In pointed and controversial tract making its rounds on activist email lists, author Laurie Garrett tells the world why she is not attending this year?s International AIDS Conference. The missive, titled ?The Wrong Way to Fight AIDS,?-written for the International Herald Tribune- is notable for managing to be simultaneously largely correct, and wildly off the mark.

Garrett has been a tireless first responder to the pandemic. She has won both the Pulitzer and Peabody awards, and is the rare writer who can grasp both the minutia of molecular biology and the staggering enormity of HIV epidemiology. Her contributions to fighting and ultimately ending this pandemic are unquestionable.

Garrett?s basic point is that the AIDS establishment- from the pharmaceutical companies to public health officials to the non-profit sector to the activists have grown complacent, willing to accept, and even grow fat on the largess of life-long combination anti-retroviral therapy.

She has a point. Many who lived through the early days of the epidemic see people living longer and healthier lives, and see this battle as largely won. The contrast from the days of never ending deaths and illness is indeed stark. Others never experienced what my doctor calls, ?the great dying,? and may see HIV/AIDS as a bothersome chronic, manageable illness rather than the ever worsening world wide crisis it really is.

Much of the outrage- where there has been any of late- has been directed at the world wide inequities in access to life saving HIV drugs. The simple and painful truth that the vast majority of the world?s HIV positive population still does not have access to treatments that have done so much good in the richer countries of the world, woke people up and got the international treatment access movement the boost it so badly needed.

Garrett feels that, as a group, we have taken our eyes off the prize- effective prevention and a cure. She claims that the gestalt of the moment is to shift funding away from vaccine and other prevention research, into expanding drug treatment- as much to benefit the drug companies and the ?vast, multibillion dollar AIDS treatment industry, employing hundreds of thousands of individuals worldwide that serve as a vested lobby on behalf of a prolonged medical approach to a virus that ought to be eliminated entirely from the pantheon of threats to Humanity.?

I suspect that Garrett can?t see the trees for the forest. She claims for example that, ?no leading figure in HIV research has publicly uttered the word cure since the early 1990s.? Uh, no. Cure focused research is active, growing and exciting. Last December a group of around 50 scientists gathered to review and share the most recent work aimed at curing HIV. While I did not attend those who did were quite enthusiastic. A follow up meeting, organized primarily by the Treatment Action Group along with Project Inform, the Forum for Collaborative AIDS Research, AmFAR and FAIR, will take place in a few months.

Even when Garrett is right on the money, she isn?t saying anything new. For example, she rightly points out the untenable economics of chronic treatment. In the lead article in the most recent issue of Project Inform Perspectives, our founder Martin Delaney made pretty much the same arguments. The main difference between these two pieces was perspective- where Garrett sees only the bloated and complacent establishment; Delaney sees the promise of cutting edge research.

It is also folly to draw a clear distinction between prevention and treatment. While Garret details the crushing failures of vaccine and microbicide research, she somehow overlooks the simple fact that effective treatment against HIV is one of the best prevention efforts. Reducing community viral load through wider access to, and probably early use of anti-HIV drugs is likely to make a real dent in the spread of HIV.


All in all, Garrett is more right than wrong. There is too much self congratulation in this field, and far too little sense of urgency. The current paradigm of life long drug treatment is indeed untenable, even within the world?s richest countries. Many within the pharmaceutical industry have a powerful disincentive to finding a cure. The same could be said for some within the larger AIDS establishment.

Where I part company with Garrett is in her conclusion that nothing much is being done beyond feeding the coffers of the pharmaceutical companies and the rest of the establishment. Many of us have not forgotten our roots as ?radical activist.? We are not content to settle for life-long anti-viral treatment. We will not rest until there is a cure.

The tone and tenor of some of the responses to Garret have be unnecessarily harsh, in my opinion. We should not forget the tremendous ally and mover that Garret has been, since the early, dark days of the epidemic.

A few years ago, Project Inform decided that too little focus was aimed at curing HIV. We launched an effort to make sure that the activists, scientists and everyone else inside the ?AIDS movement? kept its eyes firmly on the prize. While some may indeed be content to rest on their collective laurels, we are not they.

So, yes Laurie, here in Mexico City we will take up the slogan, ?Until There is a Cure,? just as we have been doing. We are glad you are with us.