On 29 April to 1 May 2005, Pugwash meeting no. 306 was held in Gordon’s Bay, South Africa.
Threats Without Enemies: The Security Aspects of HIV/AIDS
Hosted by the South African Pugwash Group at Villa Via.
Workshop Report by Sandy Rowoldt Shell, Rapporteur
Having invited the participants to introduce themselves, Professor Gwyn Prins of Columbia University and the London School of Economics and Political Science (LSE) opened proceedings by giving the background to the workshop and setting the rationale for the agenda.
Background to the workshop
In response to a proposal made by the South African Pugwash Group to convene two exploratory workshops to examine the different dimensions of the HIV/AIDS pandemic as a security issue, the Pugwash Council agreed and these workshops took place during 2004.
The first workshop was held at Betty’s Bay in the Western Cape Province, South Africa from 7-9 February 2004.
The second workshop was held near Warmbaths in the Limpopo Province, South Africa from 25-28 June 2004. This second workshop probed more deeply into the political, epidemiological, statistical and national policy ramifications of HIV/AIDS as a threat to international peace and security.
The third exploratory workshop
The particular purpose of this third meeting was to share the experiences and lessons, both good and bad, learned thus far in the management of the pandemic in South and Southern Africa with countries that could be considered to be experiencing the “second wave” in the global spread of the HIV/AIDS pandemic.
In view of the many similarities of the pandemic shared between Southern Africa and India-particularly in terms of clade, aetiology and, to a certain extent, the degree of denial at both leadership and grassroots levels-the Pugwash Group believed there is a specific urgency to engage, in the first instance, with appropriate specialists from the Indian sub-continent.
Beyond India, the Pugwash Group believes that this knowledge must also be made available authoritatively and swiftly to those firmly in the path of the pandemic in Russia, Central Asia and China. The Pugwash Group believes that this workshop offered the first opportunity for an inter-continental exchange of this nature. Given India’s vast population of 1,1 billion, coupled with the speed of the spread of the pandemic on the African sub-continent, there is no time to waste. There is a compelling need for the urgent sharing of knowledge, skills and experience. There is as much to be learned from what has not been done or has been done poorly in the Southern African region as from what has been effective.
Four papers were selected for the workshop that would describe the South and Southern African experience to date, with two invited Indian delegates given the opportunity to respond.
The first paper would present a status report on HI virological research and future prospects for the virus in Southern Africa. Subsequent papers would deal with the arrival and vectoring of the virus in South Africa, the controversies around AIDS statistics and a history of the political management of the AIDS pandemic in South Africa. Responses and comparisons would follow from the Indian delegates on HIV/AIDS and security in India.
Any comprehensive understanding of the present state of the pandemic in South and Southern Africa needs an appreciation of the changing nature of the virus and the attendant challenges facing virological research nationally and internationally. Accordingly, the first paper looked at preventive strategies and vaccine developments.
The greatest challenge to the development of a successful range of vaccines or any other form of viral control is that viral diversity is becoming a growing characteristic of the HIV pandemic. This diversity is increasing as fast as it can be measured. The presentation of one case study served as a reminder “that HIV remains a frighteningly versatile foe, one that can mutate to escape immune attack or to acquire drug resistance with surprising speed …”. Virologists were faced with the reality of the development of a “super strain” of the virus exhibiting multi-drug resistance and extremely rapid development in its clinical course to AIDS.
That HIV is developing into an increasingly complex molecular pandemic was recognized at the International AIDS Conference in Bangkok in 2004 with an acknowledgement that the virus is changing at an even more rapid pace than had been so far understood.
Adding to the seemingly insurmountable challenges of combating the virus on a grand scale, surveillance levels remain poor internationally with only specific pockets of populations being targeted. What is needed is more and better surveillance of populations, especially among the newly infected and over time. Innovative and ethically acceptable methods of testing wider population ranges need to be developed and implemented before the full impact and vectors of the thrust of the pandemic can be assessed.
