Oleh/By : DATO' SERI DR.
MAHATHIR BIN MOHAMAD
Tempat/Venue : DEWAN MERDEKA, PWTC,
KUALA LUMPUR
Tarikh/Date : 23/10/99
Tajuk/Title : PERASMIAN KONGRES ANTARABANGSA
AIDS DI ASIA DAN
PASIFIK YANG KE-5
Saya ucapkan terima kasih kepada pihak penganjur
Kongres Antarabangsa Aids di Asia dan Pasifik yang ke-
5, kerana menjemput saya untuk merasmikan kongresnya
pada petang ini.
2. This congress is somewhat unique for many reasons.
It is the first to be hosted by a non-governmental
organisation (NGO) that mainly works at the grassroot
level. It is also the first ever to be held in a Muslim
country and it is the last major conference on HIV/AIDS
to be held this century. For all this, I would like to
congratulate the local organising Committee for its
hard work and achievement in successfully organising
this Congress. I am sure it will be a success.
3. Currently about 33.4 million people are now living
with HIV/AIDS around the world and 1.2 million are
children under 15 years. Some 5.8 million became
infected in 1998 alone, of which 590,000 of them were
children under 15 years. In 1998 about 2.5 million
people died of AIDS and 510,000 of them children under
15 years. AIDS is among the top five killers in the
world and is still considered an emerging epidemic
whose death toll rises each year. About 13.9 million
people have died of AIDS since the beginning of the
epidemic.
4. What is most disconcerting is that more than 95
per cent of all HIV-infected people live in the
developing world and 95 per cent of all deaths from
AIDS occur in the developing world, 'largely among
young adults who would normally be in their peak
productive and reproductive years'. When it comes to
HIV infection, women appear to be heading for an
unwelcome equality with men. About 41 per cent of
worldwide infections in 1997 were women and in 1998
this figure rose to 43 per cent. Sub-Saharan Africa is
home to 70 per cent of people who became infected in
1998. It is also the region where four-fifth of all
AIDS deaths occurred in 1998. Nine out of 10 children
who became infected in 1998 live in Africa. In some
countries, life expectancy has been reduced by as much
as 22 years because of AIDS. In Asia, well over seven
million Asians are already infected and HIV is clearly
beginning to spread in earnest in India and China.
Whether measured against the yardstick of deteriorating
child survival, crumbling life expectancy, overburdened
health care systems, increasing orphanhood, or bottom-
line losses to businesses, AIDS has never posed a
bigger threat to development than it does now. And
unless something is done it will pose an even bigger
threat in the years to come.
5. One of the reasons why developing countries are
over represented in the satistics for infection and
death is that many developing countries do not have the
resources to carry out effective prevention programmes.
Many are struggling under crippling debt, some are
politically unstable. Under these conditions, health
care budgets are grossly inadequate to provide basic
healthcare let alone conduct effective prevention
programmes. Countries in Asia and Pacific have been
affected relatively late by AIDS. Unfortunately some
have been in denial about their vulnerability to HIV.
Responses to AIDS have therefore been slow and
inadequate. Also, developing countries cannot afford
to provide treatment to their people infected by HIV.
HIV drugs are extremely expensive. Thus more people die
and at a faster rate in developing countries than in
developed countries. AIDS deaths in the U.S. dropped by
50 per cent after the introduction of protease
inhibitors. Thus developing countries not only have
more people becoming infected but once infected, they
cannot get help to survive. In contrast, in developed
countries, less people are becoming infected and those
that do live longer and lead normal lives because of
the availability of treatment. Hospices for people with
AIDS are being closed in the U.K. and Switzerland but
in developing countries, people cannot even set up
hospices and some people with AIDS have to be cared for
at home. There is not enough bed space in hospitals for
people with AIDS. AIDS has therefore augmented the
divide between the North and South, between the haves
and have-nots. What is worse is that the have-nots will
have even less because of AIDS.
6. There are people who would rather believe that
AIDS only happens to other people, to foreigners, to
those who have 'sinned', anyone but to our families,
our friends, our communities, ourselves. While we deny,
we will not take action and therefore we expose our
people to the risk of infection through sheer
ignorance. In Asia, we do not need to re-invent the
wheel. There are major lessons to be learnt from
Africa, even though conditions here may sometimes be
different, we must not insist that we are so unique
that we don't have to learn from the suffering of
Africa. If we do, then we will have to learn through
tragic experience. We must therefore all work together
because AIDS requires a comprehensive response.
Collaboration between all sectors, whether within
Governments, between Governments and NGOs, between
different Governments, with the participation of all
sectors of society, is the only way to effectively
manage the AIDS pandemic. Leaving any gaps will allow
the virus to get through and spread the epidemic.
