Last updated: July 15 , 2004

DISPATCH II FROM THE INTERNATIONAL AIDS CONFERENCE

Written and edited by Phil Rose, Michael Kink, Terri Smith-Caronia and staff at Housing Works

The International AIDS Conference is always an overwhelming experience, with more sessions, abstracts, panels, plenaries, symposia and satellite meetings than anyone could possibly absorb in the course of six days. Still, moving from session to session, mingling with thousands of people from all over the world, snapshots inevitably form. Sometimes those snapshots are the most important and lasting messages the conference offers. What follows are a few snapshots from Monday, Day Two.

Bangkok: A City of Contrasts
When you step out of your luxury hotel you can't help but immediately notice the amazing contrasts bumping up against each other in this old but modern city. In the absence of any apparent zoning laws, on one side of the street, skyscrapers brush up against old French-style villas, on the other, a shanty town. People line the entrances of a brand new subway system to beg, or more often to sell the most meager trinkets to survive. The smell of food being cooked on the street wafts everywhere, even at the entrance to a supermarket that could compete with Whole Foods.

There are many reasons why it is appropriate for the AIDS Conference to finally come to Asia, and specifically to Bangkok, not the least of which is the burgeoning epidemic on this continent. Early in the epidemic, Thailand broke major barriers with its straightforward prevention efforts, resulting in a dramatic decline in the infection rate parallel to that of Uganda. But there are clear holes in that effort, especially among youth, primarily girls and young women, and among drug users. Then there is the issue of access to drugs in a low-income country where the epidemic is dispersed. The Thai government has pledged to provide treatment to everyone and to begin manufacturing generics, but the U.S. government is attempting to negotiate a trade agreement that advocates claim would outlaw generic production. Finally, there is the grinding poverty that is endemic among the people most impacted by AIDS and HIV.

Thai AIDS activists are tireless in their efforts to bring attention to their concerns. It is clear that they view the AIDS Conference as a once in a lifetime opportunity to bring global pressure on their own government to live up to its promises. The world desperately needs them to succeed. We need Thailand to live up to its reputation for truly addressing the AIDS pandemic.

Women - Leaders in the Fight
Perhaps the most significant issue highlighted at this conference is the staggering increase in HIV infections among women, who now make up 48% of people living with HIV. This is a shift from 35% in 1985, and the rate of infection among women continues to accelerate in most nations around the globe. Surprisingly, the greatest rate of increase as a proportion of the infected population is not in the underdeveloped world but in North America, where women now comprise 25% of the infected population, compared to only 20% in 2001.

Clearly, gender issues must be addressed in order to really respond to the pandemic. But, as one woman noted, "This conference is running on two tracks that never seem to meet, like two trains running side by side, without any intersection. There are women, and then there is everything else."

One session directly addressed the issue of women as leaders. One speaker, Graca Machel, the former First Lady of South Africa, noted that women have been playing a leadership role all along. She cited by way of example, HIV+ women in Rwanda who were the first to take in AIDS orphans because everyone else was afraid. She asserted that the real problem was getting government and AIDS Inc. to pay attention to what women have to offer. Another speaker, Musimbi Kanyoro of Kenya, added that women, especially HIV+ women, cannot provide leadership if they are relied on as a substitute for a health care infrastructure.

The Global AIDS Village is a section of the Conference dedicated to narrative histories of persons living with AIDS, policy change discussions and advocacy efforts around the world. In one session, a woman from Vietnam shared her story of being a young woman sold into prostitution to an abusive man who beat and raped her for years. She said the HIV/AIDS situation is at a critical crossroads and that the epidemic in Vietnam requires more supportive action to deal with the increasing numbers of infections.

In another session, a Nigerian woman, speaking from the floor, stated, "Too many of us have handed our lives over to the government and the drug companies, hoping they will save us. We who are living with AIDS need to take our lives back. It's our lives and it must be our agenda."

Drug User Rights: Human Rights
It was obvious, but it took Peter Piot, the head of UNAIDS, to say it: Discussion of human rights as an AIDS issue is noticeably absent from this Conference's agenda. This is glaring, particularly in light of the number of sessions speaking to human rights issues in Barcelona. Still, harm reduction activists have been a visible presence. Sadly, too often the message is that most of the world sees drug addiction as a crime to be punished and AIDS as an inevitable, if not appropriate, consequence.

Most heart wrenching was the presentation made by a young Russian man from St. Petersburg -- where over 50% of people infected are injection drug users, mostly under the age of 30. He described his own experience, being denied AIDS treatment on the official basis that "the patient is not useful for society." According to Constantine, this was actually written in his medical chart.

