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The XVII International AIDS Conference (AIDS 2008)
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The International AIDS Conference Comes to Latin America

August 3, 2008

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JACKI JUDD: Dr. Luis Soto-Ramirez, thank you for joining me today.

LUIS SOTO-RAMIREZ, M.D.: You are welcome.

JACKI JUDD: Appreciate it. The theme of this conference of course is Universal Action Now and I have read where that theme is truly meaningful to you, particularly that last word. How so?

LUIS SOTO-RAMIREZ, M.D.: I really like the theme, but it was extremely difficult to choose that theme because when you look at all the different conference we have some things that still have to do it, I mean it is still time to deliver, it is still time to bridge the gap, it is still time to many other things.

Luis Soto-Ramirez, M.D.
Luis Soto-Ramirez, M.D.
JACKI JUDD: The themes from the previous conferences?

LUIS SOTO-RAMIREZ, M.D.: Yes, from the previous conferences, so what I think is that universal action what means is we have to act now, we have to act "ya" in Spanish, I mean at this very moment and we have to act altogether because universal has to be understood as altogether we have to act against the HIV epidemic.

JACKI JUDD: Well, do you think that those two ideas, universal action and doing it fast and now, have been lacking?

LUIS SOTO-RAMIREZ, M.D.: Yes, I think so. I think that if you look at the conferences, at the story of the conference and you look all the different areas, what you see is for example, treatment has been like this, peak '96, very nice, then go a little bit down and now we have another peak because we have four new drugs, four excellent drugs, but still you have some very nice moments and then you have nothing and then again some very nice moment. If you look at the same timeframe and you look at prevention, it is always this. So if you look at action and real action in the world, it is going a little bit up, but it still is very small, I mean, if we remember for example the WHO program 3 by 5 --

JACKI JUDD: 3 by 5.

LUIS SOTO-RAMIREZ, M.D.: So, we wanted to have 3 million people treated by 2005 and what happened? Less than 1 million, so we are always short of our commitments and that's an important point at this moment in the time because we have the commitment for universal action to treatment, prevention and care for 2010. We are going to get short. We are going to get short really.

JACKI JUDD: Run out of time.

LUIS SOTO-RAMIREZ, M.D.: We are running out of time.

JACKI JUDD: You told a reporter that we can do a global campaign for prevention first and treatment second, but that's something the world is unfortunately looking at the wrong way around, that is a serious mistake.

LUIS SOTO-RAMIREZ, M.D.: Yes, because --

JACKI JUDD: Do they need to run in tandem or are you saying that prevention in some ways needs to trump treatment?

LUIS SOTO-RAMIREZ, M.D.: Yes, I think so. Prevention has to be on top of treatment in all the world. I mean it is a need. And Mexico is a very nice example. We are having now a huge problem with the price of the drugs because the drug prices are very high here in Mexico for our income. The drugs, that's another story. But we have a huge problem, why? Because we have now so good treatments that people is living longer lives, then you add more and more cases and more cases and more cases and then what you have is that you have new cases, old cases, and put all together, the cost of treatment for those is going to be huge. We do not go to prevention. We won't go for that and that's the same for the world. I mean if we were failing the 3 by 5 initiative, now of course we are going to fail the 2010 initiative. What is the problem? The problem is that obviously we need more money for treatment, but we are getting more and more infected patients. I think that what we need is to avoid new cases. We wanted so badly the vaccine. We will not have the vaccine. We have to add in some other directions, not vaccines.

JACKI JUDD: And put what you just said in the context of this conference. What do you expect to come out of Mexico City in terms of new creative directions or commitments related to prevention?

LUIS SOTO-RAMIREZ, M.D.: If I start from Mexico just locally, I think that we already have the result of this. I mean the meeting that is going to start today and tomorrow with the Ministers of Health and Education from all over Latin America, they are going to propose sex education and a standard of sex education all around Latin America without any intervention of the church. That is something that will improve not now, but at least in the next generation will improve, of course, prevention. We have to start from that and I think that it is very similar to corruption. If you want to create a generation with no corruption, you have to start from the beginning and I think that that is going to be very important. So for Mexico and Latin America, I think that this is already happened. All the governments are paying attention to the NGOs. They are paying attention to the screams around [laughter] saying, well, you are doing this okay, but you are not doing this, you are not fulfilling this. So they are paying attention. I think that at least Latin America, it is improving already with this conference, with the push of this conference. What happened with the world? [Laughter] That I am still have to see what is going to happen in the next five days because what I think is that we have to push for more prevention also in Asia and in Africa. I mean I have seen some people that consider that prevention in Africa, it is impossible. I do not think that is impossible.

