The conference was held in two huge buildings -- so large that workmen setting it up used bikes and motor scooters to get around inside them. One building contained the auditorium for the plenary sessions, media center, several lecture halls (each holding 300+ people), a huge space for poster sessions, two cafés and commercial booths for the drug companies, book sellers, testing labs, and more.
At the end of this building was a pedestrian walkway about a city block long (the span of a six-lane highway) to get to the other building that included three more poster areas; 12 lecture halls; more booth space (this time for 300 "non-governmental organization" groups like Gay Men's Health Crisis and Project Inform); the Web Café (for internet access); the "Talking Trees" (e-mail to other delegates); an exhibit of the Quilt; an art gallery; a medical clinic; a post office; bank, and several restaurants. Because I was staying next to the airport, every so often a plane would take off or land, and it sounded like it was going to come through the building.
This conference was different this year because of its size (13,000 people, 6,000 studies presented), but also because in addition to doctors and researchers, a broader range of people attended than in previous years -- people with HIV, nurses, social workers, sex workers, and every type of person whose life is touched by HIV from around the world.
Research was presented three ways: 1) through plenary presentations given in the auditorium to thousands of people each morning; 2) oral sessions given in lecture halls seating 300-500 people that ran throughout each day in lecture halls seating 300-500 people, and 3) all day poster sessions. Oral sessions and posters were divided into the four tracks, and there were usually one-to-three oral sessions in each track happening simultaneously. Oral presentations were supposed to be more important or thought-provoking research, grouped by a common theme, like "Hepatitis C" or "Mother-to-Child Transmission." Most of the time this was true, but sometimes the research was so basic or off-point that I wondered if back-scratching had influenced the selections.
Every day there were 200 different posters presentations in each of the four tracks. Researchers posted their research on bulletin boards, and were available at these sites three times a day to answer questions. Posters from the developed world were often laminated with full-color pictures and professional lettering, while those from the developing world were simply typed or even handwritten on pieces of plain paper. In Track D ("everything else" subject matter), many researchers from the developing world stayed all day at their posters, eager and thrilled to meet anyone interested in their work. This facilitated discussions between researchers from geographically distant countries.
There were also skills building workshops ranging from "Vitamins and Their Use in Fighting HIV" to "Use of the Internet as a Vital Link between Countries." Also, each day there were 10-15 breakfast and dinner presentations sponsored by pharmaceutical companies, or groups like UNAIDS or the World Health Organization (WHO).
The national differences in values and epidemiology were also fascinating. Deutsch AIDS Hilfe, the German government agency, famous for explicit posters of naked men and women, laid them out on the floor in front of their booth and invited people to help themselves. Talk about an instant feeding frenzy! AIDS Infoshare/Russia was selling T-shirts at discount if they were purchased with US dollars. In Nigeria, the first step in AIDS prevention is to convince people that AIDS is a disease, that it exists and that it can spread. Many people think this is not true, and so the Nigerian prevention workers wore buttons that said "AIDS is Real."
As the host country, the Swiss had an elaborate booth demonstrating their response to AIDS. This included a vending machine offering a drug injection kit and syringe for 2 SF (about one dollar). These vending machines are available in a wide variety of public locations. Condoms and clean needles are available in most Swiss federal prisons. An elementary school "AIDS Answer Wheel" was displayed. Shaped like a 5-foot wide sunflower, questions about AIDS are printed on each petal. You lift the petal, and find the answer. The sex workers' outreach unit produces small booklets containing safer sex information along with tips on how to be a better prostitute. Pink Cross, the Gay/Men Who Have Sex with Men outreach unit, has billboards with beautiful crotch shots (in bathing suits) with the headlines, "Think With Your Head" or "Protect Your Jewels" and the text: "If you can't be faithful in love, be faithful with a condom." The religious right has been vandalizing these billboards, replacing the bottom line with "Be faithfully married and monogamous with your wife."
On July 1, Canada Day (the equivalent of July 4th), Canadian treatment activists, along with several ACT UP members, protested the slow drug approval process. They wrapped the Canadian booth in red tape and held a press conference urging approval of Viramune, Rescriptor, Viracept, Fortovase and Combivir, all of which are not approved in Canada.
A small group of French activists dressed up as AIDS drugs, and accompanied Marie Antoinette in a gown with dollar signs on it through the conference chanting, "Let them eat cake, not AIDS drugs," and singing parodies of children's songs about lack of drug access in the developing world. On the last day of the conference, women from around the world linked arms and snaked through the conference chanting "Who'll bridge the gap? The women will close the gap."
In my opinion, Merck was giving away the most useful gift -- CDs of the conference abstracts. Many booths had small Swiss chocolate squares with the names of their drugs on them. "Compliance with 16 chocolate Fortovase a day? No problem!" said Donald Rhoan, a PWA from Canada. But after a while I started to think about how cruel this was for the PWAs from Uganda, Nigeria, India. This conference was full of the companies that make the drugs giving discussions about these lifesaving resources. They were giving out bags, pens, even chocolates with the name of the drugs, but not the drugs themselves.
For me, it was too easy to simply say that the drug companies are all evil and should be stopped. There are some serious issues that need to be addressed. For instance, what responsibilities should governments and international organizations share in negotiating prices with drug companies? A Malaysian delegate was quoted in the conference newspaper saying, "We should tie the prices to the Gross National Product of each country. That way they'd be affordable and it would be equitable." The gap is a chasm, growing wider daily.
Vaccines, the orphan stepchild of funding, must play a vital role in the future. However, most treatment advocates believe the current vaccines will be failures or will work poorly. At the end of the conference UNAIDS announced that they had brokered a deal between several drug companies to provide antiretrovirals and opportunistic infection drugs to Chile, Ivory Coast, Uganda and Vietnam. In a separate meeting, the Under Secretary of Health for Uganda stated that they would be receiving combination drugs for 1500 people. Uganda has more than 3 million infected citizens.
Each day, 16,000 people are infected worldwide, 90% of them in the developing world. UNAIDS deserves recognition for their leadership in getting a commitment from key players. It is clear that the governments of developing countries are unable to cope with the AIDS epidemic alone. Governments of the developed world and international funding organizations must sit down with the business community, the pharmaceutical companies, advocates and medical providers in the developing world to address real-world solutions. If they don't, the gap will widen to swallow the bridge.
Geneva Conference Reports:
AIDS Treatment Data Network: http://www.atdn.org/trs/aids98/reports.html
AIDS Treatment News: http://www.aegis.com/scripts/atn98.ig?Citit=AIDS+Treatment+News
Being Alive: http://www.mbay.net/~bngalive/index2.html
Critical Path AIDS Project: http://www.critpath.org
Johns Hopkins AIDS Education: http://www.hopkins-aids.edu/geneva/hilites.html
Positively Aware (the Test Positive Aware Network): http://www.tpan.com
Project Inform: http://www.projinf.org
Treatment Action Group: http://www.aidsinfonyc.org/tag/taglines/9808.html
University of California, San Francisco: http://hivinsite.ucsf.edu/img/soc/geneva98.html
Photos by Karin Timour