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XVI International AIDS Conference: Daily updates from Lifelong AIDS Alliance staff
XVI International AIDS Conference: Daily updates from Lifelong AIDS Alliance staff
The International AIDS Conference, held every two years, is the largest forum related to HIV/AIDS in the world, drawing more than 20,000 scientists, health care providers, government officials, and others from around the world.

This year's conference is being held in Toronto, Canada and is being attended by four Lifelong staff members: Executive Director Tina Podlodowski, Director of Programs David Richart, Director of Marketing and Development Cory Curtis, and Education and Prevention Manager Erick Seelbach.

The following are daily updates from LIfelong AIDS Alliance staff. Visit www.LifelongAIDSAlliance.org for additional updates from the conference.

SUNDAY, AUGUST 13, 2006

Four of us from Lifelong (Executive Director Tina Podlodowski, Director of Programs David Richart, Education and Prevention Manager Erick Seelbach, and myself) arrived in Toronto today for the XVI International AIDS Conference.

With 27,000 delegates, a conference agenda that is 479 pages long, a conference addendum (for something organizers have dubbed "The Global Village" listing all of the HIV/AIDS educational related activities outside of the programmed discussions) that is 96 pages long, and delegates representing more than 100 countries, the first few hours have already been an odyssey! Of course, those numbers pale in comparison to the 25 years that we've been living with HIV/AIDS and the 40 million people infected with the virus worldwide. AIDS is the fourth leading cause of death in the world and ending it really has become the most crucial and essential public health crisis that the world is likely to ever face.

In the first few hours at the conference, there has been a sense of urgency. The conference's theme, "A Time to Deliver," stresses that many of science and health's brightest minds are working on treating and ending AIDS. However, due to the sheer cost, dimensions, and inequities of the disease, a cure is still a long way out and many of the people most in need of treatment, prevention, and education are being left behind.

In tonight's opening session, Bill Gates, who keynoted after a long list of politicians, said that throughout the world, for every new person treated for HIV/AIDS, ten more are infected. It's clear that we're simply not keeping pace.

Among the opening night's most interesting moments (which took place in Rogers Centre-home to the Toronto Blue Jays and Argonauts):

o A welcome by Canada's First Nations Chief Brian Lafonte that spoke honestly and openly about stigma, discrimination, Gay issues, and IV drug use. Of all HIV/AIDS cases in Canada, 1/3 are among Canada's First Nations population-a staggering statistic that really shows that this disease, once rooted in the Gay population-has reached farther than we can imagine.

o A passionate speech by Frika Chia Iskandar, a 25-year-old Indonesian woman who has lived with HIV for six years. She spoke of the challenges that young Asian women, and all people living with HIV/AIDS for that matter, face in getting access to drugs, medical care, and basic information. She is as old as the AIDS virus-an entirely new generation is growing up never having known a world without AIDS.

o Canada's Governor General Michaelle Jean was one of the high (and unexpected) moments of the evening. Having no idea what a Governor General is, her impassioned speech led me to dig a bit more. Her official title is Her Excellency the Right Honourable Michaƫlle Jean and she is appointed by the Queen of the England (the country's official head of state). She carries out Her Majesty's duties in Canada and was the highest ranking Canadian official present. If Her Excellency's views match those of the Queen, it would indicate the Monarch as fairly progressive and in touch. She spoke of the basic dignity that all people are entitled to and the inequities that AIDS both stems from and creates. They are pretty simple sentiments, but it is all too rare that someone in government talks about this disease on such a personal and passionate level.

o The absence of Canadian Prime Minister Stephen Harper was noticeable. Conference Co-Chair Dr. Mark Wainberg took the PM to task for not attending the conference and protesters unfurled pillowcases with "Sleep In Steve" painted on them. It was a significant absence. AIDS is not a political issue and the PM should know better. As evidenced by the country's other political talent who spoke, there are many who far outpace the PM on this issue. He's clearly an unpopular guy, as at dinner tonight the sales tax was listed on the cheque as a Harper Tax. It seems that he's angered more than just the AIDS communities.

o Finally, the night ended with Bill and Melinda Gates. They are standing on the edge of changing history with investments in global health and, from their rather quiet and non-grandstanding presence, you'd have no idea. While Bill did show some support for the President's PEPFAR plan and the ABC (abstinence, be faithful, and use condoms approach-an approach widely derided by those in prevention) he spoke squarely of empowering women to better protect themselves. To put the power to prevent infection in the hands of women could greatly change the course of AIDS in the near term. He insisted that by empowering women, it in no way lessened the obligation of men to prevent the spread of the disease. Melinda continued his theme and spoke smartly and boldly about the stigma, discrimination, and fear that STILL surrounds AIDS. She summed it up: people and politics discriminate, AIDS does not.