JACKI JUDD: Why is it important to Latin America that this conference is held here, first one ever?

LUIS SOTO-RAMIREZ, M.D.: First one ever, that is the main [laughter] reason, it is the first one ever. I mean the International AIDS Society decided and I am feeling part of that because I started at the governing council of International AIDS Society in 2000 in South Africa. The International AIDS Society said let's go to developing countries. So then we went to South Africa to Durban, then we went to Bangkok, Thailand and then what happened? We were thinking to going back to Asia and I agree, there is a huge problem, there are a lot of issues, but you know I think that it is not a matter of numbers. It is a matter of human beings. So even we in Latin America and the Caribbean have less HIV/AIDS cases than in India itself, just India. We have our own problem and nobody look at us.

JACKI JUDD: You felt the international community was really overlooking Latin America?

LUIS SOTO-RAMIREZ, M.D.: Of course, of course, and you can see for example the Global Fund never pay attention to Mexico. We were considered a rich country that we are not and they never gave us the opportunity to participate in the Global Fund until this year that we will participate in the ninth application for the Global Fund, but yes of course Mexico and some other countries and yes, for example, Guatemala. In Guatemala, we saw something that was amazing. Medicines, [inaudible] went to Guatemala, started treatment to many people in rural areas, and then just disappear. Then one day the government said, okay, now we have, I do not know, 3,000, 4,000, 5,000 cases that we have to treat. Where is the money to treat those patients? So, yes, the world has forgotten Latin America and AIDS and the HIV --

JACKI JUDD: Is it an overstatement to say this week that changes?

LUIS SOTO-RAMIREZ, M.D.: I think that it is already changing.


LUIS SOTO-RAMIREZ, M.D.: I think that it is already changing.

JACKI JUDD: Then a final question for you, what is your definition of success at the conference?

LUIS SOTO-RAMIREZ, M.D.: I think that at least for Mexico, it is already a success. I mean we have two days ago or three days ago, the President Calderon receiving all the NGOs and he said something that was amazing, "I do not want to hear my advisors. [Laughter] I hear them all the time. I want to hear you."

JACKI JUDD: And this is an audience that you would not have had with the President had the conference not been here?

LUIS SOTO-RAMIREZ, M.D.: I am sure that it won't because the President and he said that this conference allow him to understand what is the problem of HIV and to be inside of the problem. So I think that is very useful. The meeting with the first ladies, the meeting with the ministers of Health and Education, I think that for Mexico is already a success. What happened with the rest of Latin America? I think that is having also a success. I mean I have seen, I always travel all around Latin America giving my Resistance Workshop that I am a specialist on resistance and I have seen a lot of changes. For example, I was three weeks ago in Ecuador. I was pushing the Minister of Health to get resistance testing. They do not get resistance testing. They have drugs, but they do not have resistance testing. They do not get resistance testing. Maybe we will perform some of the first resistance testing in Mexico and then send the results, but they will get this, at least the opportunity for that. So I think that the conference is pushing for more action.

JACKI JUDD: It is very interesting how you framed the answer to that question because when I ask other people at these conferences, the answer is usually a very 10,000-foot level, but you are answering it in a way it is happening on the ground.

LUIS SOTO-RAMIREZ, M.D.: On the ground, that is where we have to do it and I hope for at least the Mexico City population it will have also a very nice opportunity to get more information. We are pushing a lot for people coming to the global village. I mean I hope so that these people will come, these people will be tomorrow at the march against stigma and discrimination and homophobia because we are still really homophobic in this country and we have to change this in order to really prevent HIV. I mean I think that the best statement for this conference will be human rights preservation is the best maneuver for prevention.

JACKI JUDD: Okay, final word, thank you so much, Dr. Luis Soto-Ramirez.

LUIS SOTO-RAMIREZ, M.D.: You are very welcome.

JACKI JUDD: Appreciate it. Okay.

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