7. We have worked hard to develop our economies.
Lately these have been attacked and in some cases,
Governments have been destabilised by these attacks.
Without political and economic stability, Governments
cannot pay enough attention to AIDS. Furthermore, AIDS
has the potential to further derail any recovery that
we work for. This is because AIDS lowers the resistance
to diseases and treating these diseases will increase
the cost further. In addition there will be the need
to care for the families and orphans of AIDS victims.
Access to care and treatment -- the high cost of HIV
drugs means that most people in developing countries
just cannot afford them. But this high cost need not be
so if developing countries can get together and
challenge the pharmaceutical companies to reduce the
prices or allow compulsory licensing of lifesaving
drugs. Compulsory licensing is allowed under WTO but it
is sad to see certain powerful countries aligning
themselves with giant pharmaceutical companies to deny
developing countries the right to produce cheaper drugs
to save the lives of their people. Profit is taking
precedent over people's lives. Access to care means
not just access to the most sophisticated
antiretroviral drugs but also to drugs to treat
opportunistic infections. This is possible for many
countries, even if they can't afford the protease
inhibitors.
8. We accept that phamaceutical companies expend a
lot of money on research and need to recoup in order to
continue their research, but they should not try to
recoup from the sufferings of the poor. The
Governments of the rich should bear most of the cost of
such research. We understand that some countries are
never as prosperous as they are now. Surely they can
spare some of their wealth to reduce the burden of the
poor people in poor countries.
9. Still , whatever their GNPs and national reserves
might be, Governments must ensure that people living
with HIV/AIDS get the best possible medical care to the
level that they can afford.
10. Governments must also try and ensure that an
equitable portion of their health budgets go to HIV
treatment and care services. This leadership from
Government will also help in reducing discrimination
towards people living with Aids, who are often told
that no medical care should be spent on them since
they're 'going to die anyway'. Stigma and
discrimination remains the greatest obstacle to
prevention and care and treatment. People living with
HIV/AIDS are an invisible sector of society, forced to
hide their status because of the fear of society's
stigmatisation and marginalisation. When their status
becomes known, their fears are well-founded -- people
with HIV/AIDS have been fired from work, denied
treatment in hospitals, or given lesser treatment, have
been thrown out by their own families and ostracised by
their neighbours. In extreme cases, some have committed
suicide because life became too unbearable.
11. As long as there is stigma and discrimination
which drives people with HIV/AIDS underground,
prevention cannot work. People's lives cannot be
extended by care and treatment if they are afraid to
even come to hospitals. They cannot afford to provide
for their families and for their own medical expenses
if they have no work. Their families suffer just as
much -- the stigmatisation extends even to the next
generation.
12. Religion plays a vital role in the prevention,
care and treatment. For too long, many religious
officials have hidden behind a veil of denial,
condemning those who have been infected while doing
little to prevent others from also suffering the same
fate. They have not extended their hand to those who
became infected nor to their families. This leads to
despair and even disillusionment with the religious
authorities because of their uncaring attitudes. It is
not for us to condemn and punish, for many who have
contracted the disease are victims of ignorance and the
culture of their society.
13. Every religion promotes the preservation of life
and urges its adherents to extend their hand to those
in need. In this respect many people fail in their
religious duties while at the same time claiming moral
superiority over those who have been infected. They
take no responsibility over the increasing numbers of
people becoming infected even though it will mean that
their congregations will become smaller and smaller.
Religious authorities need to be educated to play their
role in a meaningful way, not to obstruct efforts by
others.
14. Governments play a leading role because they set
policy and facilitate the implementation of policy. But
how is policy derived? Good HIV/AIDS policy comes from
knowledge about HIV/AIDS and from consultation of all
affected parties including and especially people living
with HIV/AIDS. An effective Government response comes
most of all from the political will to do the best for
its people. Political will will ensure that adequate
budgets are directed at effective prevention programmes
which are constantly evaluated. Political will ensures
that people living with HIV/AIDS will not suffer
needlessly from financial burdens, from stigma and
discrimination. Political will ensures that all sectors
of society will play their part in fighting the
HIV/AIDS epidemic, including NGOs, businesses,
religious bodies, schools and Government departments.
Without political will, the best policies will never be
effective. Cambodia is a fine example of how, with
political will, even a poor country can do something.
