“We have an obligation to decide whether the evidence is enough. We’ve waited too long to do what we know is right. Enough is enough. We need to move to implement.”

Acknowledging that “we have a consensus in this room but not outside this room” BCCFE’s Dr. Julio Montaner, looking dapper in a dark suit and bright red tie, opened the third annual International Treatment as Prevention Workshop in Vancouver last week. 

Fitting that we should be there in his home town. Vancouver was the site of the 1996 International AIDS Conference where the advent of protease inhibitors caused such excitement, leading some to rush to predict the end of the epidemic was nigh.  It wasn’t of course, but the power of those antiretrovirals launched in 1996 to not only restore health but virtually eliminate infectivity in some circumstances has led us all to the place we are at today. That place is a room of three hundred experts from all corners of the globe.  There are almost 40 countries represented here, including many high ranking diplomats, scientists and health officials, not to mention people living with HIV from around the globe. We even have a Prime Minister in our midst.

It’s challenging to cover all that transpired in the following four days, so you’ll find only the highlights here. Those with a deeper interest in this hottest of hot topics are advised to go the conference website here for more coverage of the many excellent presentations that will be posted there later this week.

But it would be remiss not to include some highlights here – the stirring opening remarks of Canada’s Stephen Lewis and UNAIDS head Michel Sidibe, for instance, the exciting debate on whether treatment as prevention (TasP) works for gay men, the voice of a remarkable community activist Paul Kawata from The National Aids Minority Council – and the place of PrEP in all this talk about test and treat.

First a few recurring themes which  resonated with me . .

The way forward. TasP is clearly seen as the way to end the epidemic, without of course abandoning other strategies like condoms, circumcision and behavioral interventions.

Is it working? Most of the world is adopting TasP strategies in some shape or form, some quite aggressively. (Canada, now seemingly  famous for its hesitancy, only has the example of B.C. ) Many jurisdictions are boasting reductions in new infections – New York, San Francisco, Washington D.C. and of course British Columbia are the most quoted North American examples.

When to start treatment. Offering  treatment early is now a given to a) produce better clinical outcomes and b) reduce infectivity. Most treatment guidelines around the world either reflect that or are swiftly moving in that direction, with strong support in the room for offering treatment on diagnosis.  Having said that, the new WHO guidelines previewed at the conference are still taking a more conservative approach with a recommended CD4 threshold of 500 for treatment initiation in asymptomatic patients.

The human rights angle. In Canada some worry that expanded testing and early treatment to improve health outcomes and help reduce transmission represent the potential for human rights abuses. Globally, TasP presents human rights issues too, but which are almost the exact reverse of our domestic ones – namely the right of patients everywhere to have proper access to testing and to receive early treatment in the face of economic and social challenges.

Expanded testing models.  In progressive jurisdictions, HIV testing seems to be gradually moving from an opt-in to an opt-out model. The cost effectiveness of this approach seems to be justified by the unearthing of sufficient numbers of new infections in people who were not  previously considered, or did not consider themselves at risk.

The HIV treatment cascade.  It’s known by different names but is quickly become the de facto means of visualizing and monitoring the continuum of engagement from testing to viral suppression, so TasP advocates are using the concept to the hilt. It’s also become clear that Canada, and many of its provinces, are not currently well placed to do this kind of monitoring. How many of us are on treatment? How many of us are undetectable?  We just don’t know. Other countries do.

Emerging issues. To name but a few . . drug resistance, low rates of retention in care, access to testing, need for more community involvement.

Now on to some personal highlights . . 

What Stephen Lewis said

Stephen Lewis, for those who don’t know him, is a former leader of Canada’s NDP party and former United Nations' special envoy for HIV/AIDS in Africa. He is also an incredibly eloquent and passionate speaker. Lewis said this . .

“There seems to be a consensus in the room – almost full-throated in its fervor – of moving from what was a contentious theory to what Michel Sidebé called “a human right”. I think we should all take this moment as a cause célèbre and move the mountains that are necessary and see this as a clarion call meeting for treatment as prevention.