There is growing recognition that certain genetic strains of the virus are transmitted more easily and more rapidly. Clade C, responsible for approximately 50% of the world’s HIV infections, including among the populations of South Africa and India, is the most readily transmitted. This clade of the HI lentevirus exhibits a lower replicative capacity that leads to slower progression of the disease. This, in turn, allows for a longer time for possible exposure and therefore a greater number of opportunities for transmission.
A further challenge to the development of an effective HIV vaccine is the HLA (human leucocyte antigen) diversity of a population, compounded by the existence of dual infections and the growing phenomenon of super-infection.
The massive immunological challenge is complicated by the absence of successful means of animal testing that will replicate the progression of viral infectivity in humans. Ethical issues preclude the use of “live attenuated” HIV vaccines in trials.
Poor immunogenicity results in humans have hindered progress in the development of a successful DNA vaccine and the current hot topic in immunology revolves around toll-like receptors. Despite this hope, virologists must conclude that there is unlikely to be any major successful vaccine in the immediate future. ARVs and prevention presently must remain the most effective strategies to combat HIV.
The arrival and vectoring of the virus in South Africa
The second Pugwash workshop held at Betty’s Bay in February 2004 discussed the challenges posited by dissidents contributing to the AIDS debate who have attempted to discredit the quality of datasets used in scientific descriptions and projections of the pandemic. The importance of being able to demonstrate the integrity of the data used in the analysis of the pandemic was dealt with in the next presentation that began with a rigorous interrogation of a specific range of datasets gathered in Region A of the Eastern Cape and used to track the arrival and vectoring of the virus in the region.
The impetus for gathering the data that comprises the primary dataset came in 1988 through the efforts of the then Medical Officer of Health in the Nelson Mandela Metropole who recognized the growing impact of the pandemic and the need to be able to track and measure it over time. Using the offices of the AIDS Training Information and Counseling Centre or ATICC, case-level data recording HIV-positive patients were submitted by various agencies in Region A including antenatal clinics, medical practices, insurance companies, District Surgeons, Medical Officers of Health, hospitals, army bases, police and prison records and the Eastern Province Blood Transfusion Service. The data, cumulating over time to nearly 30,000 cases by 2000, was analysed in terms of 43 variables and, given its twelve-year span, offers the opportunity of tracking the pandemic from infection to death.
Added to this primary dataset was data from graveyard records and an additional set from undertakers back to 1974, pre-dating the onset of the pandemic.
Ratepayers’ lists, telephone directories from 1988-2000 and TB records from SANTA augmented and endorsed the primary dataset building in total a composite set of irrefutable, case-level data.
One of the main reasons why HIV/AIDS has spread so rapidly in Africa is that the continent has been embroiled in twenty years of intermittent military violence in several regions such as Angola, Burundi, the Democratic Republic of Congo, Eritrea, Ethiopia, Liberia, Mozambique, Namibia, Rwanda, Somalia, South Africa, Sudan, Uganda and Zimbabwe. As has been argued in many studies, war creates favourable conditions for the transmission of HIV. South African Defence Force troops and the liberation armies, which were deployed in neighbouring countries during the liberation wars, were subsequently merged into the South African National Defence Force and distributed to army bases across the country. These became an almost perfectly randomly distributed set of sites for the incipient pandemic between 1992 and 1994. Recruits who had been called up to do national service simply returned to their homes without any exit testing or counselling. This process established an additional possible vector for the spread of the virus. This hypothesis is evidenced in the records of the Region A datasets described above.
If South Africa had followed the example of Cuba, which rigorously tested their troops on their return from their engagement in Angola, the HIV pandemic might have been arrested in this country as it was in Cuba. However, there was no testing. Worse, the blood transfusion services continued soliciting blood donations from the military establishment until 1985. There was no HIV screening of the blood supply in, for example, the Eastern Cape, until 1988 (tests only became available in South Africa in 1985). The blood supply of the Eastern Cape was therefore potentially open to HIV contamination for almost a decade after the first incursions into Angola by South African troops in 1976.
