Report on the XV International AIDS Conference

The International AIDS Conference (IAC) is a huge international meeting that takes place every two years. The International AIDS Society is the custodian of the IAC. This year the meeting was hosted by the Thai Ministry of Public Health along with five other co-organizers, GNP+ (Global Network of People Living with HIV), ICW (International Community of Women Living with HIV), ICASO (International Council of AIDS Service Organizations, UNAIDS (Joint United Nations Programme on HIV/AIDS), and the TNCA (Thai NGO Coalition on AIDS).

The 15th IAC was the largest ever of these meetings. There were 17,000 registered delegates with more than 10,000 abstracts submitted and 8,641 accepted covering five separate tracks, A: Basic Science, B: Clinical Research, Treatment and Care, C: Epidemiology and Prevention, D: Social and Economic Issues, and E: Policy and Program Implementation. (To view abstracts visit www.aids2004.org.) The theme of the conference was "Access for All" with the purpose of promoting access to science, prevention, treatment and resources for all people regardless of geography.

It was also the first such meeting to be held in South Asia which brought much needed focus to the exploding epidemic in the region. The Asia Pacific Region is now home to an estimated 7.5 million HIV infected individuals. Although prevalence rates are under 1% for most countries in the region, these numbers mask the explosion of actual numbers of infected persons. India is an example. With a population of just over a billion and a national prevalence for HIV of 0.86%, there are an estimated 4.6 million PWHA (people living with HIV/AIDS) in the country. It seems India will have the dubious distinction of becoming the first country to surpass South Africa in total numbers of infections, a distinction some feel India may have already earned.

Prior to the meeting, the snapshots in my head were conflicting. There'd been a lot of positive press coming from the US Administration and other global leaders. Stuff that really looks good in the press releases. But then, there were also snapshots of contrast. Activist dissent and criticisms, the realities on the ground and in the trenches, a landscape of broken promises, lack of leadership and empty rhetoric. In this report I hope to present perspectives of where we are in the global war on AIDS.

The 2000 IAC meeting in Durban, South Africa was a major turning point with regard to scaling up treatment globally. Prior to Durban "access for all" with regard to medications wasn't even on the horizon. But in Durban, activist pressure and public opinion began to send major pharmaceuticals scrambling to make bilateral deals with developing countries for reduced pricing, no-profit pricing and drug give-aways. Then came the UN's Special Assembly on HIV/AIDS or UNGASS in June 2001, followed by the introduction of generic HIV medications, and the creation of the Global Fund for AIDS, Tuberculosis and Malaria in 2002.

The next two years were witness to the WHO's (World Health Organization) "3X5" initiative (treat 3 million by 2005), the introduction of new drugs and classes of drugs for those infected with HIV, innovative public-private partnerships, successful examples of how some countries and projects were proving that care, treatment and prevention could be provided in the poorest of settings, and substantial increases in funding.

So, where are we at today? The global impact of HIV disease is referred to by government and international leaders as being as great a threat to global security as that of terrorism. But where is the warlike response from global leaders in government, politics and international institutions? Iraq is a warlike response, but the war on AIDS is not being fought with that intensity by world leaders. In spite of the fact that HIV therapy can be had for as little as $0.38 a day, only about 450,000 out of the estimated 6 million people worldwide who need therapy immediately are receiving it. Three million individuals will die this year while another five million are infected. How could this be? The short answer: no political will or leadership.

Opening ceremonies for the conference were scheduled to begin at 7:00 p.m., Sunday, 11 July, 2004. I spent a major share of my time in the media center attending press briefings that morning and then participating in an opening day protest and march later that afternoon. Kamon Uppakaew, Chair of the Thai Network of People Living with HIV/AIDS, described the purpose of the action "... to make it clear that the world will no longer accept the broken promises or political barriers that deny access to vital prevention or treatment for people living with HIV/AIDS."

Among the many issues raised by protestors, a key issue was inadequate funding of the Global Fund to Fight AIDS, TB and Malaria. Activists feel that the Global Fund offers the most cost effective, multilateral global mechanism for the scale up of prevention, care, treatment and healthcare infrastructure development. They accuse rich nations of deliberately sabotaging the Global Fund with inadequate and anemic support.

For 2005, the Global Fund requires $3.6 billion to launch the next two rounds of funding and renewal of on-going projects. Richard Feachem, Director of the Global Fund, said his "... call to the Administration and to Congress is for $1.2 billion from the U.S. in '05. That is what we're seeking, in order that we can maintain this strong U.S. position at one-third of total Global Fund funds."