"And I would say to some of my colleagues and friends that we have to stop the groveling and the begging and scraping before the political potentates. Just because Barack Obama and Hillary Clinton have used the phrase “AIDS-free Generation” doesn’t mean that we should wear our knees threadbare in their presence and applaud with unseemly adoration because the phrase is offered. The 1.65 billion dollars that is in the budget for next year for the Global Fund is frankly, compared to the possibilities of the United States, pretty paltry.  There is a tremendous fight still to wage! And there is a good feeling in this room that we have the vehicle called ‘Treatment as Prevention’ in order to do it. So along with gender equality, and the rights of key populations, there is another moral imperative in this world, and it’s called ‘Treatment as Prevention’, and it deals with HIV and AIDS.”

What Michel Sidibe said

Michel Sidibe heads UNAIDS. He is also an effective and commanding speaker. Sidibe said . . 

“Treatment as prevention should not be seen any more as putting people on treatment but as a human rights issue, one of access to best possible care. It should not be available just for rich people but for people in every country of the world. It is an issue of science, economics, and morality,” he said. “And if you don’t pay now, you will pay later.”

“If we have the evidence that antiretroviral therapy can help someone living with HIV to stay alive and protect their sexual partners from infection by up to 96%, then we have a moral obligation to make it available,” said Mr Sidibé. “Providing HIV treatment as soon as possible is ethically and morally correct, economically and programmatically feasible and consistent with what we have learnt about clinical best practice over the last decade.”

Treatment as Prevention in MSM. Does it work?

One of the most eagerly anticipated highlights of the conference was a lively debate between David Evans of San Francisco’s Project Inform, who argued it does and Myron Cohen, lead investigator for HPTN 052, who argued the reverse.  Although in truth the two were not too far apart.

Evans argued that while we need to fully respect the rights of individuals to refuse treatment, there are strong arguments for HIV-positive MSM to use treatment to reduce risk. He cited in particular the biological data that proves ART reduces transmission, and convincingly, that we have a chance here to alter the trajectory of the epidemic.  “It's a social and individual imperative” he said. Saying that while there are gaps in the science, we need to use "best guess estimates" on the impact of ART in MSM. “It’s not right or moral to wait for the data to catch up.  . . We have come to the limit of efficacy of existing strategies.” Evans highlighted the need to implement TasP in combination with other interventions to remove the stigma and fear associated with HIV and pointed to successes in San Francisco, where a significant reduction in HIV transmissions has been observed despite an increase in STIs.

The affable Myron Cohen then took the stand and immediately framed the argument in terms of receptive anal intercourse (UAI), not MSM sex, which he described as a very efficient means of transmission. He said that there are no direct measurements of the efficacy of ART in MSM, only epi. data which shows mixed results. Out, of course, came the old argument that ART does not eliminate virus from the semen, even though, significantly, he described the concentrations as typically “trivial”. He said STIs are a huge problem in amplifying risk in UAI. He said that modest increases in UAI have countered the preventive benefit of ART in MSM, although in the absence of ART we would probably be seeing many more new infections. His main point though was that implementing treatment as prevention in MSM, which he actually seemed to support, is about managing expectations and how you communicate these risks.

In the questions that followed, Julio Montaner countered that the question is not whether TasP works in MSM but how much it works.

Is PrEP an essential component of treatment as prevention?

A second lively debate, arguing for were San Francisco’s Robert Grant and against, South Africa’s Brian Williams.

Grant described PrEP as a game-changer because of its potential to decrease the burden on treatment programs, motivate HIV testing, and provide more timely identification of acute infections. Most importantly, Dr. Grant argued, PrEP may destigmatize HIV drugs and the people who use them. “You don’t have to be perfectly adherent to show substantial benefits” he said.  Williams was far less enthusiastic, countering that PrEP was useful in limited cases but not essential. “The only way to stop the epidemic: he said “is universal and early access to ART. TasP could eliminate HIV, PrEP won’t. Therefore TasP is the more effective strategy."

Again Montaner was active in follow up, suggesting that PrEP is a distraction from the primary need, asking can we afford to focus on  it?  The consensus seemed to be, though, that it is not appropriate to make a comparison between PrEP and TasP as both have their uses.