Researchers remain largely oblivious, even resistant, to the obvious military epidemiology. There has yet to emerge an alternative and convincing explanation for the pronounced regional variance in the provincial breakdowns. Accordingly, it is argued that the military should be considered seriously as an additional vector in the spread of the pandemic.
The battle over HIV and AIDS statistics
The third presentation followed the interrogation of HIV data with an analysis of the battle over HIV and AIDS statistics, raising the question: “Do the models reflect reality?”
Since the mid-1980s, there has been a range of interest groups who have joined the battle over HIV and AIDS statistics. Conflicting numbers have been posited in the media by different interest groups regarding the number of HIV-positive individuals, the numbers of AIDS deaths per annum and the numbers of AIDS sufferers. These groups range from outright HIV/AIDS dissidents, who denounce the figures as being inflated for financial gain by the pharmaceutical industry, to various AIDS lobby groups who tend to exploit exaggerated figures generated by less than reputable sources to foster support for their causes.
The presenters argued that in setting the ground rules for HIV statistics, it is essential to gain an understanding of what is being measured, of the nature of the HIV test itself and of the construction of the sample being tested.
With regard to testing, the typical protocol would involve an initial plus a confirmatory test of a blood sample. Only if both tests were positive, would the case be recognised as HIV positive. In practice, if properly applied, HIV testing has proved highly accurate.
The issue of sampling is perhaps of even greater importance. Given that it is seldom possible to test an entire population, the most common way to study a large population is by means of sampling. It is essential that samples are properly constructed or conclusions will be drawn for the entire population that, at best, could be misleading.
It is therefore extremely important in the battle of HIV statistics to understand exactly how a sample has been constructed and so be assured that extrapolations from this sample to the greater population will have any degree of certainty. Any sample will have an element of bias to the extent that it is not truly representative of the entire population being sampled. Primary errors relating to HIV statistics (and therefore the source of “battles”) lie in the way in which sample data is extrapolated to large populations.
It was critical to recognize the differences between HIV statistics, which are virtually all based on data sampling, and AIDS statistics that are gleaned from individual patient clinical records. Because AIDS is a syndrome and not a single disease, there is no single test available to classify the presence of AIDS. Instead, it is common for researchers to use the staging system used by the World Health Organisation, which have defined four stages of the disease from acute HIV infection (WHO stage 1), through early disease (WHO stage 2), followed by late disease (WHO stage 3) to AIDS (WHO stage 4). The first two of these stages are largely asymptomatic while Stage 3 sees the onset of opportunistic infections and attendant symptoms such as weight loss and oral infections. In stage 4, HIV-positive individuals experience a range of more severe conditions such as pneumonia, extra-pulmonary TB and wasting syndrome. These conditions are collectively referred to as AIDS.
It is clearly important to be able to distinguish diseases that can cause symptoms similar to those exhibited in AIDS. In doing this, one of the critical requirements for an AIDS diagnosis is a measurement of the CD4 cell-count, which measures the strength of the body’s immune system. Stigma, poor administration and lack of resources can all contribute to the difficulty in collecting accurate AIDS data.
Concomitant with the difficulties experienced in the collection of AIDS-prevalence data is the under-reporting of AIDS deaths. Over the last few years, the topic of AIDS deaths has become a subject of considerable controversy. AIDS dissidents and denialists have compared figures of modelled AIDS deaths to the figures of actual deaths in South Africa and have concluded that some models vastly overstate the actual numbers of AIDS deaths. However, there is a relatively close fit between the number of deaths estimated by the ASSA2002 model compared with the number of registered deaths issued by Statistics SA.
