From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference newspaper - Friday 24 July - part 5
Note: non-commercial reproduction.
Archive-Number: 5788
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 26 Jul 92 17:17:27 GMT

(article continued from part 4)

Mark Harrington:
'The big thinkers must work together'

It's time for activists to move on, says Mark Harrington. Having 
served as a "catalyst" in the field of clinical trials, they should now 
be campaigning for change in the conduct of basic AIDS research, 
he believes. "It means a very different approach, which doesn't put 
drugs at the centre of the agenda," he says. "It means asking, what 
are the questions we need to solve in order to solve AIDS?"
Basic scientists may now race to barricade themselves in, but those 
who know him say Harrington's is an informed voice whose 
knowledge of AIDS research would shame some delegates. He was a 
key figure in ACT UP New York until he left with others to form the 
separate Treatment Action Group last winter. TAG began as a 
subdivision of ACT UP but felt obliged to split, says Harrington, 
because infighting and factionalism started to distract them from 
the work that had to be done. "I would have preferred ACT UP not 
to split up, but work had to take primacy." He stresses that ACT UP 
has made "enormous headway" despite these problems. TAG is 
focusing on one current preoccupation of basic AIDS researchers: 
pathogenesis. Clues to what happens between initial  infection  and 
the onset of disease may well be obtained by studying seropositive 
individuals who remain healthy for a long time, or by looking at less 
well studied aspects of the immune system.
Yet, says Harrington, some basic scientists are stuck in a "mindset" 
that prevents the most effective and open collaboration. In clinical 
research, he believes, activists have made some headway in getting 
researchers to work together. Basic scientists, however, "really 
prize their autonomy. It is hard even to get the big thinkers to 
work together." 
. . . .
Aldyn McKean:
"ACT UP is not narrowly focused"

Aldyn McKean has been seropositive for 12 years. "Activism may 
well be one of the reasons why I am alive," he says. "Certainly there 
are many people who are alive and healthy because of drugs that we 
fought to get access to." As a key member of ACT UP  who has 
worked with the movement since it was founded in 1987, he 
believes his own mental and physical wellbeing has benefitted from 
the experience of doing something positive to fight AIDS. 
McKean has not, like others, left ACT UP for more focused groups. 
He has no conflict with the smaller groups, but believes ACT UP's 
greatest strength lies in its broad base. Activists, he believes, are 
more likely to achieve their aims if those whom they are 
challenging recognise that they represent a broad, grassroots 
organisation. ACT UP has succeeded with what he calls "small, 
dramatic guerilla-based actions," such as the campaign against 
Burroughs-Wellcome to lower the price of zidovudine, precisely 
because of this broad backing, he says.
He is not worried by the recent formation of "factions" within ACT 
UP. "Show me a progressive organisation that doesn't have 
infighting," he says. "In a sense it's a sign of health because it means 
that ACT UP is not narrowly focused."

*********************************************************
A partnership for the sexes
by Sharon Kingman

Think of the Catholic church and AIDS, and most people will think 
of the church's restrictive policy on condoms. Yet the Catholic 
church's response to the pandemic runs much deeper and wider 
than the preaching of "family values". 
Some of the responsibility for broadening the horizons of people, 
some of them within the church, who would reject and blame those 
infected with HIV lies with people like Maura O'Donohue. 
A nun and a doctor, O'Donohue coordinates Third World AIDS 
programmes for CAFOD, the Catholic Development Agency, in 
London, which works with other international Catholic agencies 
under the umbrella organisation, the Caritas International 
Confederation.
She readily admits that ignorance about HIV can lead to prejudice 
and discrimination. "But that has not on the whole been my 
experience: even in situations where that might be the initial 
reaction, it has disappeared very quickly once people have attended 
our AIDS education workshops."
Behaviour
The condom question is not an issue for CAFOD, she says, which is 
a Catholic organisation dealing with Catholic partners. "They do not 
expect us to supply condoms and we are never asked to supply 
them." 
CAFOD is spending # 1 million this year (about US$1.7m) on 
education programmes which are dissemi-nated via a vast network 
of Catholic agencies, churches, organisations, schools and homes in 
more than 130 countries.
The educational message focuses on  behaviour change. "We have to 
give people the information and let them decide what they want to 
do," O'Donohue says.
But while many education programmes have focused narrowly on 
the high-risk behaviour  of homosexuals, intravenous drug users and 
prostitutes, she says, projects funded by CAFOD tackle problems as 
wide ranging as drug trafficking, street children, child prostitution, 
slave labour, sex tourism, migration of labour forces, refugees from 
war zones and drought, and youth unemployment - all of them 
linked by poverty. 
"We try to integrate AIDS awareness into any development 
programme we are involved in and take a multidisciplinary 
approach."
O'Donohue says. 
She trained as a doctor in Dublin and Liverpool. After working as a 
medical missionary in Nigeria for a few years, she spent 14 years in 
Ethiopia, which she left in 1987. 
In the mid-1980s, she decided that she should start working in 
AIDS, as this seemed the most urgent health problem. Since 
joining CAFOD in London, she has spent about three-quarters of her 
time visiting projects and organisations in Asia, Africa and Latin 
America. 
Working with AIDS has changed her "considerably", making her 
"much more aware of the many hidden social problems that society 
has tended to ignore". The contact she has had with people with 
AIDS and HIV has also had a tremendous effect on her, she says. "It 
has shown me that all individuals, particularly those who have been 
discriminated against, have great potential and that, whatever our 
initial judgements may be, people are essentially good. I have been 
amazed at how people, who know what they are suffering from, are 
yet so dedicated to trying to help others."
When the work threatens to overwhelm her, O'Donohue takes 
refuge in her native Ireland, or in the English Lake District, where 
she enjoys walking. But she says she rarely feels intimidated by the 
problem of AIDS, only occasionally by the amount of work that is 
needed. In those moments, she consoles herself that progress is 
being made, against all the odds.
Cycle of debt
She points to a project set up to help 15 villages in one area of 
Thailand, where many people have so little land that they cannot 
grow enough food for a whole year. As a result, they borrow to feed 
their families and enter an ever-worsening cycle of debt and 
poverty. The project has helped by setting up rice banks and 
providing boats and buffaloes. "Now, after four or five years, one of 
these villages has already stopped sending its young boys or girls to 
the town, which means they used to go into prostitution." Instead, 
the project is providing skills training in mechanics, metalwork 
and tailoring. 
Another project, in Africa, is looking after 3,000 children orphaned 
by AIDS and providing care for up to 2,000 people with AIDS in 
their own homes; volunteers help identify those who need 
assistance, support their families and help work their farms. 
O'Donohue uses this example to highlight the unequal distribution 
of resources in the world. "This one programme in Africa costs less 
per year than it would cost to treat a patient with AIDS in the US 
for a year. I think this should make us question the demands we 
make and the expectations we have of society. Are we entitled to 
expect so much when others have to make do with only a tiny 
fraction of the resources we have available?"
Another challenge is the prices pharmaceutical companies charge 
for drugs, she says. "We need to ask, how can they cost this much?"
If there is one issue that she feels people need to address in order 
to tackle AIDS effectively, it is the status of women - the need to 
educate them and allow them socioeconomic independence. 
"The big hope is to get women sitting down together with men and 
looking at their joint responsibilities to society, in a balanced way, 
in partnership. That is a major key to controlling this epidemic."
*********************************************************
A head start against HIV - to little avail
by Cindy Patton