The story sounded all too familiar, whether the speaker was from Nepal, India, or Italy. Drug users are expendable and harm reduction is too counterintuitive to even contemplate. But Constantine had the best response to this reasoning: "Remember," he said, "it's not just me who is infected. It's the whole of society that is infected."

Posters and Presentations
There were an overwhelming number of poster presentations -- most striking are the diverse global research efforts on HIV/AIDS in countries such as India, Cambodia and Uganda. One such presentation included an HIV counseling and testing project in thrift stores, with the goal of reaching high-risk individuals. The seven-day-a-week walk-in approach in Los Angeles, California makes testing accessible and provides an atmosphere that reduces the amount of anxiety about testing. Since 1997, the program has provided about 35,000 tests and identified 700 newly diagnosed people with HIV/AIDS.

Also interesting: a paper on a model for the design, implementation and evaluation of programs that build capacity in community service organizations for HIV prevention developed by the CDC. The National Minority AIDS Council (NMAC) can demonstrate that the model supports community service organizations, and shows that human capacity building programs are a valuable resource in developing HIV prevention services programs. NMAC-sponsored conferences and trainings are among the ways to reach participants from those service organizations dedicated to HIV/AIDS.

New AIDS technology wasn't left out of the conference. One international initiative in particular stood out today: a web-based HIV/AIDS information-sharing network, used as a tracking tool for HIV/AIDS commodities. After analyzing information needs and existing options to deal with this set of multifaceted, rapidly changing information, Management Sciences for Health (based in Virginia) chose a web-based information tracking system, centrally maintained and accessible to all stakeholders.

While many donor programs for developing countries target the supply and use of HIV/AIDS pharmaceuticals/commodities, the knowledge base for HIV/AIDS medicines is growing, and the information on availability is in flux. Effectively cataloguing commodities information: shows where assistance may be needed; tracks overstocks and depletions of AIDS commodities in multiple regions; avoids duplication by donor organizations; creates a centralized base for information sharing; and improves estimates of patient populations (by region) by analyzing projected purchases. It was nice to see that technology could be used aggressively to dramatically improve national approaches to the epidemic in developing regions.

Another highlight of today's events was the restructuring of an AIDS pioneer, The Global Network of People Living with HIV/AIDS (GNP+). Through many hardships, including a severe lack of financial and human resources, this global organization of PLWHAs announced several changes dedicated to improving global resources. Beginning with the guidance of Joseph Schiech (who died of AIDS last year,) a strategic development and restructuring plan was put in place to create a sustainable future for the organization. The group now focuses heavily on the most pressing needs of regions to develop operational and governance procedures. This allows the regions to develop programmatic activities, and lets them operate or develop as partners within a network -- functioning autonomously and independent of the central secretariat. Since its conception in 1986, the GNP+ has expanded its activities, continuing to address the enormous needs of the global PWA community. It was a great pleasure to witness the resurrection of a group that specifically addresses global concerns.

Global Fund -- Broken Promises and Enough Guilt to Go Around
Joined by Thai activists, Health Gap, Act Up Philly, Housing Works and others, Act Up Paris led a dramatic demonstration denouncing the shortfall of pledges to the Global Fund to End AIDS, Malaria and Tuberculosis. (Graca Machel noted in an earlier session that the real problem is recycled financial pledges that are never honored.).

The World Health Organization estimates that over 95% of people with AIDS have no access to treatment. Readers may recall the solemn commitments made at the UN in 2001 to reach a global target of $10 billion dollars per year. As the richest country in the world, the United States' minimum share of this global commitment is at least $3.2 billion every year. Instead, President Bush pledges money already promised but in new wrapping paper.

Following a large march, chanting "Fund the Global Fund! Keep the Promise!" PWAs from around the world charged the leaders of the G7 countries with "Deadly Stinginess". Moving from one larger-than-life image to the next in a mock trial, they found George W. Bush, Britain's Tony Blair, Italy's Silvio Berlusconi, France's Jacques Chirac, Germany's Gerhard Schr?der, Canada's Paul Martin and Japan's Junichiro Koizumi guilty as charged. Then they issued international warrants for citizen's arrest to underscore the fact that people with AIDS from around the world are putting the responsibility for the deadly global crisis where it belongs. The action culminated with splashing each leader's face with ceremonial red blood, bathing them in their shame, awash in death.

Earlier in the conference, Richard Feachem, head of the Global Fund, reminded conference participants that the Fund announced a few weeks earlier it is suspending indefinitely Round Five awards despite the overwhelming number of qualifying requests, due to the lack of donor commitments and the failure of donors to honor commitments they had already made.