Words of a community activist

Paul Kawata of the National AIDS Minority Council scored major points in the closing hours of the conference with a beautifully delivered speech from the viewpoint of a person living with HIV supporting moving forward on TasP.  But “when will people with the virus be part of this discussion?” he asked.  And “how do you end the epidemic when the communities we need to target don’t care anymore?” He made a powerful argument for preventative strategies rather than tackling social determinants of health. Giving stigma as an example, Kanata argued “we are not going to solve social determinants of health. We can’t let them be an excuse.”

Overall impressions

By any standards this was a highly important gathering – a show of global solidarity for a cause whose time has surely come. It was notable for both who was in the room – a stellar collection of impassioned and knowledgeable scientists and advocates – and who wasn’t.  Where were representatives, policy makers in particular, of the Canadian provinces, for instance, whose less than stellar performance in containing the epidemic points more than ever to the need for a search for new directions, new strategies?

On a personal level, I enjoyed the conference as much as any I've ever attended.  Stimulating beyond words, it left me – and I suspect most attending – with more optimism that we now are poised with tools in hand  to end the epidemic than I have felt in a very long time.

During the conference, I took time out to interview Julio Montaner (left). Forthright as ever, he was proud of the progress TasP initiatives have made to date, but profoundly disappointed ("my heart is broken" he said) at the lack of uptake in his own country outside his native province. You can read that interview here.

For those still not convinced, by the way, that treatment as prevention is the way to go, I recommend the excellent interview with Stephen Lewis below, talking with passion on why he feels there really are no alternatives that make sense any more.

Executive Director Richard Elliott said it best. “This year has had more challenges than achievements” he confessed to an attentive crowd at the Canadian HIV/AIDS Legal Network’s 20th anniversary gala in Toronto this past week.

Here’s what the Legal Network has faced in the space of a few short months.  Funding cuts, courtesy of the Federal Government who will no longer fund anything even smelling slightly of advocacy. A stinging defeat at the Supreme Court where two high profile appeals dealing with criminalization of non disclosure resulted in a major setback with disclosure now required in all cases except for the safest of safe sex. And then just last week, perhaps an even crueler blow as Bill C-398 which the Legal Network pumped their heart and soul in to supporting went down, if not in flames, at least to defeat in a close vote at second reading. The term “Oy vey!’ was invented for these folks’ fortunes of late.

Anybody who knows the Legal Network and Richard Elliott in particular, who  just last week was awarded the Queen's Diamond Jubilee Medal in Ottawa, knows none of these setbacks happened through want of trying. It’s our experience, in fact, that the Legal Network, under Richard’s direction, is one of the most hard working, dedicated and persistent working units in the HIV community.

Which is why it was a pleasure to celebrate – yes, celebrate - with them this week at toney Convocation Hall in downtown Toronto, where 20 years of work were being lauded as well as two awards handed out for excellence in human rights issues.  Well known HIV physician Dr. Philip Berger won the Canadian award and the Andrew Rylkov Foundation won too for its work in challenging Russia’s draconian drug laws.

The star of the show however was undeniably Stephen Lewis, formerly special envoy to the United Nations on HIV/AIDS in Africa.  An eloquent speaker at the best of times, the silver tongued 75-year old did not disappoint. I managed to corner him before he spoke with a question I’d thought was a bright one. “Mr Lewis” I said, “Canada is such a liberal thinking country. Why are we leaders in prosecutions for non disclosure of HIV?” “We are NOT a liberal thinking  country” he said. “Of course that’s the answer”  I said, immediately regretting I hadn’t asked him something brighter.

Behind the podium, Lewis was in fine form, immediately launching in to a glowing appraisal of the Legal Network. ”I am an immense fan - an unrestrained fan – of Richard Elliott, a shameless groupie” he said to laughter. “I love the work of the Legal Network. They are an astonishing organization, I want you all to recognize the enormous reach … it has an impact and integrity and reputation which is absolutely stunning around the world. Whether in Canada you are dealing with questions  of injection drug use in the downtown eastside of Vancouver or whether you are dealing with decriminalization - where the Legal Network is right and the Supreme Court of Canada is wrong and one day the Supreme Court will  understand the errors of their ways – or whether you are dealing with the astonishing defence by the Legal Network of Canadian access to medicine legislation, defeated by a reactionary, arbitrary, Neanderthal  government whose ugly response to the legislation stands as an iniquitous moment in Canadian political history. That  a piece of legislation which could have saved hundreds and thousands and millions of lives was considered inconsequential by the government and was defeated by seven votes, perfectly orchestrated, is a real shame on the integrity of the Canadian political system, and it’s heartbreaking.  But it just means you rise to fight another day.”

