We are here 16 years after a young boy with HIV named Nkosi Johnson addressed this same conference. He was ignored by our political leaders then. We know he would not be ignored today.
We are here 16 years after the Durban Declaration said "no" to the madness of Aids denialism, 16 years after many of us marched on the streets outside this building demanding access to antiretroviral (ARV) treatment and the start of Prevention of Mother to Child Transmission (PMTCT) programmes in developing countries.
Our marches then helped save 15 million lives. After we marched, the world woke up to the political crisis of Aids.
It started to act.
If activists had not marched, then I would have been denied treatment. I would be one of your statistics.
My name is Nkhensani Mavasa. I am 38 years old and living with HIV.
I am the chairwoman of the Treatment Action Campaign (TAC). We are a movement of 5 000 poor people in South Africa. Most of us are women. Most have HIV.
I come from Giyani, a rural town in Limpopo province where access to health services is still a challenge.
Where I live, we have to travel far to clinics. When we get there, often there are too few health-care workers. Often people wait for many hours and then have to go home without medication or even seeing a health care worker. The reality is that this has not changed much in the last 16 years.
Friends, we learnt last year that all people living with HIV must have access to ARV treatment. That knowledge is so important, but it is like starting all over again. Once more, we have a huge challenge: 20 million more people on treatment as soon as possible.
We know that today there are 17 million people on treatment. After many years of activism, billions in donor dollars, through the efforts of hundreds of thousands of health-care workers we have achieved 17 million.
But another 20 million people still need treatment and many of those people live in places like Giyani.
The main task before all of us gathered here is to ensure that an additional 20 million people can access treatment – and not just treatment, but also all the health care and counselling that is our human right and must go with it.
We now need a road map to treatment for all – not just talk – a road map that is backed up with the money and political will to make it a reality.
In South Africa, we have a five-year National Strategic Plan. For the world, we need an International Strategic Plan. Do you agree?
It is possible to treat everyone and prevent every infection. But to do so, we must be honest with ourselves and we must be serious.
I will briefly mention three major obstacles on the road to treatment for all.
First, to bring treatment and care to an additional 20 million people, we will need health-care workers.
Where possible, we will need to shift tasks to properly supervised and paid trained community health-care workers and lay councillors.
We need a global plan for this now. We cannot leave it to chance because we know chance does not deliver.
Do you think we can have strong health-care systems without people?
If we agree, why is it that here in South Africa committed community health-care workers and lay councillors are losing their jobs?
Where I live in Giyani, people are defaulting (on ARV treatment) because there are no health-care workers to help them stay on the treatment.
And health-care workers who do have jobs are overworked and struggling to keep their heads above water.
How will we ever reach the 90-90-90 targets without thousands more health-care workers?
Second, we can’t bring treatment to an additional 20 million people if our health-care systems are mismanaged and rife with corruption.
This is a problem across the world, not just here in South Africa.
Too often, at conferences like these, we focus on the technical side of fixing health-care systems, but turn a blind eye to the political problems.
Let me elaborate on one example here in South Africa.
A man facing multiple serious charges of fraud and corruption is in charge of the collapsing public health-care system in the Free State. The Free State has a population of 3 million people.
HIV prevalence is 14 percent. Life expectancy is the lowest of all South Africa’s provinces.
This man has victimised community health-care workers and whistle-blowers.
On his watch, the Free State lost a quarter of its public sector doctors last year.
This person’s name is MEC Benny Malakoane.
We cannot reach 90-90-90 if we turn a blind eye to the Malakoanes of the world.
Third, we will not bring ARV treatment to an additional 20 million people if we allow our political leaders to continue to be complacent about HIV.
Worse than that, in too many countries, political leaders are clamping down on civil society organisations that fight HIV.
We are not the enemy. The enemy is complacency and corruption.
We cannot continue to speak of an end to Aids when less than half of people who need treatment have access to treatment; when new infections are rising in parts of the world; when over a million people still die of Aids and TB every year; and when civil society organisations are being intimidated.
That is the old Aids we know. It’s not going away without a big fight.
Yes, we have made massive progress. Thank you, Mr Sidibe. Thank you, Deborah Birx. Thank you, Minister Motsoaledi. But it has not been half enough.
We ask UNAids and others to stop spreading complacency by talking about an end to Aids.
Our lives are not an advertising campaign.
Friends, we must demand action from world leaders based on the facts and the most important fact is that 20 million people need treatment right now.
Let us also not beat around the bush about political priorities.
The US spends $600 billion on defence every year.
That while the Global Fund struggles to raise even $30bn.
That while the world invests less than $0.7bn on TB research a year.
This is a disgrace.
HIV and TB are still crises in our communities. We must make this a crisis for our elected representatives.
We have rights. We must demand better.
Friends, comrades, when your house is burning with your family inside it, you don’t quietly ask for help.
You beg. You scream and shout. You demand.
Our house is still burning.
President Barack Obama, Chancellor Angela Merkel, President Xi Jinping, President Jacob Zuma… our house is still burning.
Please don’t turn your backs on us.
* Speech delivered by Nkhensani Mavasa, chairwoman of the TAC, at the opening of the 21st International Aids Conference on July 18