Barcelona 2002: Renewal of Commitment
International AIDS Conferences serve as benchmarks for measuring changes in the disease.
The 1996 Vancouver conference is remembered for immortalizing the positive impact of combination therapy and initiating the hope of viral eradication. The conference in 2000 convened in Durban, South Africa. Media coverage impressed the world with images of the ruthless and unrelenting trek of HIV through the developing world, and communities of color in the United States.
At 21 years, the HIV/AIDS epidemic entered its adulthood in Barcelona. The Barcelona conference will be remembered for several issues consistent with a maturing epidemic.
The diversity of the conference delegates and representation of non-governmental organizations spoke to the expanding impact of the disease. Three Africans attended the first International AIDS Conference in Atlanta in 1985. At Barcelona half the delegates were from the developing world. Emerging epicenters like Poland, Russia, Brazil, India and China had strong representation.
As the scope of the problem has changed, so too has an appreciation of its drivers.
A new realization that acquired immune deficiency syndrome is not related simply to infection with HIV clearly emerged, too. AIDS is a collection of old, familiar diseases that take advantage of the opportunities created by HIV, poverty, poor nutrition, unclean water, child and domestic abuse, imbalances of social capital, homophobia, depression and substance abuse. The HIV epidemic is syndemic with these other social ills.
The Role of Prevention
The role of medicine in prevention also grew.
Prevention of HIV transmission from mother to child through the use of antiretroviral drugs is successful, safe and increasingly simple and inexpensive. Decreasing perinatal transmission is the greatest prevention success story in the developed world and offers remarkable opportunity to the developing world.
Developing countries like Uganda and Thailand made science-based prevention policy issues. By addressing HIV transmission issues honestly and accurately, they reported remarkable accomplishments in their ability to lower transmission rates.
In only months, definitive news about the usefulness of the concept and efficacy of a vaccine based upon the body's capacity to develop effective immunity through the production of antibodies to one of the outer proteins of HIV will be announced.
If clinical trials demonstrate at least 30-percent effectiveness in providing immunity, this vaccine may be licensed and a process to improve its rate of success will be initiated. If the vaccine proves ineffective, resources will be freed up to pursue other approaches.
Either way, vaccine research is approaching a significant crossroads.
Unfortunately, a junction like this will not be encountered again soon. Information about the next candidate vaccine does not become available until 2008.
Since HIV transmission is intimately related to multiple social conditions, advances in preventing perinatal transmission and vaccine research that medicalize prevention may curiously impede a "cure" for HIV disease. Antiviral therapy and vaccines may function as quick fixes not responsive to larger, more structural and systemic factors driving the disease and promoting human suffering. Without addressing the upstream issues, the effectiveness of medicalized prevention may be limited. Social scientists as well as clinicians and researchers need to work together.
Rallying for Treatment
The opening ceremonies of the conference were preceded by "AIDS Therapeutic Treatment Now," a rally and march demanding expanded access to HIV treatment organized by AIDS Healthcare Foundation and three other groups, and co-sponsored by AIDS Project Los Angeles and more than 500 other organizations. If the question: "Should we extend treatment?" was raised in the Durban conference, then Barcelona will be remembered for asking "How will we do it?"
The development of generic versions of anti-HIV drugs in certain developing world countries will be part of the solution. The Global Fund to Fight AIDS, Tuberculosis and Malaria, established by the 2001 United Nations General Assembly Special Session on HIV/AIDS, may supply some of the leadership.
The establishment of this fund signaled the realization that health should be a priority for governments, and that HIV/AIDS is a global problem, closely connected to endemic diseases and requiring the financial support of richer nations. A protest against the size of the United States' contribution to the Fund, held during a speech by U.S. Health and Human Services Secretary Tommy Thompson, hijacked much of the news about the Fund's potential.
The Global Fund's impact is not clear simply because its initial grants are on the verge of distribution. The hope is that the Global Fund will function as the mechanism to balance the needs of the national and regional level with the community level and develop sustained and effective medical and social responses.
Whether governments have the will to embrace "Knowledge and Commitment for Action," the theme of the Barcelona conference, remains to be seen.
This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.