The ASSA2002 AIDS and demographic model directly models five interventions that affect the pandemic: (i) Information and education campaigns; (ii) Improved treatment of sexually transmitted diseases; (iii) Voluntary counselling and testing; (iv) Mother to child transmission prevention; and (v) Antiretroviral treatment. All five of these interventions will have an impact on the pandemic in future, which could in part lead to additional uncertainty around HIV-prevalence rates and AIDS mortality. Four of the interventions will have a reducing impact on the HIV-prevalence rate by reducing new infections. These four are: (i) information and education campaigns; (ii) improved treatment of sexually transmitted diseases; (iii) voluntary counselling and testing; and (iv) mother to child transmission prevention. The remaining intervention, namely antiretroviral treatment, will result in HIV-positive people remaining HIV-positive for a longer period of time and will therefore increase HIV-prevalence rates.
With the introduction of antiretroviral treatment, it has become necessary to consider a fifth and even a sixth disease stage in the modelling process. Without treatment or other intervention, HIV-positive individuals progress through each of the four WHO disease stages, but individuals who experience their first AIDS-defining illness are assumed to move to stage 5 when they will receive ART. Stage 6 represents those individuals who have discontinued ART. A final stage, stage 7, is AIDS death.
Key conclusions from the first part of this presentation included:
- There are sufficient data points and time series of HIV data to extrapolate HIV data to estimates at the population level with a high degree of confidence.
- There IS a large-scale epidemic of HIV infection in South Africa.
- AIDS sickness and mortality statistics are still subject to many sources of uncertainty and error. In addition, the positive impact of treatment will now start to change the profile of AIDS statistics continuously from a modelling and extrapolation point of view.
- More rigorous AIDS treatment programmes will now start to enhance the value of AIDS data significantly.
- There is currently NO clear picture of the real level of AIDS sickness and mortality in South Africa.
The battle over HIV and AIDS statistics has developed in part as a result of the differences between the statistics produced by different AIDS and demographic models. The two principal AIDS and demographic models currently being used to estimate the current and future impact of the HIV/AIDS epidemic on South Africa are Spectrum and EPP, used by UNAIDS and the ASSA2002 model developed by South African actuaries, which is based, in turn, on the Doyle model, the original actuarial model developed by Peter Doyle of Metropolitan.
The factors that have resulted in a battle around HIV and AIDS statistics in South Africa need to be understood to avoid similar debates in countries where the epidemic is still in its initial stages. These factors have included: the differences between estimates from the main AIDS and demographic models for South Africa; the lack of some models to validate their estimated AIDS and total deaths to recorded deaths; the controversy around statistics caused by AIDS dissidents; and a misunderstanding of the statistics and the modelling process.
It is an incontrovertible fact, however, that South Africa has an HIV epidemic of massive proportions, of which the impact will be felt by generations into the future. It is important to acknowledge, however, that the country has developed considerable local skills in quantifying the extent of the epidemic. Efforts to argue about the data should be redirected more constructively towards dealing with and preventing the consequences of this massive pandemic.
A history of the political management of the AIDS epidemic in South Africa 1982-2005
This presentation addressed the issue of how successive polities in South Africa have handled the HIV/AIDS pandemic. Despite some good policy plans, the principal problem with both the former National Party government and the current government has been one of implementation. Failure of leadership to deal effectively with the problem has led to attempts by civil society to bypass the administration by appealing to the courts to enforce the implementation of declared AIDS policies. The rift between sectors of civil society trying to deal effectively with the pandemic and the government grows ever wider. The root of the problem is seen as the failure of South African governments to define the AIDS policy problem consistently and correctly.
Statistics released by the Joint United Nations Programme on HIV and AIDS (UNAIDS 2004) were cited:
- more than 5.3 million South Africans were HIV-positive at the end of 2003;
- AIDS is killing the population at a rate of between 600 and 1,000 people each day;
- the country will have around two million AIDS orphans by 2010; and
- between 1,400 and 2,000 additional South Africans are becoming infected daily.
Without effective treatment for HIV and AIDS-i.e. without the comprehensive and systematic rollout of ARVs-the need to implement an urgent and appropriate public programmatic response is patently clear.
