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From Atlanta to Bangkok
HDN Key Correspondent Team. 12 July 2004. A posting from Break-The-Silence e-listserve ([email protected]).
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Perhaps more than any other medical challenge, HIV has transformed how we think about society?’s response to the illnesses of individuals. The International AIDS Conferences, held since 1985, provide a window onto the unique social history of this epidemic.
The first International AIDS Conference took place in Atlanta, home of the US Centers for Disease Control. Treatment and prevention were both on the agenda, along with basic science. Following a similar meeting in 1986 in Paris, the tenor of the Conferences began changing from 1987.
Attendance nearly tripled, with more than 7,000 delegates gathering in Washington DC, and protestors turned out to contribute in their own ways. One of their major complaints was the length of time needed for experimental treatments to go through the clinical trials system. The conference itself included a ?“living with AIDS?” panel discussion in which HIV-infected people shared their experiences.
People with HIV again had a presence the following year in Stockholm, expressing their views in a series of conference sessions known as ?“The Face of AIDS?”. The conference also featured a display from the AIDS memorial quilt, which is made up of thousands of panels for individuals who died from HIV-related causes. At the policy level, the World Health Organization opened the conference by stressing that fighting AIDS-related discrimination was a necessary component of fighting the epidemic itself. And the International AIDS Society was formed in connection with the Stockholm conference, partly to play a co-ordinating role for these annual meetings.
During the next few years, the political and social components of the meetings continued to take on new dimensions. At Montréal in 1989, studies suggested that needle exchange programs might greatly reduce the amount of needle-sharing among injection drug users. AIDS activists kept up a daily campaign addressing a number of policy issues, sometimes disrupting conference sessions to publicly deliver their messages. The 1990 Conference in San Francisco saw a series of demonstrations capped off with protestors drowning out the speech by the US Secretary of Health and Human Services with jeers against what they called regressive US policies towards HIV-positive people.
The event conveyed the depth of some people?’s anger towards what they saw as the lack of leadership on AIDS issues from the US. But at the same time, it also demonstrated that the body of delegates joining the conferences was becoming increasingly diverse. While hundreds of people were reported to have joined the protest, there were plenty of delegates with similar views.
The San Francisco Conference was the last to be held in the United States. The 1992 Conference was scheduled for Boston, but the refusal of the US Government to allow people with HIV from other countries to enter the US led the organizers to cancel the Conference and move it to Amsterdam. Since then Conferences have been scheduled in Vancouver (1996) and Toronto (2006) to allow AIDS workers from the US to attend Conferences at reasonable cost.
A wide array of stakeholders continued to shape the dialogue at conferences in Florence (1991), Amsterdam (1992) and Berlin (1993). Almost 11,000 people attended in 1992, and attendance exceeded 14,000 the following year in Berlin. The mood in Berlin was dark; good preliminary results were in on two new classes of antiretroviral drugs ?– protease inhibitors and non-nucleoside reverse transcriptase inhibitors ?– but people were weary of yet again having their hopes raised and then dashed should these drugs turn out not to be clinically effective.
The 1994 Conference was again characterized by an absence of major treatment breakthroughs, but it was significant for other reasons. This was the first time the event was held in Asia, with more than 11,000 delegates gathering in Yokohama, Japan. And the International AIDS Society was restructured so that it could assume greater responsibility for future conferences. Yokohama was the last annual conference, and since then the event has taken place every two years.
At more recent conferences, organisers have sought to amplify the calls for a unified global response to AIDS. The official theme in Vancouver in 1996 was ?“one world, one hope?”, and the theme in Geneva in 1998 was ?“bridging the gap?”. The research updates in Vancouver did appear to finally offer true hope ?– this was the year when data began to confirm that combining drugs from multiple classes could produce sustained clinical benefits. But it looked like the first treatments with real potential to stave off immune system breakdowns would only be affordable for a relatively wealthy minority.
Hence the focus on ?“bridging the gap?” in Geneva. More than 3,000 people from developing countries were reported to be among the conference?’s 12,700 delegates. Community representatives played an unprecedented role in helping to plan the event. But the scale of the global healthcare gap led some delegates and their allies to conclude in the wake of the Geneva conference that far more needed to be done. Their frustration and in some cases outrage was channelled into activities surrounding the historic conference in Durban, South Africa, two years later.
The Durban conference represents a turning point in the global effort to mobilise a response to AIDS. It was the first Conference to be held in a country in the South, in one of the areas hardest hit by the disease. It focused the world?’s attention on the magnitude of the tragedy unfolding in Africa, while at the same time drawing large delegations from many African countries. And it inspired many HIV-infected participants to assert their hard-won right to join researchers and policy-makers at the decision-making table.
This alone, of course, would not be enough to marshal the resources to provide care and prevention services on the necessary scale. But Durban set future conferences on a course that would be hard to reverse, especially since the 2002 Conference in Barcelona solidified a global commitment to scaling up interventions in the countries that needed them the most.
What started out as a conventional medical conference has thus been transformed into a partnership between a vast array of stakeholders. People might argue that it is a highly unequal partnership, with some groups and coalitions wielding far more power than others. Still, what has happened is unprecedented in history. And actions taken by each of us this week can help to determine how our remarkable coalition continues to evolve. |
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