A Government that is effective in managing its HIV/AIDS
epidemic is one that is essentially democratic because
HIV transmission is facilitated in an undemocratic
setting. Where people have no rights to the maintenance
of their health because of financial reasons, ignorance
or discrimination, they will be more likely to become
infected with HIV. Therefore a Government that believes
that all its citizens has a right to life and to good
health will have a better chance of reducing the impact
of HIV/AIDS on the country. The right to life and
health is a basic human right.
15. An effective Government is one that understands
that the virus recognises no borders and therefore it
is imperative that Governments cooperate with each
other to fight the virus. HIV travels wherever human
beings travel, whether it is for pleasure or for work
or because of political reasons (refugees) and man-made
barriers cannot really stop it.
16. What can stop HIV is cooperation between NGOs,
Governments and other health organisations to address
the issues of cross-border movement of peoples, migrant
workers, especially illegal ones, and the trafficking
of women and children. Blaming foreigners for bringing
HIV into a country is misplaced, especially if one's
citizens are also free to travel abroad. NGOs and
Governments therefore need to sit down together to
discuss what is best for their own citizens even when
they are in another country. When migrants are
marginalised in another country, they also become
vulnerable to infection which then puts them at risk of
deportation. When they are deported home to a country
which is even less able to help them, the risk of
further transmission of HIV is almost guaranteed. Men
who work abroad and who get infected with HIV often
return home and infect their wives because they are
ignorant of their status and of what can be done to
protect their wives. Efforts to educate migrant workers
about HIV before they leave home as well as during
their stay abroad will result in less infections among
them and therefore among their wives and children.
Governments working together is an example of good
neighbourliness and also an example of the ASEAN
philosophy of 'Prosper-Thy-Neighbour'. Not working
together implies a 'Beggar-Thy-Neighbour' attitude.
17. In Malaysia, the Government had responded to the
HIV pandemics as early as 15 years ago, that is
immediately after the first HIV victim was confirmed in
1986. Since then the prevention and control of
HIV/AIDS epidemics has been organised, coordinated, and
collaborated through a 'National AIDS Task Force'
comprising of 28 members representing various public,
private, academic, religious, and non government
organisations. Through this National AIDS Task Force,
we have developed our policies, objectives, strategic
approaches, technical guidelines, and researches
pertaining to HIV/AIDS.
18. In 1993 AIDS/STD section was created as a separate
component of Disease Control Division in the Ministry
of Health. Now this HIV/STD section is entirely
responsible for planning, organising, coordinating,
monitoring, and evaluating the promotive, preventive,
and curative parts of the AIDS epidemics.
19. The Ministry of Health in its efforts to
strengthen its collaboration with NGOs working with
HIV/AIDS issues, has responded to their call to assist
in the formation of Malaysian AIDS Council (MAC) which
was registered in 1992. And now the Malaysian AIDS
Council is recognised as an ambrella organisation which
coordinates the activities of other HIV/AIDS related
NGOs.
20. In view of the growing number of young people
becoming infected with HIV, we have started
incorporating comprehensive HIV, and drug abuse
prevention education through PROSTAR in 1996 or
'Staying Healthy Without AIDS for Youths'.
21. PROSTAR is a community mobilisation programme
where youths between the ages of 16 and 25 will be
trained as peer mobilisers, energisers, motivators, and
changing agents towards 'Healthy Young Generation'.
As of March 1999, about 21,500 selective youths have
been trained to lead their peers on issues pertaining
to HIV/AIDS. To ensure our youths will sustain their
wealth of energy, ideas and enthusiasm, we -- as
parents, leaders, decision-makers, professionals, and
communities -- need to work closely with them.
22. Recognising that women are especially vulnerable
to HIV-Infection, the Government had addressed this
critical issue through two nationwide programmes,
namely; screening of pregnant mothers for HIV, and
Women and AIDS. For this programme alone, the
Government has already spent RM6 million since it
started in 1998, and as of May 1999, about 25,000
antenatal mothers had been screened for HIV-Infection,
100 cases turned out HIV positive, and were immediately
given free treatment costing RM600 for each case per
month.
23. As evidence of our commitments, the Governemnt has
spent almost RM43 million for the HIV/AIDS control
programme every year since 1993. About RM16 million
goes to curative services, RM5 million for healthy life
style promotion, while RM22 million goes to preventive
aspect of the programme.
24. It is now time for all of us, for all Heads of
Governments in the Asia-Pacific region to hold a summit
on AIDS so that we may better coordinate our efforts in
recognition of the transborder nature of the epidemic.
This will show leadership in the region and within our
own countries and underline the seriousness of the AIDS
pandemic and the need for urgent action to combat it.
25. Dengan ini saya dengan sukacitanya merasmikan
Kongress Antarabangsa Aids di Asia dan Pasifik yang ke-
5.
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