"You need to know how sad I am about where we find ourselves," says George Ayala, Psy.D., executive director of the Oakland, California-based MPact Global Action for Gay Men's Health and Rights. "How did we get to a place in the global HIV response where the needs and desires of public health elites matters more than the concerns of people around the world who are actually living with or at risk for HIV?"
Ayala is talking about the decision on the part of the International AIDS Society to hold the 2020 edition of the biennial International AIDS Conference (IAC) -- the world's largest forum about the epidemic, drawing some 20,000 people -- in the U.S., specifically in California's Bay Area. That decision, announced in March, drew an immediate backlash, with a wide array of HIV/AIDS activists in the U.S. and abroad saying that it was wrongheaded and even dangerous to hold the conference in the U.S. while the Trump administration is pursuing policies hostile to immigrants, foreign visitors (particularly from majority-Muslim countries), LGBTQ people, and HIV high-risk and high-incidence populations, including sex workers and drug users.
Major protests over the decision broke out at the 2018 IAC in Amsterdam. And now, even as IAS says it is going forward with plans to hold the conference in both San Francisco (wealthy, expensive, touting dramatic HIV reductions in recent years) and Oakland (poorer and more people of color, with only a fraction of San Francisco's HIV resources), Ayala and a broad network of activists worldwide are moving forward with planning a simultaneous conference outside the U.S., likely in Mexico City or Tijuana. That confab, they say, will prioritize the concerns and solutions of communities affected by HIV over those of researchers and public health officials.
A Diverse Outcry
Activists point out that the majority of global networks of people living with HIV or at high risk -- including MPact, Positive Women's Network, Positive Trans, International Treatment Preparedness Coalition, and International HIV/AIDS Alliance -- oppose the conference being held in the Bay Area. The primary objection appears to be against holding it in the U.S. at all during the Trump era, given the difficulties that many people from poorer countries may have obtaining visas in the first place -- or actually getting into the country upon arrival.
On top of that, "All that has to happen to put the HIV entry ban back on is an executive order," says JD Davids (a staffer at TheBody who will be transitioning out in mid-September), a trans HIV activist who is part of an emerging coalition, HIV Power Shift, seeking to center affected communities over policymakers and researchers. And, based on precedent, it's highly conceivable that Trump might reinstate the ban by tweet perilously close to the conference date in order to sow bureaucratic chaos and curry favor with his base. If that happens, "conference organizers would seriously weigh the impact of this policy change," Megan Warren, the IAC conference organizer, wrote in an email. But activists wonder how the IAC -- a massive feat of planning, contracts, and budgets -- could change its location on such short notice.
Protesting IAC Conference Locations Is Not New
This is not the first time that the location of the IAC has drawn ire from activists. First imposed in 1987, at the height of AIDS-phobia, the U.S. ban on HIV-positive people coming into the country led to major protests of the IAC when it was held in San Francisco in 1990 -- and to moving the 1992 conference site from Boston to Amsterdam. In 2000, many protested the IAC taking place in South Africa while its president, Thabo Mbeki, was publicly denying that HIV caused AIDS -- but South African AIDS activists demanded it be held there as a global rebuke to Mbeki's denialism. In 2012, Obama finally ended the U.S. HIV travel ban in time for the conference to be held in Washington, D.C. However, ceding to conservatives, he still banned entry to sex workers and drug users, few of whom managed to attend, with the rest holding their own conferences in Kolkata, India, and Kiev, Ukraine, respectively.
That particular ban still stands; such folks would have to lie on U.S. visa applications -- a risk if customs and border entry officials scan their online or social media presence. According to New Orleans-based Kelli Dorsey, an independent sex-worker activist who was formerly the executive director of Different Avenues, an advocacy group for girls and women who engage in underground trades such as sex work, that's exactly what's been happening recently to Canadian sex workers who have been stopped at the U.S. border.
To have only a handful of sex workers and drug users at IAC 2020 would be "a dramatic loss," says Dorsey. "We'll miss out on learning how those folks are running programs in order to strengthen our own programs."
The inability of foreigners to get to the conference is not the only reason many activists oppose it being held in the Bay Area. They worry that, media-wise, it will be completely overshadowed by the Democratic National Convention (DNC), which takes place the following week.
