This Sunday, July 18th, 2010, 25,000 participants and 2,500 media representatives will converge on the XVIII International AIDS Conference (IAC) in Vienna, Austria. This biennial shindig brings together all those involved in combating the global AIDS epidemic: researchers, healthcare workers, governments, UN organizations, activists, donors, industry, the media, and, critically, people living with HIV and AIDS.
As a veteran of over ten such conferences, I believe the time is long overdue to take stock, to question its value.
Is it, whisper it, time to pull the plug on the International AIDS Conference?
When the first Conference took place in 1985, it was a cutting edge forum for researchers and activists to come to terms with a new, deadly and unknown threat to human health. We agreed that no community, organization or government can effectively address the HIV and AIDS pandemic working in isolation, and the International AIDS Conferences have provided a global venue for this effort.
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Back then we were still working in the dark. The first FDA-approved antiretroviral drug AZT didn’t debut until 1987. The same year latex condoms were found to be effective in preventing the transmission of the virus through sexual intercourse. Transcriptase inhibitors, drugs that help suppress the transcribing of viral RNA into healthy cells, were years away. And treatment as prevention was a pipedream.
Since then we have learned so much about HIV: about both prevention and treatment, about the side effects of stigma and discrimination and how they direct the path of an epidemic.
Meanwhile the conference has taken its own path, from an inspiring research-based symposium to a multi-million pound behemoth. At a conservative estimate the conference costs about $27 million to stage. Then there’s inestimable outlay in terms of time and effort preparing for this colossal event. When you throw in the costs of travel, accommodation (as much as 300 EUR a night in Vienna) and cultural programmes, you can see it’s quite a bankable enterprise, and one which the IAC secretariat is understandably reluctant to change. Whether it is really at this stage of the AIDS response the best use of our time, talents and money is another question.
Then again, can a conference really be said to have credibility when the largest implementer of HIV programmes has been missing in action for the past few years? The US Government made the political decision to effectively withdraw from the conference since 2004, a move interpreted by many AIDS experts as payback for the heckling of the then Health and Human Services Secretary Tommy G. Thompson at the 2002 AIDS conference.
There is an alternative. On alternate years to the IACs, regional conferences are held. Inevitably they are overshadowed by the more glamorous and cosmopolitan IAC. But these regional gatherings are where, I believe, we should be directing our funds and our energies. For too long the global stage has been used as a platform to utter platitudes about what we should do – only for these very politicians and speakers to return to their home countries and regions with very little intention of changing the status quo. This is especially true for those at the forefront of the epidemic in different regions: young women and girls; men who have sex with men; sex workers and their clients and people who use drugs.
In the scramble to surpass the last conference, to stage a bigger and better spectacle, these global summits lose sight of one quintessential feature: this is an extremely parochial pandemic.
One thing we’ve learned over the last 25 years is that one size doesn’t fit all. Paying more attention to and gaining real political commitment to the regional variations means the difference between life and death. By focussing on the nuances of each regional epidemic and addressing the structural determinants of HIV, we can better meet the needs of those in different regions and from contrasting cultures. Take the conference venue for example. Central and eastern Europe is experiencing one of the fastest growing epidemics fuelled primarily by drug use, but in Africa where sex is the primary mode of transmission, young woman and girls are bearing the brunt. In Latin America, a region which struggles to catch donors’ attention, men who have sex with men are disproportionately affected; as they are in the Arab World from where there is an ill-omened silence.
In this age of both scarce resources and if we really want to convince governments of the importance of continued HIV investment we need to do it through better targeted regional meetings. For that reason, it¹s time to give the IAC a rest, or, at least, cut it back to every four years. Time enough for new research to bear fruit, for strategies to have been tested and for data to have been evaluated. That way, the next time the great IAC bandwagon rolls into town, there will be something genuinely new onboard.