Geneva AIDS Conference _ with an activist prelude to DURBAN 2000
"Bridging the gap"-- in the slogan created by the conference organizers, there is a myth that must be dismantled: after having regulated the epidemic in their countries, the North has decided to put the pressure on the South. The myth of a possible eradication, already successful in the North and to be prolifigated in the South, turns ''AIDS'' into the same type of epidemic as malaria or tuberculosis. The myth of humanitarian generosity, or the aid given from the top to the bottom, from the rich states to the poorer ones. Western nations adore this type of sanitary operation in which a political agenda is neatly erased behind fronts of charity and science.
If certain advances made by research have permitted some of us to prolong our lives, they have also reinforced the inequalities and widened the gaps which prolifigate the epidemic. Today more than ever, there are those who have access to treatment and those who do not. This is true at every level throughout the world .
Southern countries, which make up nearly 95% of infected populations, do not, on the whole, have any treatments at their disposal. It is also true within individual socieities : in the North as well as the South, there is no equality in the face of AIDS. It hits economic, sexual and political minorities hardest; it hits immigrants and prisonners, women and homosexuals, drug users and low-income communities; it hits the victims of the economic and judicial system, and deviants of the moral order.
Instead of the model of charity and gift-giving, we revendicate one of war and alliance. There is not the North on one side and the South on the other ; on one side, Western science and the other, Third World diseases ; on one side, the generosity of the conquerors, and the other, the gratitude of the victims. There is one side with the head of states and their minorities on the other; centralized countries sided against their periphery, the World Bank against its debitors, governments against their activists.
This conference should be an occasion to forge alliances among those fighting, instead of an enactment of a ficitious solidarity. Claiming to construct bridges all the while widening the gap? Humph, sounds like a fishy plan to us.
WORLD AIDS CONFERENCE: Aims To 'Bridge The Gap' Between Developed And Developing Nations
At this year's 12th World AIDS Conference in Geneva, Switzerland, scientists will address worldwide disparities in HIV/AIDS treatment. Commenting on the conference's theme, "Bridging the Gap," a Lancet editorial argues: "This gap is more a gulf, yawning between what is deliverable (if not always delivered) in the western world and what is affordable where AIDS is the biggest burden." The big debate will center on treatment access, "equity between countries [a]nd on priorities within countries".
According to Warren Lindner, a senior adviser to the conference, "if we don't address the gap then millions of people are going to die and all we can do is help them die in a peaceful way -- that is wrong." However, the WHO's Rachel Baggaly said, "We must not raise false hopes" in regard to drug accessibility. Dr. Anton Pozniak of King's Medical College in London concurred: "We have had a cure for TB for 30 years and it costs just 26 dollars for a full treatment. Yet more people are dying of TB now than ever before". The Lancet questions whether the conference has the "muscle to persuade the drug industry that its prices are too high," and concludes: "We think not" .
A Gap Too Far?
Focus on the disparity comes at a time when researchers are faced with a paradox, Newsweek reports. While they know more than ever before about AIDS, the disease is "spreading faster than ever," and "gaining ground -- on both sides of the gap." The most advanced available treatment -- triple cocktail therapy -- is "hardly everything it promised," and "gruelingly complicated." And, in reality, the AIDS virus has been shown to be "so sophisticated in duping the body's defenses that a cure or a vaccine is still years away -- if possible at all".
The Kaiser Daily HIV/AIDS Report
"Bridging the Gap" or the World AIDS Zeitgeist
The 12th World AIDS Conference is ready to break over Geneva. The Conference mandate is to "Bridge the Gap." Out of context, "gap" really doesn't mean much. Here it would, at best, be an understatement for the "gulf," the "pit," the "abyss" of good intentions granted to the North after two wild years of protease inhibitors.
These are thoughts on "Bridging the Gap" from the perspective of having one foot in the local/global HIV/AIDS Community, and the other in the lower spheres of the AIDS bureaucracy.
I'd like to start by "increasing the gap." I mean the gap between doses, and many readers will know what doses I'm talking about. It seems there's always some new and improved molecule hitting the market these days. One month it's Invirase, the next it's the upgraded version and everyone's dying to buy it (to coin a phrase). The research departments of our pharmaceutical friends must be at least as well endowed as their marketing departments. All we need now is a special introductory price and it'll feel totally like a supermarket here. Well, there have been some specials lately, but not in this neck of the woods. Glaxo Wellcome's "South" branches are flogging AZT at a quarter of the American price in developing countries where AIDS is merrily reaping lives and economies. Developing countries that will also attend the Conference, albeit somewhat discreetly.
