First day at the XVIII International Conference on AIDS in Vienna

When I attended my first International Conference on AIDS in Durban, South Africa, exactly 10 years ago, I was still swinging between returning to a clinical career or staying in public health. That conference sealed the deal. The energy at what is now referred to as the historic Durban conference, was beyond anything I had ever experienced. Watching Nelson Mandela “Madiba” at the closing ceremony was the icing on the cake. As I listened to him speak, I knew then that public health was indeed my calling and with HIV/AIDS being the biggest public health challenge of our time, these were inevitable linked.

Today, on the 18th of July 2010, I find myself in Vienna, at the opening ceremony of another International Conference on AIDS. Its 10 years on, and in the context of the global financial crisis things are a bit subdued. Okay – obviously Vienna is no Durban and in place of the legendary lively dancing of the South Africans, we were entertained by the Schloss Schoenbrunn Orchester. Ten years on, there are over 4 million people now on life-saving antiretrovirals in the developing world, but the problem of HIV/AIDS has not gone away. In fact the numbers are so large that they make little sense unless  you are infected or affected….and the problem is that many still do not know if they are infected or not. The bottom line is that we cannot afford to let up in the fight against AIDS, or it will re-emerge with a vengeance. We were reminded of the work still to be done by these simple slides.

While both the number of new infections (and deaths) have peaked, the burden of disease continues to increase, challenging us to continue the work already started. This year in Canada, the G8 failed to follow through on the promises they made in Gleneagles. While they have no qualms in bailing out the defaulting banks and defaulting countries, letting more people die from AIDS appears to be an acceptable area to cut public spending. This is all at a time of new emerging evidence that treatment with ARVs is also an effective prevention tool, with new studies in partner organisations demonstrating a risk reduction for transmission by as much as 90% when one of the partners is taking antiretrovirals.

Treatment is becoming prevention ~ Treatment 2.0

 Michel Sidibe addressed an International AIDS conference for the first time as the Director of UNAIDS, taking over from Peter Piot after several years. He spoke with passion about his vision calling for a “Robin Hood” tax on financial transactions to sustain the response to HIV/AIDS. He spoke about his sadness at the persistence of mother to child transmission in the developing world after so many years, and said that its elimination by 2015 was ‘sacrosanct’. In this area Nigeria made its début at the conference when it was shown as the country with the highest number of untested exposed infants in the world. Honestly – what could possible be sadder:

The opening ceremony ended with the Deputy Prime Minister of South Africa Kgalema Petrus Motlanthe. He proudly defined a new era of South African commitment to antiretrovirals as comparable to its commitment to delivering the just concluded football world cup. He said of his country’s new drive:

“I am responsible, we are responsible, South Africa is taking responsibility.”

I leave the venue after the opening ceremony, deep in thought about the past ten years. I have come to reinvigorate and recharge my batteries. To remind myself of the reasons I chose public health. I wonder if it is possible to be a good public health physician without being a bit of an activist….we still have a huge problem on our hands on the continent…not time to relax just yet! I thought of the campaigners that interrupted the opening ceremony complaining about the broken promises of the G8…and wonder if I should have joined them….