Examining the reasons why successive South African governments have failed in combating the HIV pandemic, an inability to identity the true nature of the problem has been identified as a root cause. The National Party government regarded HIV and AIDS primarily as a moral issue leading to an unwritten policy response steeped in a moralist discourse rather than identifying and responding to the problem in biomedical terms: according to the government, those affected were homosexuals, intravenous drug users, commercial sex workers and black migrant workers, who could be regarded as aberrant members of the population. However, when the virus began to affect those in what the government regarded as ‘normal’ South African society, the growing epidemic became increasingly identified with the black sector of society, thus serving to racialise and politicise the epidemic. The apartheid government could use AIDS as an excuse to exclude foreign mine workers, and could throw the blame on liberation movements for infiltrating South African society with AIDS as a new weapon.
When it became obvious that HIV/AIDS was entering white South African society as well, the government gradually reconceptualised AIDS as a biomedical problem, creating medical bodies and legislation to facilitate a biomedical response to the growing epidemic. In a rapidly changing political landscape, with the institution of South Africa’s first democratic government and radical constitutional changes looming, government policy shifted to allow greater room for human rights-based perspectives on the epidemic, culminating in the formation of the National AIDS Co-ordinating Committee of South Africa (NACOSA) and the accompanying process of 1992-1994, which led, in turn, to the drafting of the democratic National AIDS Plan (NAP) of 1994.
But the National AIDS Plan proved to be over-ambitious and the new Mandela government reverted to a biomedical conceptualisation of the AIDS policy problem. A series of profound errors were made, including the Virodene debacle (1997) and the mishandling of the Sarafina II scandal (1996), which effectively corrupted the AIDS policy environment.
When President Thabo Mbeki took office in 1999, he exacerbated the situation by questioning the fundamental tenets of medical science. His obdurate declarations denying proven medical and scientific findings on HIV and AIDS forced politics to enter the biomedical domain. Mbeki re-conceptualised the problem largely as a monetary issue, blaming the profit motives of the large pharmaceutical companies for continuing and increasingly disastrous projections of the prevalence of the virus. Mbeki’s and his minister of health’s stubborn resistance to the empirically proven scientific evidence surrounding the virus and the pandemic, combined with an almost inexplicable heel-dragging regarding the rollout of essential anti-retroviral treatment, has led to nation-wide confusion and delay. The policy problem remains firmly an area of contention and it would seem that the President and the health ministry may become increasingly isolated even within the broader governing alliance-the African National Congress-regarding policy and strategies to combat the epidemic. Increasingly, sub-national bodies (provincial and local levels of government) are working with members of South Africa’s civil society in an effort to ensure the rollout of treatment strategies. HIV and AIDS arguably constitute the most politicised issues in South Africa today.
Regarding the way ahead, there would seem to be three identifiable groups of issues requiring further examination:
- The problem identification phase is an essential and under-valued step in the process of AIDS policymaking and needs closer examination and resolution.
- A chasm has developed between the respective perspectives of the government and AIDS civil society on the most appropriate way forward for AIDS policy design: the government is pushing for the continual drafting of AIDS prevention strategies, and the TAC, in particular, is emphasising the importance of treatment strategies. AIDS prevention and AIDS treatment should not be seen as mutually exclusive but rather complementary.
- Research should be conducted to explore ways in which technical knowledge and discourses can be democratised to avoid the present situation where the state seeks to exclude non-state policy actors from exercising the right to make statements on and define the very problem of AIDS policies themselves.
There are, however, some chinks of light in the darkness of state intransigence including moves by the ministry of finance to bankroll improved ARV rollout, evidence of increased capacity to provide essential services in some of the provinces and local authorities, the successful bypassing of the highest and most intransigent by civil society in the creation of programmes and infrastructures, and several new appointees within the national health department who appear to be committed to accelerating measures to combat the spread of HIV and AIDS.
