Thought Leadership

Preparing for Mexico: Another International AIDS conference

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by chikwe ihekweazu and ike anya

Every other year, the HIV/AIDS ‘community’, an odd mixture of scientists, youth, community workers, activists, politicians, and various others gather in one city in the world for one of the largest conferences related to an area of scientific endeavor. The inspiration of community effort found in rallying and supporting science to overcome one of the biggest health issues of our time; HIV/AIDS were primary motivating factors in drawing many of us into the public health arena. Between Ike and myself we have attended all the conferences in the recent past; Durban where it started for us…with its powerful theme “Break-the-Silence”, Barcelona and the lunch of the ambitious “3 by 5” initiative, Bangkok and the euphoria of ABCs, Toronto when it was finally “time to deliver”…

Now its time for the next one in Mexico: themed “Universal Action Now!”

from the 3rd to 8th of August.

We will share out thoughts in this regard in a series of posts leading up to the conference.

Two years ago we were at another AIDS conference in Toronto. We were told it was “time to deliver” but it was not good news. 25 years on, with close to 40 million people infected, mostly resident on our continent, it was impossible not to feel guilty on how it had all come to this. Often as members of the “scientific community”, with our self gratifying altruistic attitude, we are all too quick to imagine that we can come up with quick solutions to new health challenges of our times. But this has defied us all. Peter Piot’s remarks during the opening ceremony were poignant;

“in an exceptional crisis, we must learn to act in exceptional ways”.

In these conferences, we attend less in search of new science as these will be published in journals anyway, but to seek some motivation to keep on believing and working. But it is hard in these AIDS conferences, it is hard…especially as an African: I cannot forget the words of this Ugandan lady:

“I abstained before marriage, I was faithful in marriage and still I became infected with HIV”.

It became obvious to many during the conference that our celebrated ABC strategy of “Abstain, Be Faithful and Use a condom” was failing African women. Regretfully, we had come to the painful realisation that men cannot be relied on to take the decision to “abstain”, “be faithful” or “to use a condom. Women were bearing the brunt of this epidemic, getting infected earlier, caring for the sick and elderly.

In Toronto Bill Gates made his appearance on the podium for the first time at one of these AIDS conferences. He announced his intention to give up day-to-day running of Microsoft, a company that has revolutioni zed our way of life, and devote the rest of life into work for his foundation: The Bill and Melinda Gates Foundation. It is now one of the largest funders of research into health issues in the world. I could not help but think; in 10 years time Bill Gates might be remembered less for his role in the growth of information technology but for the public health issues. Maybe the man was in the process of redefining his legacy…just maybe. Could Microsoft become a footnote in the Bill’s legacy?

As usual, in the midst of despair, there were some success stories and ground for careful optimism. Botswana went against the norm and introduced universal testing in 2004. This policy requires that each person who attends a hospital to be tested for HIV unless he/she actively opts out. Botswana’s argument was that the requirement for extensive counseling prior to testing, a legacy from the era when treatment was inaccessible to most of those infected was now an impediment for universal access to treatment. Many in the ‘international community’ remained skeptical. We heard that in 2 years, this new policy led to an increase from 18 to 25% of people who are aware of their HIV status in Botswana. In a Satellite session organised by Botswana a nurse summarised her emotions as follows;

“I cannot continue burying my friends while we insist on voluntary counselling before testing, if I wanted to be an undertaker, I would not have trained as a nurse”.

One of the most interesting sessions at the conference held on the Wednesday afternoon, titled “25 years of AIDS reflecting back, looking forward”. The panel included Antony Fauci and Peter Piot and was chaired by Richard Horton, the Editor of the pre-eminent medical journal, “The Lancet”. Most of us Nigerians is this session as we were in our bi-annual, mid-conference moaning session, a meeting of sorts where we all come to cry our eyes out to the leaders of the official delegation (more on this in subsequent posts!). We knew it would be a difficult call to miss this session, but patriotic instincts can be so strong. Anyway, thanks to the marvels of modern day technology, we quickly rushed to the net to catch the webcast as soon as it became available. Richards opening remarks were poignant and profound. We felt like our country was were being addressed directly when he asked:

“Why are we not using these meetings as a global accountability mechanism for country progress, to hold everyone of us accountable for what we have done in the previous 2 years, and set specific, measurable objectives for the next 2?”

On ARVs and the hope it offers for Africa, Kevin DeCock, director of the WHO Department of HIV/AIDS warned;

“We cannot treat our way out of this epidemic, continuing at the present pace, there will be 450,000 new cases on treatment each year yet there’ll are 4 million new infections”.

Many scientists moan at the lack of scientific rigor at these AIDS conferences. We will argue that it is just as important that this conference is open to a wide variety of people from all backgrounds. I remember the conference in Durban, in 2002. The motivation to pursue a career in “public health” was created less by the over-whelming science than by the inspiration of people like Zachy Achmat of the Treatment Action Campaign. At the time it was considered almost insane to imagine that ARVs, then costing about $10,000 per person, per year would ever be available to treat people living in Africa. Yet Zachy and his group believed and convinced us that it was possible. Today we have seen that it is possible. This was not achieved by science!

History will not judge us by our scientific advances but what we do with them.

Where will we be in 25 years time? A quick death from pandemic influenza or a slow one from HIV/AIDS? Hopefully, none of the above will come to pass.

At the end of the conference, Peter Piot, the Director of UNAIDS repeatedly said,

“…we know what works….what remains is the will….!”

What do Nigerians think?


Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

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