Although some countries have been slow to deal with HIV among 
sex workers, Cameroon uses sex workers as a resource in 
combating the epidemic, says Professor Lazare Kaptue, Inspector 
General of the Cameroon Ministry of Health.
"We have been working with sex workers for three years," says 
Kaptue. "They now go out to their community to give advice and 
education to others, on how HIV is transmitted and how it can be 
prevented."
Working with consultants from Family Health International, the 
Ministry of Health and the sex workers developed an innovative 
educational campaign which included a humorous play. In it, the 
women role-play typical customers to demonstrate strategies for 
enforcing condom use.
Risky
Using such an approach to empower the community, especially 
when dealing with sexuality, might have been risky. "In the 
beginning, I wasn't sure it would work, but there were no 
prohibitions," says Kaptue. "The play toured throughout Cameroon 
and was very well received."
Kaptue's emphasis on the community has also moved the Ministry's 
work with patients in a unique direction. With over 1,000 cases of 
AIDS, the pressures on hospitals and care facilities is increasing. 
"Being in hospital is not always best for the patients, so we try to 
keep patients in the community. We do this by trying to get families 
involved," says Kaptue.
In order to equip communities better for both prevention and care 
for their members, the Ministry, in cooperation with the European 
Economic Community, produced a booklet for all children to take 
home and talk about with their families.
Understanding
"We discuss the routes of transmission, but the emphasis is on 
understanding the AIDS epidemic as a whole," says Kaptue. "We 
hope that if children understand transmission and prevention early 
on they will be more willing to take precautions later on."  Kaptue 
says the main problem has been financial. More money is needed 
for projects, but the worst thing is that the economic situation of 
the country makes it difficult for individuals to follow low risk-
behavior.
"We try to get women to give up sex work, but they ask, if they give 
it up, what other work will they do? We wish we could find them 
jobs, but there are women who have graduated from high school 
and university and yet they can't find other jobs," Kaptue says.
Kaptue became involved in AIDS work when the incidence of HIV 
was very low in Cameroon. At that time, routes of transmission 
were still unclear, many clinicians and health workers were afraid 
and unwilling to get involved.
Keep fighting
"I was the head of health services when the epidemic came and no 
one else would do the work," says Kaptue. "I don't know why I 
wasn't afraid, but I felt I had to fulfill my responsibilities. I thought, 
who else will do it?"
Kaptue's long experience with AIDS prevention and his country's 
programme has been frustrating. He had hoped that by acting early, 
he could help his country avoid the worst effects of the epidemic.
"I was the first to start AIDS work in the Cameroon," says Kaptue. "I 
thought that if we started early and worked hard, we could slow the 
incidence in our country. But the rise has been almost as rapid as in 
other African countries. So I feel very disappointed. I don't know if 
I didn't do a good job, or if the problem is just bigger than I 
thought. But just because I am disappointed does not mean I am 
going to give up. We have to keep on fighting and find new ways to 
reach people."
*********************************************************
Conference Newspaper 
VIII International Conference on AIDS/ 
III STD World Congress
Amsterdam, The Netherlands 
19-24 July 1992

Editor: 	Sharon Kingman
Deputy Editor:	Cindy Patton
Writers: 	William Check
	Janis Kelly
	Simon Rozendaal
	Wim Zeijlemaker
Translators:	Elena Hanselaar 
	Annette Eskenazi
Managing Editor:	Jackie Bailey
Production Manager: Karin Balster
Layout & Design: 	Kuiper & Company
Photography: 	Rob List 
	Fotografie BV

Published by: 	Medialert Projekten BV
Publisher:	Willem Korteling
Printing: 	Salland Rotatie 		Drukkerij, Deventer
Conference Directors 
of Communications: 	Hilary Rao
	Nono Landheer
Conference Com-
munications staff: 	John Willoughby
	Pien Witteveen

Supported by an educational grant from 
The opinions expressed are those solely of the authors.

The Conference Newspaper gratefully acknowledges the generous 
assistance of 
Van Beek Automatisering.

-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids