August 15, 2006—Activism is much more than a tradition at the biannual International AIDS Conferences. So far at this week’s Toronto confab, there have been half a dozen noisy marches, interruptions and several “occupations.”

“That’s where the energy of the conference comes from,” said Center for Health and Gender Equity Executive Director Jodi Jacobson as the second full day of the meeting came to a close. “The real issues bubble to the surface because advocates put them there, not because the conference sessions reflect them.”

Canada knows to expect confrontation. Montreal’s 1989 gathering set the precedent when activists took over the meeting en masse to demand the inclusion of people with HIV in top-level decision-making. Vancouver gained global notoriety in 1996 with the announcement of combination antiretroviral therapy, arguably the greatest coup for AIDS activists to date.

It looked like things were going to get saucy in Toronto this morning when ACT UP and Health Gap took over Abbott’s booth in the exhibit hall and accused the company of price gauging following an announcement that the company will sell Kaletra in middle-income countries for $2,200 per year. Activists did pretty much the same thing to the Bangkok Abbott booth in 2004. The difference this year, however, was that the booth had sat empty even before the activists arrived.

Asia Russell of Health Gap said, “The drug company was too afraid of activist criticism.” But Abbott spokesperson Tracy Sorrentino would not concede to this. She said the company had decided this year to make a charitable donation to the Catholic Medical Missions Board and the Elizabeth Glaser Pediatric AIDS Foundation instead of having a booth.

Then came a goose-bumping salute to India’s Independence Day. A coalition of treatment activists—mostly Southeast Asians—gathered by the hundreds and marched with the orange, green and white flag of India through the winding hallways of this convention center to demand independence from Big Pharma.

The groups want less restrictive patent laws that will not only benefit Indians but also secure India’s generic drug industry, which many in Africa and elsewhere in the developing world depend on for their treatment. “Are these profits…they’re making in the rest of the world not enough?” asked Anjali Gopalan, Executive Director of India’s NAZ foundation, who made the march this afternoon. “It’s not like they’re going to go into the red without India’s market.”

An increasing number in the Indian government are leaning toward the U.S./Big Pharma/WTO troika, however. “If research companies don’t make enough profit, they’re not going to put money into R&D, ” said Shailesh Singh of India’s governmental National AIDS Control Organization.

For all the visible fuss about treatment access, however, the Toronto conference may come to be known for its focus on new prevention technologies. With treatment rollout well underway in so many parts of the world, vaccines a mere sparkle in a researcher’s eye and frustrations aplenty with abstinence-only education, a yawning gap has opened for new prevention technologies such as microbicides, pre-exposure prophylaxis and male circumcision.

The emphasis on these new tools (with a robust boost from the Bill & Melinda Gates Foundation) is a stopgap while the world waits for a vaccine. Alas, the conference underscores how elusive a vaccine really is. “Toronto is the conference [where] our distance from a vaccine has fundamentally sunk in,” says prevention activist Julie Davids, Executive Director of the Community HIV/AIDS Mobilization Project (CHAMP).

To add to the sinking feeling, prominent French vaccine researcher Francoise Barre-Sinoussi let slip in a press conference today that a vaccine might be expected “in this century.”  “I thought she had misspoken,” Wall Street Journal reporter Maralyn Chase whispered across the table this afternoon in the IAC media center. But when Chase asked the researcher herself if she had intended to say “in this decade,” her answer, sadly, was “no.”

Other interesting prevention drama unfolded when Bill Clinton, the conference’s ubiquitous media darling, went public today with a rare admission that he had been dead wrong for getting in the way of federal funding for needle exchange while he was president.

Canada’s new Prime Minister Stephen Harper is playing his own head games with the injection-drug using community by threatening to shut down North America’s only safe-injection room even though data is overwhelmingly supportive of its success. The prime minister is also garnering flack for declining an invitation to the conference.

Protesters have kept with tradition by shouting down Minister of Health Tony Clement—who did show up—with heckles asking, “Where’s your boss?” The original activists would be proud to know their legacy is in full bloom in Toronto.