So the pharmaceutical industry has begun taking "Bridging the Gap" at its word. True enough, AZT may not be as expensive as it used to be for a Ugandan woman about to go into labour (targeting mother-child transmission here), but it won't change much for HIV+ people in Niger, which is the world's poorest country this year (though it'll probably be another one next year). Access to treatment will be one of this Conference's most sensitive topics. Let's hope we hear some voices, either dignifies or hysterical, over the general hubbub in the hallowed Halls of Palexpo [the Geneva Conference site], demanding the possibility to choose an antiretroviral therapy for themselves as well.
"Bridging the Gap" also brings to mind the fifteen years we've spent with our dicks sheathed in latex. HIV prevention hasn't been easy for anyone, but we all should reflect on the fact that turning 20 in the year 2000 places one in the highest category of risk for HIV infection. Prevention workers from all over the world will be in Geneva seeking support and inspiration for the work they do. Maybe they'll notice with us that condoms are not really the hottest thing for those of us who have reached adulthood with HIV. This Conference could be the right place to think on something interesting to tell today's youth about the need to protect oneself from HIV infection. No mean feat given the climate of spiritual bankruptcy today's youth in inheriting.
Prevention, as a global phenomenon, begins with the fight against thoughtlessness and ignorance. For those of us who are privileged to have easy access to information about HIV, we could start fighting thoughtlessness based on a new respect for each other. By speaking and listening to each other, for instance. Or laying our cards on the table before playing for high stakes in love or sex. Information can help us to deal with ignorance, but one could hope that this Conference will highlight the reasons why ignorance is such a tough nut to crack. When you live in a country where the price of human lives is less than cheap, why shouldn't AIDS be "a white man's disease?" Even so, health pundits of certain countries, which are known to be quite different from us, will be attending Geneva 98 and proving that even they can broach the topic of men having sex with men. Why shouldn't we?
Vaccines will also be high on the Conference agenda. For some people, it makes damn good sense that this disease can only be fought globally if we develop one or several vaccines that could stop HIV from undermining the body's immunity. One shot and that's it. It's not easy to disagree with these people: poor countries represent 90% of the pandemic and one hardly sees how they could deal with a new market of consumer goods, however promising in terms of health, when their resources are so scarce. Wouldn't the best thing be to make the bottom fall out of the market and stop all this pill popping? Meanwhile, back at the research institute, our favourite mad scientists are waltzing though the minefields of ethics: genetic engineering, heroic inoculations, integalactic kaffuffles between pharmaceutical planets. "Bridging the Gap" also brings us into the science-fiction of AIDS.
Activists from all lands, network! Geneva 98's mandate was to give science and communtiy equal say in Conference programming and other issues (the so-called Geneva Principle). Thanks to this principle, activists from North and South will attend the Conference with a new desire to deal with a number of non-medical questions: issues of confidentiality, criminalisation of HIV transmission, human rights, the legal confusion of getting back to work, migrations and deportations, latent or overt homophobia... the list is long and positively screaming for attention.
During the Community Symposia, representatives of the scientific would will be there to listen politely to some of these demands, others will perhaps need a good dose of red paint to get the attention they crave. While the euro-american activist nomenklatura gathers in Geneva, escorted by their friends from the South, Chilean HIV+ drag and transgendered queens are barricading themselves in Wing 3 of the Santiago Penitentiary to demand some attention to their physical and mental health. Maybe we should send them some of our Prozac?
Christopher Park, Conference Community Liaison Officer
dialogai'Infos No.82, Geneva
The 12th World AIDS Conference: A Cautionary Tale
Two recent letters in The Lancet raised a number of concerns about the recent 12th World AIDS Conference. Although Lancet letters are often abstracted by the wire services, I have yet to see any reference to these two important comments. Since I'm an inexperienced abstracter and there is a lot of 'meat' in the letters, I fear this message is rather long--sorry!
