It was two steps forward and one step back at the World AIDS Conference
Since the 1996 International AIDS Conference in Vancouver, 10 million people have been infected with HIV. Last July, 13,200 of the world’s most HIV-expert minds converged in Geneva to figure out what to do about it.
At the 12th World AIDS Conference, scientists, doctors, journalists, academics and activists nosed and dozed through 5,400 presentations, which stretched from biomolecular breakthroughs to transsexual prevention. They flipped Vancouver’s idealistic slogan, “One World, One Hope,” on its airy head, devoting more time and talk than ever before to “Bridging the Gap” between the rich North and the poor South.
And 1996’s euphoria, when Dr. David Ho trumpeted “HIV eradication,” gave way in somber 1998 to what Ho called “remission” and others called “the new reality”: a cold-eyed reappraisal of the protease-based promises, building on the known limits of the immune system. The big buzz? Weary Geneva-junkies heaved a sigh: “Where to begin?”
Jon Cohen Journalist, Science “Geneva was a reality check. Talk of a cure is now talk of remission. The limits of the new treatments are now more pronounced: It’s hard to take so many pills, the drugs mess with metabolism, only the wealthiest countries can afford them, and the virus continues to replicate even in people who are ‘undetectable.’ I don’t think the doom and gloom of Berlin has returned. It’s just that the zeitgeist meter—which registers despair on the left and elation on the right—is now resting somewhere near the center, which is precisely where it belongs.” Buzzword: “Remission”
Rachel King THETA (Traditional and Modern Health Practitioners Together Against AIDS), Uganda “The conference was heavily biased toward antiretroviral therapy, which gives hope to people who can afford it, but not to people who can’t. Two-thirds of the world’s HIV infections are in sub-Saharan Africa: It would have been nice [for the conference] to consider those people more seriously. Much of Africa lives without clean water. Antiretrovirals are not an option for more than a very small, very wealthy population there.” Buzzword: “Bridging the Gap”
Richard Horton Editor, The Lancet “The most important thing for me was coming face to face with the incredible indifference to the human burden of HIV in the poorer parts of the world. There was very little effort by either session chairs or speakers to do any more than pay lip service to the conference’s theme. And the callous exploitation of the event by the majority of pharmaceutical industry representatives was simply sickening.” Buzzword: “Adverse Effects”
John James Editor, AIDS Treatment News “The conference reported solid scientific advances, especially in immune recovery, new drugs and information on growth-hormone treatment and changes in body shape. The mainstream press was unduly pessimistic, for two reasons: There wasn’t one big story this time (like the arrival of protease inhibitors at Vancouver), so the press spun the lack-of-story into a lack-of-treatment.” Buzzword: “Immune Recovery”
Matthew Sharp ACT UP/Golden Gate “I was glad to see so much discussion of side effects, such as lipodystrophy. In terms of ‘Bridging the Gap,’ it was too little, too late. There were few concrete proposals besides drug companies lowering prices in developing countries. Vaccines are clearly the answer for developing nations, but given the conference’s theme, they were ironically downplayed.” Buzzword: “Metabolic Complications”
Ken Morrison Conference Co-Organizer “At a conference like this, it’s the little things that count, such as the informal hallway chats. It’s hard to name a significant product of the conference—count the permutations of exchanges possible with 13,686 persons, and you have the most important element. From what I overheard, the general mood was relatively positive. The hope of Vancouver is not dead, but has evolved into a stronger sense of global solidarity.” Buzzword: “Ethical Trials”
Greg Lugliani Communications Director, GMHC “The most important aspect of the conference was the paradigm shift from total eradication to practical eradication—the use of the body’s own immune system to fight HIV. The big story was multidrug resistant HIV. The most underreported aspect? Prevention. We all want to read about a cure—prevention just isn’t sexy.” Buzzword: “The New Reality”
Robert Gallo Virologist, Codiscoverer of HIV “It sounds almost Pollyanna, but I don’t think the conference was misnamed. Nothing surprised me scientifically, but I was impressed by the magnitude of concern for the developing world. I have never seen so many Third World people at these meetings, feeling excited and part of it all.” Buzzword: “No buzzwords, no take-home messages, no new reality. All the warning signs were at Vancouver.”
Maggie Atkinson Toronto’s AIDS Action Now! “The mistakes of Vancouver introduced real caution into Geneva’s tone. The long-term effects of the protease drugs, which got only lip-service before, now got real concern. It’s so important in international forums to question the ethics in clinical trials, but there wasn’t enough discussion of it.” Buzzword: “Immune Restoration”
Marina Mahithir Malaysian AIDS Council “The conference further strengthened my conviction that Asian countries are very marginalized. The general mood was too focused on antiretrovirals. The theme’s intentions were good, but cultural differences weren’t acknowledged. I wonder if any attempts were made to get an Asian person to speak at the opening ceremony. It smacked very much of ‘Never mind, all those Third Worlders look the same anyway.’” Buzzword: “Expensive”