Looking forward to five more days, many more stories, and that constant thread of hope-and determination-that runs throughout. While this conference is global in scope, it does drive home that if we don't solve the AIDS crisis at home in the US and in Seattle, that we can't solve it anywhere. While Lifelong has made strides, there's still a long ways to go. - Cory Curtis

MONDAY, AUGUST 14, 2006

Greetings from Day 2 of the International AIDS Conference, where 27,000 people means the lines are very long, the sheer number of seminar possibilities are staggering, and the weather (humidity!) is a conversation starter that crosses any barriers that language difference might present&

After an 80 minute wait in a tightly packed line (at least Cory, David and I meet some great activists from Nigeria who we got to know very closely!), the doors to Session Room One were finally flung open to admit nearly 4,000 attendees to the "marquee" session of the day, "Priorities in Ending the Epidemic", a conversation with the two Bills - Clinton and Gates, moderated by NPR's Charlayne Hunter-Gault.

We often point out the one of the major reasons we all do the work we do to make Lifelong AIDS Alliance a strong organization is because AIDS is the greatest moral, health care, economic and civil rights challenge on the planet. It was nice to have that restated and reconfirmed today by the richest guy on the planet (and head of a $62 billion foundation) and, arguably, one of the greatest masters of politics and government on the planet. Two smart guys, those Bills.

I agree with the Bills - this breath-taking human tragedy - AIDS - is the challenge that illustrates our global interdependence on each other. And our global need to have everyone involved in AIDS awareness, action, prevention and treatment.

I also agree with the second point of the Bills - that one of the biggest stumbling blocks to a solution to the HIV/AIDS epidemic is stigma and discrimination. At Lifelong, we discuss this all the time. But, complacency around the AIDS epidemic has seemingly become endemic. Whether it's a trip to Botswana or the Chicken Soup Brigade kitchens, the Bills are adamant that "you have to go there, to know there." Meaning, get out into the world and see how AIDS affects lives today.

Stigma comes in the form of the thing we refuse to discuss openly and honestly in order to stop HIV, starting with sex and sexuality and including, but not limited to, men who have sex with men, IV drug use, "abstinence only" education (which may delay sexual activity in some youth, but has a dismal track record in keeping those safe once they become sexually active), women's lack of power over their own bodies in many cultures, and so much more.

Discrimination comes in the form of laws the make Gays second class or non-existent citizens, make women unable to make choices without spousal consent, make needle exchange unable to happen in many communities, and make youth unable to get medically accurate sex education, and so much more.

The United States is no stranger to either stigma or discrimination - and, we cannot expect the rest of the world to deal with stigma and discrimination if we won't do so at home. As a wealthy county, a media-rich country, a resource-rich country we have to lead. In our own backyards, and around the globe.

And finally, to the last point of the Bills. We can spend all the money we (and the Bills) have on care for the 50 million people around the world living with HIV/AIDS, but for every one person we can successfully treat to prolong life (STILL no cure), 10 more are infected. We have got to move prevention efforts to a different level with different tools to slow the epidemic. These include Microbicides, oral prevention therapies, widespread condom distribution and education, coupled with the political, cultural and personal power for men, women and youth to use these tools.

Way to go Bill! And Bill!

(See the very end of this post for Microbicide 101 if you are wondering what is a Microbicide, and what it does&)

Tomorrow's big session is a critical look at the global response to HIV/AIDS including PEPFAR, UNAIDS, the Global Fund, and, at home, the Ryan White CARE Act. The rumor is a few sparks may ignite as we get a visit from Chile's fiery first female president, Michelle Bachelet. She won the 2006 election in a runoff with 53.5% of the vote. A moderate socialist, she campaigned on a platform of continuing Chile's free market policies, while increasing social benefits to help reduce the country's gap between rich and poor, one of the largest in the world.