Lewis described the decision of Health Canada to reduce the Legal Network’s funding as “absolutely outrageous, to cut back the funding on the suspicion that the material produced by the Legal Network might conceivably lead to advocacy is so insubstantial and nonsensical, it’s deeply wounding and offensive.”

Lewis spent some time too outlining his concerns for global health. “Let me remind you that there are 34 million people on the planet living with AIDS.  There are 8 million people in treatment.  We have a tremendous way to go before we can secure the health and survival of the other 26 million."

The indefatigable Richard Elliott was up next, his speech concentrating heavily on HIV human rights issues and the manner in which they had been tackled since day one.  “It was clear early on in the epidemic” he said “that HIV would travel along and therefore expose the social fault lines of inequality, that HIV was not just a public heath disaster of staggering proportions but also a human rights disaster.  And so it was also clear that any effective response to the epidemic would not only need to overcome the understandable fear of disease and death but would also need to challenge the deep seated range of prejudices against sex and drugs….The law for better or worse, plays a role in the evolution of the epidemic.  Too often the law is hindering HIV prevention and care, too often it directs and enables abuse and deprivation “

I was particularly interested in what Richard would have to say about Bill C-398 as work in my own community has included collaborating locally with the Grannies for Africa to persuade our (conservative) MP to vote in favour of the bill. Richard has been incredibly helpful in this regard. Here’s what Richard said to the attentive crowd at the gala. “We started over knowing that it was going to be a tough slog. We have built an extraordinary coalition. I have to salute in particular the Grandmothers Advocacy Network. Despite all the efforts last week, that came to an end when the forces that are currently arrayed against those reforms won a crucial vote in the House of  Commons by seven votes,  However we can be proud of what we did and the work that we did to build that coalition is not for naught and we can turn that energy and that anger and our hope to something different.”

On the Supreme Court decision Richard mourned the setback but took consolation in the fact that “without our intervention the court will have likely not recognized that perhaps we shouldn’t be prosecuting people for aggravated sexual assault, at least in cases of safer sex.” 

All in all it was a stirring and buoyant evening. Clearly the Legal Network could do with help financially – Stephen Lewis urged the crowd to take out memberships – but they are strong in spirit and resolve. Anyone who interacts with them often, as does PositiveLite.com, knows that their work continues unabated.

Like the Grannies, they remain a force to be reckoned with.

********

Coincidentally, CANFAR has just released more videos in their "Thinking Positive, with Valerie Pringle" series which includes a good interview with Stephen Lewis.  We've included it below.

photos by Bob Leahy

Richard Elliott: This has been an important year for the Canadian HIV/AIDS Legal Network. In recent weeks you have likely heard from us with updates on critical issues that affect the lives of people living with and vulnerable to HIV/AIDS. I wanted to inform you directly about these activities, as we have been at the forefront of very important issues, with many clear victories. If you have a few minutes, please take the time to watch this short video update  below. 

I would like to also remind you to join us on December 4, 2012 at 7:00 p.m. at the Law Society of Upper Canada (Convocation Hall) to celebrate the Canadian HIV/AIDS Legal Network and honour recipients of the 2012 Awards for Action on HIV/AIDS and Human Rights - Dr. Philip Berger (Canadian recipient) and the Andrey Rylkov Foundation for Health and Social Justice (International recipient).

The Awards for Action were established in 2002 by the Legal Network and Human Rights Watch to highlight outstanding contributions that decrease vulnerability to HIV and AIDS and protect the rights and dignity of those infected and affected. They honour excellence and commitment to work that has a direct impact on HIV and AIDS and human rights issues - and particularly work that directly benefits marginalized individuals and communities.

This event will also celebrate the 20th anniversary of the Canadian HIV/AIDS Legal Network - a global leader in the movement for health and human rights.