The first letter, from Richard Horton, the track B "team captain", mirrored comments he made (also not well reported) at the closing session. Headed "a cautionary tale", he reports that he left Geneva "...with an overall sense of disappointment. There seemed to be a malaise amongst the AIDS community--scientists, physicians, and activists alike. For a meeting dedicated to 'bridging the gap', why was it that every day last week, whenever a speaker from a developing world country rose to talk about an issue central to this challenge, seats emptied and the hall began to bleed delegates through the aisles and out into the corridors of the conference centre. I watched this happen at least six times to speakers from Africa, India, and Thailand. It was shameful."
"If delegates to an AIDS conference walk out of a room when their colleagues have travelled long distances in sometimes difficult circumstances to share their experiences, why should any government listen if delegates do not," Horton asks. He reminds us that on the opening day, Mercy Maklamena of NAPWA (Kwa Zulu) asked how it is that despite all their training and education, doctors have such limited vision. Horton notes that this question hung over the whole meeting.
Horton believes that "the conference needs to renegotiate its contract with the pharmaceutical industry." Although industry support is essential for such a large conference, he asks why there was hardly a mention of how industry intends to support the conference theme. "Why," he asks, "are leaders from pharmaceutical companies not invited to speak about their strategies to help manage the wider HIV epidemic? Industry remains the only part of the AIDS community left unaccountable for its policies and priorities. The failure to call them to account is nothing less than a betrayal of those in the developing world."
In conclusion, Horton notes that the principle in Geneva was that of an equal voice to science and the AIDS community. He suggests that in Durban, the principle should be equal voice to North and South. "But," he concludes, "that principle will be pointless if participants cannot practise the oldest and still the most important skill of a good doctor--that of first listening quietly and with humility." In response--and support, Ivan Wolffers from the Vrije University in Amsterdam refers to the conference as 'pretentious and costly'. He suspects that the organisers must have considered it 'disastrous, because they have created more gaps than there were previously.' As an example, Wolffers criticises the isolation of the hall for the posters in the Social and Behavioural Sciences track--'it looked like the Siberia of science', with few participants tempted to make the trip--one more added gap!
Another unacceptable gap was that between locals and expatriates from developing countries, with, for example, abstracts from Bangladesh given by Americans. Wolffers notes that many of the sponsorships for developing countries were given to expatriates, including those working for international organisations which might have been expected to pay themselves [one of the many reasons why I myself declined to attend!] He noted few Asians attending; '20 representatives from Indonesia is not much for a country of 210 million inhabitants'.
Wolffers wonders why there was no session on the impact of the economic crisis in Asia upon the epidemic; 'some governments are cutting their AIDS programmes by 50%', and migration, an important co-factor in HIV transmission is increasing. 'Sex workers who used to work in brothels with fairly well-organised STD/AIDS programmes are increasingly working on the streets.' Wolffers received the impression that the organisers felt that the only important issue in Asia is access to effective treatment. 'To focus only on the gap between those treated with HAART and those not simplifies the debate about why HIV-1 infection disseminates so easily in conditions of poverty,' he says.
In conclusion, Wolffers hopes for a more open policy at Durban, and calls for greater use of electronic information systems to allow more people to take part in the preparation, particularly to bring clarity to review, scholarship and organisational issues.
I would comment that it is my impression that the fault, if there be any, does not lie wholly with the 'North'. I have it on good authority that at least a not insignificant proportion of those attending from developing countries demonstrated clearly that they were only 'along for the ride'. It is common that presentations from the third world tend to be more of a self-inflating litany of achievements rather than a sharing of experience and ideas. I wonder how many of those who Horton noted leaving were themselves from developing countries?
That said, I think two points come through quite clearly from this debacle. First, that the drug companies _are_ taking advantage of us. Perhaps naively, I have felt that engaging them in constructive discussion is preferable to outright confrontation; I'm beginning to wonder. Not that I support some of the more outrageous demonstrations, which if they occurred in Geneva, appeared so far to have achieved little. As Horton says, we must find a way to encourage? force? shame? them into taking a more responsible approach, one of real partnership in addressing these challenges.
The second point is that it is clear that we must rethink the whole strategy of these hugely expensive and unproductive conferences. I was informed that the city of Vancouver came out of the last one with a profit of over $60 million! Lord knows what Geneva cost! I'm not so naive that I would expect (I might hope!) that all this money could be put to some real purpose in closing the gap, but there should at least be some clear, measurable objectives that pass a test of cost-effectiveness... Shouldn't there?
Chris W. Green (email@example.com)
Jakarta, Indonesia___ INTAIDS
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