Bachelet is a surgeon, pediatrician and epidemiologist with and served as Health Minister and Defense Minister under President Ricardo Lagos. (Sorta Condi Rice and Jocelyn Elders rolled into one!) She is a separated mother of three and a self-described agnostic, which sets her apart in a predominantly conservative and Catholic country.

Should be a good one! Goodnight from Toronto!

Microbicides: The word "microbicides" refers to a range of different products that share one common characteristic: the ability to prevent the sexual transmission of HIV and other sexually transmitted diseases (STDs) when applied topically. A microbicide could be produced in many forms, including gels, creams, suppositories, films, or as a sponge or ring that releases the active ingredient over time.

Scientists are currently testing many substances to see whether they help protect against HIV and/or other STDs, but no safe and effective microbicide is currently available to the public. However, scientists are seriously pursuing almost 60 product leads. If one of these leads proves successful and investment is sufficient, a microbicide could be available in five to seven years.

Today's prevention options-condoms, mutual monogamy, and STD treatment-are not feasible for millions of people around the world, especially women. Many women do not have the social or economic power necessary to insist on condom use and fidelity or to abandon partnerships that put them at risk. Because microbicides would not require a partner's cooperation, they would put the power to protect into women's hands. - Tina Podlodowski

TUESDAY, AUGUST 15, 2006

Each delegate here at the International AIDS Conference represents approximately 1,500 people living with HIV/AIDS in the world. That's an incredible responsibility for each of us - to know that we are here to learn from each other, to connect across cultures, to encounter the almost overwhelming variety of human experience, to understand that we here are but a small fraction of the pandemic that unites us. The Global Village is the living and vibrant example of that. There's a strong feeling of celebration and connection as you walk through and see people communicating across cultures, sharing stories and ideas, exchanging arts and crafts, and simply reveling in the shared humanity.

The Conference is spread over two buildings of the Metro Toronto Convention Center, and there's a constant flow of people moving about between the Global Village, the Exhibition Hall, the Internet Cafes, the Session Rooms. There are Conference volunteers and security everywhere - helping people find their way, checking for Conference badges (which are scanned every time you enter the buildings), and keeping the traffic flow moving. There are simultaneous activities happening everywhere in the Center from 7:00 a.m. until 9:00 p.m. - so much to choose from that I always feel as though I'm missing something!

There have been both discouraging and encouraging aspects to the sessions that I attended. Though there are a large number of delegates from the United States, much of the conversation has focused on the pandemic in the rest of the world. References to the U.S. seem to be focused either on the effects of U.S. policy on prevention and treatment in the developing world or on the work of the two Bills (Clinton and Gates) overseas. There doesn't seem to be a widespread recognition that we still have an ongoing epidemic or that access to prevention and treatment isn't universal in the U.S. I don't want to downplay the importance of talking about the pandemic in the rest of the world, but we shouldn't have that conversation without also acknowledging that despite tremendous strides in the U.S., we still have epidemics fueled by social policy, inequalities, poverty, and racism that affect marginalized populations.

And the word "Gay" has been startlingly absent from the conversation. We hear an occasional "homosexual" or "MSM," but despite the fact that there is an MSM Guide to IAC, that there are Gay men everywhere you turn here, and that there are a few sessions devoted to prevention with MSM, it is very clear that AIDS has been de-Gayed in the rhetoric of the global pandemic. In one particular session on prevention with MSM, I was struck by how providers around the world - from Australia to the Netherlands to Thailand - are asking questions about the work that parallel many of the conversations we have in our Prevention Education staff meetings: how do we address HIV prevention in the bigger context of men's lives; how do we compete with sex; how do we most effectively access and interact with folks on the internet where they are meeting their sex partners; how do we stay current with what men are really doing to protect themselves (especially when it is different from what "we" think they should be doing); how do we make sure that our prevention interventions are effective with various sub-populations of Gay men.

Much of the broader prevention conversation has focused on shifting paradigms to look at prevention not just from an individual perspective but also from a relationship perspective as well as human rights and community mobilization perspectives. As one speaker described it, "individual, collective, and contextual aspects increase susceptibility to infection," and we must address all of those within prevention if we are to be more effective. Another speaker put it this way, "HIV transmission is much more than a viral event," it is a complex mix of inter-subjective experience, contexts, desires, values, and social factors. That same speaker described how a patient of hers said, "the exact moment I was infected by HIV, I was not getting infected." Rather, she was having a loving experience with her partner. One speaker showed a slide of how Gay men are viewed by health promoters - a picture of a man with various though bubbles that include testing, condoms, negotiation, and so on - followed by another slide of how Gay men really are - the same picture with numerous other thought bubbles that include work, relationships, body image, diet, gym, etc.