We are thrilled to have Stephen Lewis as our keynote speaker. As a Canadian politician, diplomat and international envoy for humanitarian efforts, Stephen Lewis has dedicated himself to improving the human condition and is a dear friend of the Legal Network. Formerly the Special Envoy for HIV/AIDS in Africa to UN Secretary-General Kofi Annan, he is Chair of the Board of the Stephen Lewis Foundation in Canada, Distinguished Visiting Professor at Ryerson University in Toronto, and Co-Director of AIDS-Free World, an international AIDS advocacy organization based in the United States.

In addition to Stephen, we are delighted to have Suhana Meharchand from CBC News as our host and we will also have a special performance by Andrew Forde, a dynamic violinist who has shared the stage with such talents as Mary J. Blige, Sting, Justin Bieber, Sheryl Crow, Akon, Pitbull, Kardinal Offishall, k-os and Eddie Bullen to name a few.

For tickets visit www.aidslaw.ca/awards. Awards for Action 2012 promises to be a night to remember!

Thank you for your continued support, and we hope to see you soon, 

Richard Elliott, Executive Director, Canadian HIV/AIDS Legal Network 

(Editor’s note: For those unable to attend, PositiveLite.com will be covering this event. )

Bob Leahy: Thanks for talking to PositiveLite.com. We’ll talk about the film’s connection with Toronto in a minute. Tell me about yourself, first, Daniel. 

Daniel: Thank you too. Sure, for people who don’t know me I’d say I’m a person who doesn’t give up. I think two things have shaped my life; and those two things are acting and running. Both pursuits are about discipline and determination – and both have made me the person I am today.

Bob: You’ve made a film called VOICES which is clearly a labour of love and a work that reflects the passion in your soul.  Where does that passion come from – and can you describe it for us, in a nutshell?

Daniel: In a nutshell, I’m not sure I can do that, Bob, but I’ll try! I’m a British born Asian, with North Indian heritage, and I think that background makes my passion inevitable? Punjabis are naturally passionate and expressive people and when you’re brought up in that kind of an environment it’s going to rub-off on you. There’s no escape.

Also I’m a Sikh; and Sikhism sprang out of a need to defend the community and to fight for justice, and the rights of the people. But Sikhism is also about being compassionate and caring. Defending a community isn’t just about physical fighting.

Bob: You first visited South Africa over ten years ago.  Why did you go and what were your impressions – what did you bring back with you?

Daniel: Correct, yes. I flew to Cape Town over ten years ago, to work for a few months for SABC, the South African Broadcasting Corporation, as part of my media studies. I chose South Africa because the recent history fascinated me; I wanted to see it for myself; to look at it with fresh eyes – because I didn’t believe the clichés.

What I experienced on successive trips was a nation in transition. People on the move, vast spaces and over-powering scenery, often juxtaposed with people squashed into a small area and living in absolute poverty. Then you have the wealth and privilege, and the shopping, and the eating. It’s busy. It’s culturally mixed. The faces of the people tell the story of the nation. I was hooked. It was like a drug.

What I brought back, apart from a stack of photographs that would’ve broken the back of a camel, were incredible and vivid memories; and a burning desire to record what I’d seen and heard in a film. That was the genesis.

Bob:  Now the Toronto International AIDS Conference in 2006 was important for you, wasn’t it?  I was there too, and so was our founder Bran Finch who organized a demonstration at the opening ceremonies. I’m not sure you and I met though. Tell me in what capacity were you there? What was your objective?

Wow – amazing! I wasn’t actually at the conference. What happened was that I heard about the media storm from the Producer of Voices; Simon Constable.

The news shocked me; and I instantly realized – and this was before I knew about or saw any demo. footage – that in this transformational moment there was a potential film. There was a great story. And so in the Autumn of 2006 we began to look into what happened in more depth, and to contact people.

Bob: Now that international conference plays an important in your story.  Do you want to talk about what happened there?

Daniel: Yes, it does – it’s the core of the film. In simple terms what happened was that a spontaneous AIDS activist demo. The South African government sparked savage criticism during his closing ceremony speech, from Stephen Lewis, (pictured below) the out-going UN envoy for AIDS in Africa. That very eloquent speech, and the resulting international media attention, was the turning point in the decade long fight against HIV/AIDS in Southern Africa.

Bob: When  he spoke, Stephen Lewis, called  the South African Government’s actions  “wrong, immoral and indefensible”. He was talking about AIDS denialism - promoting ridiculous treatments (or were they cures?) they had put forward, like lemon juice.  Anyway, do you want to talk about that?

