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The XVII International AIDS Conference (AIDS 2008)
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Pedro Cahn, M.D., Ph.D., IAS Conference Co-Chair

August 3, 2008

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JACKIE JUDD: Dr. Pedro Cahn, thank you for joining us.

PEDRO CAHN, M.D., PH.D.: Thank you for inviting me again.

JACKIE JUDD: Last we spoke was in Toronto in 2006 when you were planning for this conference, and one of the things you told me was that you and colleagues were going to try to go to every country in Latin America as a kind of Olympic torch idea, to get people excited, get them thinking about what they could do. Did you do that, and what did you find if you did?

PEDRO CAHN, M.D., PH.D.: Okay, we in some ways split the job with my co-chair, Dr. Luis Soto-Ramirez, and we visited, I would say, about 85- to 90-percent of the countries. And in each country in which we were there, we tried to tell them that this was a unique opportunity for Latin America to have a conference like this one, in which they can show our successes, but also discuss our failures. People were very excited about that. So, on top of the thousands of [inaudible] that we have received, and many of them are from this region, we have also kind of a regional session devoted to Latin America and the Caribbean to discuss specific issues in which we gathered people from the scientific arena and also people from the community in order to explore what the next steps are because you know this conference is a big momentum, but it will be over on Saturday. What is next? The epidemic will not be over. The conference will be over, but the epidemic will not be. But I am sure that we will have a before and after this conference in the region. We are looking forward to the impact that this conference will have on policy makers, on the communities at large, and also on the scientific community.

JACKIE JUDD: Can you be more specific about what you expect world leaders, global leaders to learn about the epidemic in Latin America this week? What is most important for them to realize?

PEDRO CAHN, M.D., PH.D.: First of all, it is to put Latin America in the agenda because it is true that Africa has the heaviest burden of the epidemic -- no discussion about it. Asia has a very difficult situation, Eastern Europe is looking at a very quickly growing epidemic, but Latin America still has 2 million people living with HIV. We used to say that the life of a Latin American person living with HIV has the same worth as a life in Africa.

So, first we want to put Latin America in the agenda. Secondly, we want donors and policy makers to understand that we have a very heterogeneous problem in the region. Brazil and Argentina are one situation, but Paraguay and Bolivia are completely different. You may have very good experiences in some countries and very bad ones in others. For instance, Argentina has prophylaxis coverage for pregnant patients of about 86-percent of the eligible women, which is good, but we are still lacking 14-percent. But let us say this -- we are in the top rank in the world, among those countries that have very good coverage for pregnant women. But if you just cross the border with Bolivia and you will find a completely different situation. If you look at some countries in the Caribbean, the situation is really very bad. If you go to Haiti, Haiti is like a piece of Africa on this continent. So really, when people think about Latin America, they always talk about Brazil. Brazil has an extraordinarily enrolled program with 200,000 people on treatment. This is really to be commended and it is very good, but Brazil is only a piece of it. We need to show the heterogeneity and the diversity of this region.

JACKIE JUDD: And you mentioned donors a moment ago. So, in the practical impact of this conference, are you hoping for more dollars to flow into this region, as well as some creative new ideas for tackling the problems?

PEDRO CAHN, M.D., PH.D.: I would say that both are true in the context of asking for more money overall for fighting the epidemic. Be reminded that we are in the middle of a process that started in 2006 during the UNGA conference, the United Nations General Assembly, in which the world signed a commitment to achieve in 2010 universal access to treatment, prevention and care. Is that happening? I would say it is happening, but at a very slow pace.

So now, one of the major merits of this conference will be to ask donors and policy makers, hey guys, what is going on with that? We are making you accountable for your promises. We need you to keep your promises. That is the reason why our theme in this conference is universal action now. Okay, enough is enough. Enough of very nice words, enough of promises -- we need people getting treatment. We need people getting prevention tools.

JACKIE JUDD: Do you think that that has been a problem at earlier conferences, too much talk, not enough follow up?