"Who [in the media] will have time to go all-in on the AIDS conference?" asks Dázon Dixon Diallo, M.P.H., who heads Atlanta-based SisterLove, which supports women of color living with or at risk for HIV, and is founder and convener of Women NOW, a global HIV/AIDS conference for women of African descent. "The opposition! They'll say, 'Look at all the crazies coming to that sanctuary city in Nancy Pelosi's backyard.' We would rather the international AIDS community come to the U.S. when we have different national leadership and we've cleaned up our house."
Diallo is also among those who feels that, if the conference has to be in the U.S., it should be in a city in the South, which is still struggling with its epidemic, rather than San Francisco, which has been able to get its HIV epidemic relatively under control due to its disproportionate whiteness and wealth (and which is also expensive for visitors). "The minute you nationalize San Francisco's story of 'the epidemic is over,' it will silence the voices of millions of others over the world. It's not time to tout success until we're all reaching it."
Related: Citing Trump Policies, Activists Want AIDS 2020 Conference Moved Out of U.S.
Voices of Support
All this is not to say that everyone in the U.S. HIV community opposes IAC coming to the Bay Area, which hosted the conference in 1990. "This is a really important moment to reflect on the progress we've made here in San Francisco since then and to share best practices, as well as to highlight the disparities between us and Oakland and the rest of the U.S.," says Joe Hollendoner, the new CEO of San Francisco AIDS Foundation (SFAF), which lobbied hard to have the conference in the area.
According to Hollendoner, "Wherever you have the conference, there are challenges for people gaining entry." He says that when the IAC was held in Toronto in 2006, more visa requests were rejected by Canada than were by the U.S. in 2012 when the conference was in D.C. He says that U.S. Representatives Nancy Pelosi and Barbara Lee have promised to do everything they can to get as many conference-goers into the country as possible. And he says he is confident that, should Trump capriciously reinstate the HIV travel ban shortly before the conference, "we have a base of support of elected officials who will fight like hell to make sure that Trump's tweet will not become a reality."
Says Rob Newells, executive director of AIDS Project of the East Bay, which serves a large clientele of color: "I'm OK with it being here. I'm born and raised in Oakland, I'm a militant person by nature, and this is a place about resistance and protest. And my perspective is that, yes, there all these issues with the conference being in the U.S. and, yes, the U.S. is perpetrating lots of bad things now -- and we need the international community to come in ahead of the DNC and help us push on these issues like sex work and drug use. We can't separate our HIV activism from our political activism. Running away from these issues doesn't help solve them."
A Bay Area conference is also supported by Marsha Martin, D.S.W., formerly D.C.'s AIDS czar and now community coordinator for the Fast-Track East Bay Getting to Zero initiative to end the epidemic. "A joint conference collaboration between two cities, as in San Francisco and Oakland, has never been done before," she notes, saying that the conference will "absolutely" be evenly mixed between the two cities and that non-science sessions will not be marginalized to Oakland so that researchers and VIPs won't have to go there. "No one wants San Francisco to dominate," she says.
"Both cities' long history of activism and commitment to change is really important now in our country," she continues. "If we don't have it here, I believe we'll miss an opportunity, much like when the conference went to South Africa in 2000" to rebuke HIV denialists.
Of course, it's too early to say whether immigration policies or other circumstances in the U.S. could worsen to the point where having the conference in the Bay Area becomes completely untenable. And it's also too early to know exactly what the possible alternate conference in Mexico might look like or how it will get people there, although Ayala says he envisions it being much smaller -- perhaps 2,500 to 5,000 people -- and that he and others are already talking with the IAC about making some satellite connections between the Bay Area and Mexico.
But Ayala stands by his decision to spearhead what might add up to a boycott of IAC by at least some U.S. activists. "It is not OK for IAS to continue with business as usual," he says. "Not OK for them to continue to justify to themselves the need for large, trade-show style conferences in the global north, to select host countries that are overtly hostile to people living with HIV and key populations" (such as sex workers and drug users).
And, in many ways, it appears that in this most fraught time in the U.S., the split over AIDS 2020 is a split between the large, well-funded institutions of HIV/AIDS -- the pharma companies, the big research centers, and the major AIDS service organizations, such as SFAF and the IAS itself -- and networks made up primarily of individuals living with, or at risk for, the virus itself, often in poor parts of the world.
"Even if they can get visas, what's going to happen to them when they arrive at our border for the conference?" asks Diallo. "This controversy isn't really just about the conference. It's about who has the power to decide where these conferences are held. We have to open up the table and share more of that power to make these decisions."