights arena. In these new contexts, AIDS
activism cannot afford to exclude any potential ally, regardless of their allegiances.

24143 HIV/AIDS epidemic and health care reform initiative in
Thailand
Pathom Sawanpanyalert. 30-3 Nakornkheunkhan Road Talad, Phrapradaeng
Samutprakarn 10130, Thailand
Issue: Thailand has been experiencing an extensive HIV/AIDS epidemic for
more than a decade and, at the same time, there have been increasing needs for
reforming health care systems and subsystems of the country
Project: In 1996, the Ministry of Public Health of Thailand, with supports from
the European Commission, started a three-year initiative to reform health care
systems and subsystems of Thailand to increase their equity in access to health
care, quality of services, efficiency of health care subsystems and accountability
to the public. The project included both macro-level national health policy research
and micro-level field model development and testing. Five provinces were chosen
to be the field sites, one of which is an HIV epicenter located in northern Thailand.
Although the project has a broad framework of the reform, the provinces were
provided with great flexibility in selecting issues to tackle with and ways to reform.
Results: The northern province chose HIV/AIDS as a tracer condition and
planned to see it through the subsystems (e.g. financing, management, delivery)
and determine how the reform initiative could help the province to better serve
the needs of the HIV/AIDS. The project in the province started with situation
analysis of HIV/AIDS and needs assessment of the AIDS patients and the HIVinfected. Specific issues were raised from the HIV-infected including accessibility
to anti-retroviral therapy, especially the very expensive triple combination. These
concerns matched perfectly with the concept of basic health services package
to be covered under a national health insurance, which is under development
as part of the macro-level national policy research agenda. Also, after the basic
package has been developed at the national level, it will need to be field-tested
in provinces.
Lessons learned: Health care reform is an international trend to dramatically
change health care systems and subsystems. For a real reform, it has to tackle
important health problems including HIV/AIDS at both macro- and micro-levels
and in all aspects of care.
24145 Medicines and quality care for all/A matter of political will
Jorge Huerdo Siquiros', C. Bonfil2, A. Brito3, M. Figueroa3, A. Diaz4,
C. Monsivais5. 'Altata 22-01 Col. Hipodromo Condesa 06760 Mexico, D. F; 2La
Jornada, Journal, Mexico City DF; 3Letra S, Journal-Supplement, Mexico City;
4Salud Y Justicia A.C.; 5Escritor, Mexico City, Mexico
Issue: Those living with HIV/AIDS in Mexico and in most countries in Latin America and the Caribbean still face tremendous problems concerning the access
to integral therapies. Most AIDS specialists affirm that an early and adequate
treatment doses improve consistently the life quality of PWA's. Yet our governments explain their reluctance to give such treatments with arguments of financial
rentability. To our authorities we are just figures and statistics. Governments such
as Brazil and Argentina have changed their attitudes and made free access to
anti-HIV drugs possible, although this has only been achieved through a strong
political pressure from PWA's.
Project: In November 1997, a proposal was presented to the Mexican
Congress, in which a special budget was claimed for the purchase of antiretroviral
drugs. This proposal, based on official figures, points out that the social security
system in Mexico should make consolidated purchases in order to get substantial
savings, and should obtain from the federal government at least 45 million dollars
to guarantee therapies for all PWA's in Mexico.
Results: Our government has stated that by 1998, around 11,809 persons
with HIV/AIDS will not have social security. This represents 50% for the Mexican
population touched by the virus, without considering undetected cases, particularly among rural and indigenous populations. The Ministry of Health created
a fiduciary as an alternative, however it only has $3.7 million US, to cover all
uninsured population.
Lessons Learned: Mexico spends of money rescuing banks from self-induced
bankruptcy or destining enormous budgets to the army or to political campaigns.
Stigmatization still prevails in Mexico and this makes it hard to get clear official
political will against AIDS. Nonetheless, it has been sufficiently proved that our
country has the economic power to pay for those therapies we so urgently need
to keep on living.
S24146 Medico-politics and HIV related responses in India -
Impact as a product of historicization with the epidemic
Ram Malkani. 18 New Pushpa Milan, 67 Worli Hill Road, Mumbai, India
Introduction: Besides technological advances in both social and biological sciences historical process affects the value of HIV related response. This presentation attempts to charecterise the historicization of HIV responses in India since
1985. An attempt is made to express the influence of this history on both the
personal and the societal. If we are to learn from history, then this model of history through charecterisation may be useful to social and programme managers

besides offering solace to individual workers.
Methodology: The history of HIV related response in India has been graphically represented, using personal encounters, peer reports, news reports and
testimonies by persons affected by HIV.
Analyses: A set of characters have emerged within this history. 1. The Herald
2. The Expert 3. The moneybag 4. The Bureaucrat 5. The Crooked 6. The Good
Samaritans.