PEDRO CAHN, M.D., PH.D.: Well, one of the results of this surveillance we perform after every single conference -- we have a group that is working very, very hard, in terms of doing focused interviews and also polls about what you have seen in the conference and what our strengths and weaknesses were in the conference, et cetera. People ask us to make policy makers more accountable at the conferences. In our strategy plan at IAS, we really believe more and more that our conference is a big moment in which we can confront a big audience of community people, scientists, journalists, together with policy makers and founders, and discuss what is going on. So, it is not the same as if you communicate by E-mail and say, hey, what is going on, and if you have to go to the podium in front of an audience of 15,000 or 20,000 people and explain why you did not deliver what you have promised to do.

JACKIE JUDD: That is pretty rough.

PEDRO CAHN, M.D., PH.D.: That is pretty rough, yes.

JACKIE JUDD: But the IAS put out kind of an accountability report after Toronto, and there will be one after this, I presume.

PEDRO CAHN, M.D., PH.D.: Absolutely.

JACKIE JUDD: Stepping back, getting away for a moment from Latin America specifically, what would be your definition of success for this conference?

PEDRO CAHN, M.D., PH.D.: My definition of success, besides the impact on the region, would be that we would be able to increase the general awareness in all the different regions in the world about the tragedy of this epidemic. I am a little bit concerned with some statements like, oh, it is not that bad at this point in time because there are some signs of stabilization and drugs are working so people do not die -- 2 million people died last year and 7,000 people are acquiring the infection every day, so there is no room for complacency. We might be doing better in some fields, no discussion about it, but can we just put ourselves to rest and say it is okay and now it is not a problem? We cannot send a misleading message.

While we are striving for expansion of the antiretroviral therapy roll out, we need to explain to millions of people that are not infected with HIV that even the best treatment for HIV is worse than not being infected. We need to spread the provincial message. We are speeding up our program of rolling out the antiretroviral therapy. We are putting 2,000 people every day on treatment, but 7,000 are acquiring the infection, so the gap is becoming wider and wider. We need to duplicate our efforts and try to really have as a result of this conference the understanding that we need a comprehensive package for prevention which includes some tools that we still do not have available, like vaccines and microbicides, circumcision for certain countries, the massive promotion of condom use, behavioral issues, and also the use of antiretroviral therapy itself -- and this is one of the issues we want to stress during this conference -- as a potential tool for helping us to curb the epidemic based on the issue that if you have more people with lower viral load in a community, you will have fewer chances to transmit the infection. So, while we are trying to reduce the gap between the 31-percent of eligible patients that are today receiving treatment and 69-percent that are not, while we are trying to shrink this second part, we are not only working in order to benefit those patients, but also to benefit the community at large.

JACKIE JUDD: I want to get back to something you said a minute or two ago. It seems to me that world AIDS leaders now are a little bit more defensive than they had to be two years ago, in the sense of people questioning whether the epidemic is stabilized, the revision of the UNAIDS estimates going down, so many billions of dollars being funneled into this. Is that an issue for you?

PEDRO CAHN, M.D., PH.D.: This is one of the biggest issues that we would like to address in this conference. There are some that say too much money has been spent on AIDS and this is weakening the healthcare systems. So, let us think about that. Is this true? Are you telling me that before the AIDS epidemic started to get funds the healthcare systems in Africa, for instance, were marvelous, were like the Mt. Sinai Medical Center in New York, or are you telling me that due to the AIDS epidemic, we do not have enough TB clinics in Africa, we do not have STD clinics? Or does it work exactly the other way around? If you look at the report that was released by Doctors Without Borders, which, as you know, is an NGO completely independent from IAS and from industry, et cetera, what they say is that they have seen that in those sites where they started HIV clinics, the overall level of clinical care for patients has improved. When a patient comes with HIV and he is coughing, he will get attention for his potential TB or pneumonia or whatever he has. It is also linked to STDs and reproductive health. You will see in our program during the week that we have specific sessions devoted to how to better integrate healthcare systems with HIV programs. It is not by shutting down the HIV programs, not by shutting down the financing of the HIV programs, but trying to up the healthcare systems.

JACKIE JUDD: Okay, that is the final word. Thank you so much, Dr. Pedro Cahn.

PEDRO CAHN, M.D., PH.D.: Thank you.


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