Opening Day March & Protest Photo by Jeff Palmer

While the Opening Day March and protest was in progress outside the IMPACT Center, Ambassador Randall Tobias at the U.S. Agencies' opening press briefing began his remarks with comments about "working together" to defeat HIV/AIDS. After speaking Ambassador Tobias was invited and encouraged by activists at the press briefing to meet with demonstrators outside, in the spirit of "working together," to receive a memorandum of their concerns and demands. The Ambassador refused to meet with protesters outside, saying he wouldn't participate "... in a media event, staged by activists," he countered by asking activists to bring him a copy of their demands.

After the Ambassador had left, I went outside to join with protestors in the march. There were about two thousand marchers representing women, youth, drug-users, men who have sex with men, transgendered groups, local NGO's and activists. While most of the marchers were local Thais, they were supported by a number of other acitivists and groups from around the world. At the end of the march, Joep Lange, President IAS, Richard Feachem, Director, Global Fund for AIDS, Tuberculosis & Malaria, and Peter Piot, Director, UNAIDS met and spoke with activists and accepted their memorandum of demands. (A full copy of the memorandum can be viewed at www.actupny.org.)

Monday, 12 July, 2004

Throughout the duration of the conference, there were numerous activist protests and demonstrations, often several a day. The photos shown here are from the Opening Day March and a demonstration on Monday which emptied out the media center. This protest included mock trials of each of the G7 leaders for breaking their promises to collectively contribute $10 billion annually toward the global effort against HIV/AIDS. There were 60 or 70 activists acting as jurists as the charges of breaking funding promises were read against each G7 leader. The activists found each of the G7 defendents "Guilty" of breaking their promises and responsible for the deaths of millions of people with AIDS, TB & Malaria. Activists then issued mock international citizen's arrest warrants for each leader, pasted "WANTED" posters across 6 foot photos of G7 defendents, labeled them as "accessories" in the spread of AIDS, and finally splashed "faux" blood on their images.

Zackie Achmat & Joep Lange Photo by Bob Huff, GMHC

This protest was followed by a press conference in the media center with activists involved in today's protest and the Opening Day March. The press conference speakers were Khalil Elouardighi, Act Up-Paris; Kamon Uppakaew, Thai Network of People Living with AIDS and Brook Baker, Law professor, Northeastern University, Boston, and Health GAP.

Professor Baker spoke of the role of the U.S. and its past and continuing neglect of HIV/AIDS. He said, "First, I don't think we can ignore the fact that the U.S. decreased funding on a per capita basis for HIV/AIDS during the entire decade of the 1990s. That's the backdrop. That's when the pandemic exploded. Recently the U.S. government has committed more resources, but those resources are still painfully inadequate."

The war on AIDS is estimated to cost around $90 billion US over the next 5 years. The general consensus for "fair share" among donors is 1/3 U.S., 1/3 European Union and 1/3 other sources. Using the "fair share" consensus that comes out to $30 billion for each "fair share" group over 5 years or $6 billion annually.

Peter Piot Photo by Bob Huff, GMHC

Professor Baker continued saying, "At present the U.S. funding committment is for $15 billion and, in fact for that time period ... it's only committed $12.6 billion." Baker was referring to Bush's five year PEPFAR program or the President's Emergency Plan For AIDS Relief targeting 12 African, 2 Caribbean and one Southeast Asian country.

According to Baker, "... the U.S. is only about a little over a third of what its commitment should be to the global need to fight HIV/AIDS. In this context the Global Fund is a critically important component ... The Global Fund is bankrupt. ... It will not be able to launch round five of grants at all, because of the neglectful funding by the G8 funders led by the U.S. ... the U.S. has reduced its funding to $200 million a year only, down from slightly over half a billion last year, a sum that

Richard Feachem Photo by Bob Huff, GMHC

was forced on the President by Congress as a result of activism ... The problem with U.S. policy is not simply that it's not contributing enough money, but it's wasting some of the money ... The proprietary drugs that the U.S. government is forcing countries to buy right now with PEPFAR funding cost two to four times as much as the same pharmaceutically and therapeutically equivalent drugs which have been prequalified by the World Health Organization. So, they're wasting money on more expensive drugs, they're underfunding their fair share of global need, and in addition they are not providing funding for critical components ... They will not spend adequate resources on condoms, ... will not fund needle exchange and other harm reduction measures for IV drug users. It will not fund programs that work with sex workers ... it will not fund family planning services where ... services include mention of abortion."

Fund the Fund Rally (see more) Photo by Bonnie Goldman, The Body

Professor Baker stated that the reason he was singling out the U.S. is because it "... has been bragging more than any other country in the world about its level of contribution to the fight against global AIDS, and yet when you look at the real numbers, when you look at a global fair share over the next 5 years of at least $30 billion, President Bush and his Administration will not support that figure." He continued on by saying that, "... activists are encouraged that Senator [John] Kerry just this week has himself committed to the $30 billion figure. And that's an important campaign issue in the U.S. that activists will be fighting for. That this is the level of funding that's appropriate."

Back to the Summer 2004 issue of Positives for Positives.