AIDS in Africa: three scenarios to 2025
Three scenarios were presented that were posited as a result of three workshops involving UNAIDS, UNDP, IBRD, ADB, ECA and Shell International’s Global Business Environment (GBE) Team. The three scenarios were based on the question “Over the next 20 years, what factors will drive Africa’s and the world’s responses to the AIDS epidemic, and what kind of future will there be for the next generation?” In developing these scenarios, consideration had to be given to how the crisis was perceived and by whom, and whether there would be both the incentive and capacity to deal with it.
Tough Choices: Africa takes a stand
A story in which African leaders choose to take tough measures that reduce the spread of HIV in the long term, even if it means difficulties in the short term. Leaders and communities come together.
Traps and Legacies: the whirlpool
A story in which Africa as a whole fails to escape from its more negative legacies, and AIDS deepens the traps of poverty, underdevelopment, and marginalisation in a globalising world.
Time of Transition: Africa overcomes
A story of what might happen if all of today’s good intentions were translated into the coherent and integrated development response necessary to tackle HIV and AIDS in Africa.
None of the African representatives supported any of the scenarios outlined above.
There was a fourth scenario dubbed “Mama Africa“, rooted in the African experience, but it was discarded by the northern sectors of the team.
While not perceived as entirely successful, there were key lessons that could be learned from this exercise. As part of the process, a clear need emerged to establish and maintain legitimacy, to be honest about who the client is and about normative agendas, to listen to the participants, to respect them, to cultivate them as future champions, to locate the project in Africa and to be sensitive to North-South issues. Above all, there was a need to beware of cultural and intellectual arrogance.
HIV/AIDS and security: a case study of India
The final contribution to the workshop dealt with India’s response to HIV/AIDS. As an emerging power, India is faced with many obstacles along the path to potential great power status. One of the most urgent and serious of these dangers is presented by the fact that there are presently 5.1 million Indians infected by HIV/AIDS translating to close to one per cent of the country’s adult population.
India has recognised that, in terms of the progression of the pandemic, it stands today where South Africa stood some fifteen years ago. Similarities abound. The very small number of sentinel sites set up by the National AIDS Control Organisation across the country means that surveillance is woefully inadequate in India. Full-blown AIDS cases, people whose ages fall outside the grouping of 15-49 years and sex workers are not currently included in the surveillance net, nor are those attending private hospitals, which cater for approximately 80% of healthcare in the country. There are also questions regarding the quality of HIV testing standards.
The US National Intelligence Council (USNIC) estimated that, by 2002, there were between 5 and 8 million HIV-infected people in India. The People’s Health Organisation in Mumbai claims that infections are doubling every 18 months to two years and that it is possible that there are between 10 and 12 million HIV-positive people across the country today.
High-risk populations who are acknowledged to be contributing to the spread of the pandemic include female sex workers and truckers, but other carriers have also been identified. While strong social stigma makes accurate assessment impossible, there are reportedly high numbers of homosexuals who are testing HIV positive. In addition, blood and blood products pose an additional risk. The World Health Organisation estimated in 1998 that up to one-fifth of all of India’s infections were due to improperly screened blood and blood products. Currently, Indian health authorities acknowledge that 8% of HIV infections are transmitted through infected blood.
High population mobility and the uneven sex ratio are further contributory factors increasing the spread of HIV/AIDS. Poor health facilities, particularly among the rural poor, give further cause for concern.
Three principal factors were identified that would transform HIV/AIDS into a security threat to India: poverty, ignorance about the disease and social stigma leading to widespread denial.
India has in the region of 1.3 million military personnel who are deployed across wide swathes of the country including in the north-eastern regions where many Border Security Force personnel are testing HIV positive. Similarly, police personnel deployed in India’s metropolitan cities are considered to be high-risk populations. International peacekeeping forces are regarded as responsible for spreading the virus among the population in their areas of deployment. India, in turn, has a commendable record of sending troops to other countries on UN peacekeeping missions.