Yes. As I said, and as I told him (in Vienna in 2010), Stephen Lewis’s forceful speech was perfectly timed. He spoke for everybody; and he articulated their concerns and anger beautifully. In many ways he could let rip, as he was about to stand down from his post.

AIDS activists and the scientific community were understandably furious about Thabo Mbeki’s total failure to tackle HIV effectively. And it’s as hard now, looking back, as it was at the time, to believe that President Mbeki’s government, and his Minister of Health, ignored proven methods of tackling AIDS; and embraced denialist theories and phantom treatments. Beetroot, garlic and lemon juice, for example. It’s just unbelievable – but it happened!

Without that stand, the  demo and the other actions and interventions of activists in Canada, and, of course, that wonderful speech, who knows where we would be now.

Bob: I think I was at that demo and I took photos; I should dig them out for you. Anyway, what happened next?   When did you decide you wanted to make a film?

Daniel: As I already said, I decided to focus the film I’d always wanted to make on AIDS after the Toronto conference or summit. But films don’t just happen, and you absolutely need evidence, substance and good material.

The end of 2006 and almost all of 2007 was spent researching. We did conduct early interviews with people who were available; such as Sir Bob Geldof and Dr. Robert C. Gallo, and we planned the budget and gathered resources.

Bob: Had you had any experience in filmmaking?

Yes. I studied media at University and created short films there as part of my course work. As I mentioned I worked at SABC and also the BBC, the British Broadcasting Corporation, in the UK. And I personally filmed footage, and some interviews about South Africa, in 2004. So I was fairly experienced in filming and editing.

Bob: What did your plan look like?

Daniel:  Our plan was to fill in the back story and the gaps. By 2007 we already had compelling archive; but what was happening before 2006? And what happened afterwards? We needed to investigate in order for the whole story to be told – even in a sketchy way.

Did that immediately present itself as the way forward? No. For about twelve months we struggled with the angle. Everybody we spoke to had an opinion, but nobody had a solution. It was only at the end of 2009 that it really crystalized. Then in the following year we set off for the second and final filming trip.

Bob: You managed to got footage of the Toronto conference and that demo we talked about and you used it in Voices, I hear.  I’m dying to see it. What’s the footage like?

Daniel: When you see the archive material we were given permission to use, and how we treated it, you won’t believe it. It’s just like you’re there on the stand. You’re there! It’s in front of you. You’re in the moment when the Minister of Health is cornered on the stand and asked to justify her policies by a tenacious female journalist. And we did that to convey the power of the moment to the viewer; and to show ‘people power’ in action. It’s raw. It’s real. It’s history. And there are parallels with the situation in the Arab world and the whole 99% movement.

Bob:  So you commenced filming in 2008?  Tell me about that.

Daniel: Yes, 2008. After spending 2007 researching and planning we gathered some funds. We formed a tight five person team – that was three cameras and two Producers; myself and Simon - and we set-off for an intensive and packed filming trip.

Bob: Where did you go and who did you interview for the film?

Daniel: 12 days in a paragraph? I’ll do my best to summarise it, Bob. But seriously, with the small budget in mind, we based ourselves at a fantastic hostel, in Alexandria, in Johannesburg and used it as a base to travel the country. Support from early partners was invaluable.

First we drove South to Free State with Save The Children. Then we headed East to Pietermaritzburg to look at the work of Fritse Muller. Then we headed for Maseru, the capital of the country of Lesotho; a nation inside of South Africa, to look at the amazing work of ALAFA there – 2,500 kilometres in total! In between there were many interviews. Every day was a working day.

And at this point I have to say that without the early partners it would’ve been a very different trip indeed. As would the 2010 trip.

Bob: Where you happy with the results, the footage from Africa? And how do you go about editing something like that?

That footage from 2008 is great. The purpose of the trip was to really look in-depth at everything -  and we did. We looked at rape, prevention, baby graves, how men are affected, we looked at the good and the bad. There was actually too much footage to use and a lot fell by the way-side – such as the to-camera diaries I recorded every day. But who knows, maybe they’ll make-it onto the DVD?

