From poverty to power - Oxfam-Québec

4 RISK AND VULNERABILITY HEALTH RISKSresponsibility on drugs companies. 59 Delivering a social good such asaccess to medicines through market mechanisms is always going topose challenges: if pharmaceutical companies do not see themselves asbearing the duty to save lives even when it is not profitable, governmentsmust use their regulatory powers to ensure that treatment isavailable to all.The attitudes and initiative of political leaders are crucial. SouthAfrica’s President Thabo Mbeki questioned the safety and value oflife-saving antiretroviral treatment for HIV and AIDS and evenpublicly doubted that HIV causes AIDS, setting back the nationaltreatment and prevention effort in the worst-affected country in theworld. In contrast, Brazil’s Jose Sarney threw the state’s weight behindthe national HIV and AIDS campaign early on, while Botswana’sPresident Festus Mogae spoke publicly about the threat in an effort toreduce the stigma that deterred people from being tested for HIV:‘We are threatened with extinction. People are dying in chillingly highnumbers. It is a crisis of the first magnitude.’ 60 Botswana was the firstAfrican country to commit itself to providing ARVs to all citizens whorequired them.Brazil shows what can be achieved by a combination of citizenaction and state support. Its simultaneous programmes of preventionand treatment have halved AIDS deaths and infectious diseases relatedto HIV and AIDS. 61Strong and effective civil society participation: A key element inBrazil’s success has been its combination of an open attitude to sex anda vibrant tradition of civil society activism.AIDS carries less stigma thanin other countries, a factor that was pivotal in increasing the visibilityof the problem. Gay-rights groups were the first to speak out publicly,and activist groups remain the keystone to the prevention strategy,distributing millions of free condoms and ensuring a supportiveenvironment for people living with HIV and AIDS. Activists alsoinfluence the health budget through vocal lobbying and publicdemonstrations. The media play an active role, with continual advertisingthrough television stations, radio networks, and print mediaoutlets, promoting safe sex and increasing awareness of the epidemic.Effective state action: In 1986 the government, pressured by activists,established a national programme that guaranteed every AIDS patient235