Relations with neighbouring countries such as Nepal are becoming strained under accusations that Nepalese migrant workers return home having contracted HIV while employed in India.
While there are no systematic and comprehensive studies to date detailing the economic effects of a rapidly increasing HIV pandemic on India, it is clear that the pandemic will have an adverse impact on the Indian economy and productivity both in the short term and in the long term.
There are particular social and cultural effects that may become evident as the pandemic spreads throughout India. It is possible that HIV/AIDS, with the passage of time, could produce yet another new and unique caste of “untouchables”. This could, in turn, provoke violence and civil strife. A growing population of AIDS orphans would imbalance societal structures and security. Alienation from their societies through stigma and social shunning could also lead to growing numbers of people resorting to alternative and even violent ways of securing their livelihood.
Within the current Indian marriage system, where caste, astrology and dowry remain factors for consideration, HIV status is set to become a major issue . There are already moves to draft legislation making HIV testing compulsory before marriage in some states.
It is hoped that the South and Southern African experience in understanding, describing and combating HIV/AIDS (including the errors and inadequacies) may prove useful signposts for those in India who are engaged in the fight against the onslaught of the pandemic.
Professor Gwyn Prins
Alliance Professor, Columbia University and London School of Economics and Political Science (LSE)
Professor M E Muller
Dean and Professor in the Department of Political Sciences, Chair of SA Pugwash Group
Chair of the Pugwash Council
Professor Nola Dippenaar
Chair of SA Pugwash Group, Department of Physiology, Faculty of Medicine, University of Pretoria
Professor Hussein Solomon
Professor, Director of CIPS and Deputy Chair of the South African Pugwash Group, Department of Political Sciences and Centre for International Political Studies, University of Pretoria
Professor R A (Andy) Mogotlane
Vice-Principal (Health Sciences) University of Pretoria
Ms Nathea Nicolay
AIDS Solutions, Metropolitan, AIDS Risk Consultant and Actuarial Specialist, Metropolitan Employee Benefits
Dr PP (Pieter) Fourie
Dept of Politics & Governance, University of Johannesburg
Ms Mary Crewe
Director of the Centre for the Study of AIDS, University of Pretoria
Dr Lynne Webber
Clinical Virologist for Lancet Laboratories, associate lecturer, University of Pretoria and Medunsa
Ms Lindy Heinecken
Deputy Director, Centre for Military Studies, Military Academy, South Africa
Dr J Boutwell
Executive Director, Pugwash Conferences
Ms Nyameka Mankayi
Psychologist, Military Academy, South Africa
Mr Gus Stewart
Director: Research Development and Policy Development, London School of Economics and Political Science (LSE)
Ms Sue Valentine
Director: Media Program, Open Society Foundation (OSF SA)
Dr J (Jayanti) Ravi
Deputy Secretary: National Government of India (Indian National Advisory Council)
Prof P Canonne
Retired; French Pugwash, Pugwash Council
Professor Robert Shell
Extraordinary Professor in Historical Demography, University of the Western Cape
Ms Desiree Daniels
Executive Manager: Metropolitan AIDS Solutions
Dr/Col Cornelius Engelbrecht
HIV/AIDS Programme Manager, SA Department of Defence (SADOD)
Dr Peet Rautenbach
Acting Head: Department of Community Health, University of Limpopo
Mr Happymon Jacob
Lecturer, Centre for Strategic and Regional Studies (CSRS), University of Jammu
Mrs Rieko (Suzuki) Kitaoka
Wife of the Japanese Ambassador to the UN
Professor Duard Kleyn
Dean: Faculty of Law, University of Pretoria
Mr Peter Doyle
CEO Metropolitan Group
Dr M Rupiya
Senior Researcher, Institute for Security Studies (ISS), Pretoria
Ms Sandy Rowoldt Shell (RAPPORTEUR)
Head: African Studies Library, UCT