Compared with 2010 the 2008 trip was a dream; but what we did discover was that we would have to return, because the South African government changed and so did the health policy.

Bob: That’s what I wanted to ask you. I mean that was a time of transition then with a new, more progressive government coming in.  Did that complicate things for you or altered the relevancy of your message in any way?

Daniel: Well, firstly it was – in my opinion – very much a consequence of Toronto. Do I think Mbeki was forced from office because of what happened in Canada in 2006? No. But it was another nail in his coffin. Some would call him a murderer. Not me, I would stop short of that; an interviewee doesn’t. But there’s blood on his hands, definitely. I’ve seen the consequences of his inaction and denial. People died needlessly.

We all like a happy ending – don’t we, Bob. We all like the happy ending and the credits rolling and it all working out. Is there a happy ending if you’re HIV? Maybe you’re happier and alive when you get the treatment you’re entitled to from your government?

There’s a question mark and we don’t know if South Africa can sustain so many on treatment. Will those HIV positive citizens become drug resistant? We don’t know. We have to be hopeful; and we have to give them the opportunity to live and to contribute to society, and not create more orphans. I think the little AIDS orphan girl we follow in Voices, from being very tiny almost to puberty, is symbolic of hope.

Bob: You’ve said the film is about not just voices by answers.  What are the answers?

Daniel: Yes. It’s titled “Voices – Nobody Will Silence Them!”  because eventually the cries were heard; the cries were answered. And the film is also called Voices because of some of the incredible people who have contributed their time, their memories and experiences. Sometimes you just hear audio and there’s a blank screen. It’s a just a statement – just a voice. Something powerful. A memory. People like Gail Johnson; the Mother of the late great Nkosi Johnson, the inspirational Zachie Achmat, and many less famous but equally important persons.

What are the answers? I think Voices shows that we’re all in a position, even in a small way – such as when people buy WAITROSE produce; which then directly helps fund an HIV clinic, in rural Limpopo – to fight HIV/AIDS. I think Voices doesn’t only show things going wrong it often shows what works, and good models. For example: peer to peer education and support, employer responsibility, youth engagement and ‘edutainment’; and real sustainable government intervention.

Bob: You’ve called working on this movie – and we’re talking almost six years - “an obsession, a blessing and a curse”.  Do you want to explain that?

Daniel: I said that? Sure. An obsession because I had to tell the story, people had to know; a blessing because my life has been enriched by the people I’ve met and the places I’ve been; and a curse, because I put so much into the film. In 2009 I was in a life-threatening accident and totally broke because of Voices and nobody would help. But I never stopped believing. I never gave-up – just like the Toronto activists!

Bob: What stage is the film at now?

Daniel: Voices is now completed and in a seventy minute screening version and ready to sell and to be broadcast. We are lining-up what we hope will be high profile screenings; and will continue those right up to World AIDS Day – hopefully one or two a month.

Bob: What does it feel like now you are almost there?

Daniel: A relief! Certainly the work isn’t over. But we’re confident, and above all, if we can screen or broadcast in South Africa, and Canada, we’ll be very pleased indeed. I have to tell you that many South Africans do not know to-this-day what happened in Toronto in 2006. Canadians may also need reminding?

Canada is very close to my heart – as I know it well, and have been there and have family there. Obviously, without Canada and the Toronto conference six years ago, and people like Dr. Mark Wainberg, sub-Saharan Africans might still be not be getting the ARV treatment they so badly need to stay alive; and could still be dying from AIDS because of denialism and inaction

Bob: When do you think people will be able to get a look at it?

Daniel: Bob I would love to give more details but we’re currently in discussions. If people can follow us on twitter: http://www.twitter.com/voiceshivaids and check our tweets then they will see information as the weeks and months pass. But international broadcast is absolutely our aim. The world must know the story and the mistakes must never be repeated.

Bob:  Daniel, I want to thank you again for talking with us. You’ve given us the trailer to look, let’s look at it now.

Daniel Larson Sidhu is an actor turned film-maker based in the United Kingdom. He established Blue Rain Productions in 2008 with the aim of creating films that would assist people to better understand others and the world. Completed in 2011, VOICES is Daniel and BRP's debut feature documentary.

Find out more about VOICES on their website here. 

Follow VOICES on twitter @VOICESHIVAIDS