There has also been much talk of new prevention technologies that will hopefully allow us to extend the ABC much further to also include DEFGHI*. These new technologies currently being studied include circumcision, microbicides, pre-exposure prophylaxis, treatment of STIs, and vaccines. There are many ongoing studies of such technologies, though we won't have trial results for quite some time, and it is likely that we won't have effective products (microbicides or vaccines) for many years. The questions to begin answering now, though, in order to prepare us for new effective prevention technologies include how do we ensure a synergistic use of social, behavioral, biomedical and barrier methods of prevention and how do we ensure that we will be able to deliver new effective prevention technologies to those most in need.

The overall messages so far, then, have been that the issues surrounding HIV are increasingly complex, that we must take more of a human rights approach to prevention, and that we must engage the hearts of people.

I'm looking forward to the next few days to see how these conversations continue.

*D for diaphragm; E for exposure prophylaxis; F for female-controlled; G for genital tract infection treatment; H for HSV suppression; I for immunity - taken from a talk by Gita Ramjee. - Erick Seelbach

WEDNESDAY, AUGUST 16, 2006

I have dreamed about attending the International AIDS Conference for six years. Now that I am finally here, I am amazed at the number of attendees and sheer numbers of people from all over the world. The cultural mixture stimulates all sorts of emotions and feelings about the epidemic.

I see many Gay white men in attendance. Many are clearly struggling with HIV/AIDS. They are tired, walk with canes and are so very pale and thin. But as I sit in session after session, no one speaks about the American epidemic or has uttered the word "Gay". I understand that 100 deaths of 9/11 proportions happen every year in Africa. But does that mean that we forget the AIDS epidemic started in the Gay community in the U.S. and it was on our backs that the international response was born? It's incredible to listen to all the speakers talk and feel like Gay men don't even exist or that our community has been desecrated by this disease. What has happened to our collective memory? At this conference it's like we would like to forget all about the American epidemic. In session after session, I listen to scientific presentations about how to stop mother-to-child transmission and the loss of women's lives in general and it is tragic.

I want to scream, "What about the Gay community?" We are still being infected and dying every day in our community and we are so complacent about it. Is it because our brothers and sisters are poor, struggling w/ substance abuse and mental health problems? Some of the people I talk to even say, "I am sick of working with Gay men. They know how to avoid the virus and yet they still keep getting infected." Yes, the epidemic has changed. The face of AIDS is different, but that doesn't mean we shouldn't recognize the sacrifice of those who have died. I hear so much talk about stigma and how attendees are working to break it down in other parts of the world and yet the deafening silence about the devastation in the Gay community is overwhelming. Frankly, there is not much talk at all about anything happening in the United States, except what the Clinton and Gates Foundations are doing overseas.

What has happened to the epidemic in America? It is clear that the ABC prevention messages that are a required part of U.S. government funding aren't working and that delegates from every corner of the world are angry at the U.S. I also understand that many are aware of the entitlement attitude of many people living with AIDS in the U.S. when people living with AIDS in other parts of the world don't have enough food to eat. Yet, as we are sitting at this conference, the U.S. government is in the process of destroying the support services that provide food, housing and case management for people living with HIV/AIDS in the United States. Not one word of protest has been spoken about that!

What do we do? While Bill Gates and Bill Clinton spoke, health care worker demonstrators chanted, "Fund health care workers first". They wanted fair wages for AIDS health care workers. ACT UP France took over the Roche booth and covered it w/ black plastic to make a statement about the high price of their drugs. But the voice of the American epidemic is silent. After I arrived, I heard that there was a "pre-conference" meeting on men who have sex with men (MSM). We need to make that discussion intertwined in the regular conference and not tucked away where no one can see it. There is an MSM track, but those presentations are sterile and lack any cutting edge information. We need to bring U.S. voices into the presentation tables at the front of each session. Lifelong is going to try to get a voice at the next International AIDS conference in Mexico City in 2008. As leaders, we will make it our goal to ensure that the American epidemic is remembered, heard and discussed. - David Richart



Courtesy of Lifelong AIDS Alliance

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