Diary of a conference delegate

Friday 8th August

Delegates are streaming away from the Banamex conference centre in Mexico City leaving it on a series of high notes. 

In the final plenary, Bruno Spire of France, gave us his combination prescription for fighting stigma and discrimination. 

1. Better acceptance of people with HIV in society

2. Improve laws and policies

3. Carry out prevention work with people, not for people.

Next to speak was Edwin Cameron who brought the conference to its feet with his global campaign to end criminalisation of HIV. 

We expect to hear much more of it in the months ahead.

We have learned much that can help us in our efforts to tackle HIV in the UK.

The lessons have come from a powerful alliance of scientists, activists, policy makers and funders, from all over the world.

Thursday 7th August

I sat in the morning plenary earlier listening to highly-respected activist, Gregg Gonsalves, speak compellingly about scaling up access to HIV drugs and the struggle for comprehensive primary care around the world. 

Gonsalves made a clear point, echoed by others, that the drive to get HIV treatment to the millions who need it has been the catalyst for building primary care for poor people the world over. 

This is a useful point to remember when listening to debates about whether AIDS gets too much money. 

"Activists for primary health care have been screaming for more funding for years" he said, "but until the movement for AIDS treatment, we did not have the billions we need to make a real run at health for all."

Gonsalves reminded the conference of the many achievements of activism over the years of which delegates should be truly proud.  At the end of last year, the global target of three million people on HIV treatment was reached - albeit two years late. 

The lesson learned, he said, was not that we shouldn't be so ambitious, instead, setting a goal and working towards it is the only way to make significant progress.  The target now is for universal access to treatment by 2010.

"All of us in this room, in fact, all who believe in the struggle not just for AIDS treatment, but for health for all, need to make a commitment today to become activists, in whatever way you can" he said. 

"This is just the beginning of our work. Let's get busy."

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THT held a session on criminalisation this morning, co-chaired by Justice Edwin Cameron, of whom I wrote yesterday, and our own head of policy, Lisa Power.

Community representatives from around the world came to share their views and experiences.  Nurse Angel Rose from Canada related how her friends, family and colleagues were totally supportive when she told them she'd acquired HIV at work. 

Two years later, the Candian media started to cover stories of people being prosecuted for transmitting the virus, and Angel found people's attitudes towards her undergoing a rapid, and in one case, violent change.

She became severely depressed and locked herself away for a year, believing she no longer had any right to a relationship.  Today is, thankfully a different story, and it's a remarkable testament to her courage and spirit.

Of course, Angel was not the only one - we heard from an American former-prisoner who said being HIV positive - and the stigma that goes with it - was the hardest thing he'd ever had to try and deal with in his life.  So hard, he'd contemplated suicide.

Delegates from Australia, France, Sweden and the UK also spoke passionately and compellingly.

Tomorrow, Justice Edwin Cameron is taking the main stage for the opening plenary.  I'm sure the conference hall will be packed.

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I'm pleased to report that activism is flourishing at the conference.  So much so, that I found myself momentarily straining to hear an activist on the plenary stage because of the rousing demonstration for better TB testing passing by outside. 

The conference started with an anti-homophobia march, largely credited with Panama's hasty decision to repeal it's laws against homosexuality.  Since then there have been moving and spirited demonstrations every day on a variety of issues.

Today, former UN High Commissioner for Human Rights, Mary Robinson joined a rally on human rights and HIV & AIDS. 

Dr Kevin De Cock, Director of the HIV/AIDS Department said this morning that we will not succeed without the efforts of activists, and there are specific challenges activists are best placed to tackle.

So, what do we want? More activism!  When do we want it? You know that answer to that one.

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Wednesday 6th August

Conference hot topic for today is the impact of criminal prosecutions of people with HIV for transmitting, or exposing others to the virus.  Two years ago at the last world AIDS conference, few people were talking about it.  Today alone, I've heard speakers from all over the world, with different laws, variously applied but one clear message. 

Richard Pearhouse from Canada put it thus: "These laws are profoundly dangerous and we're missing the real opportunity for law reform".

UNAIDS launched a new version of their policy brief on criminalization which urges governments to limit criminalisation to cases of intentional transmission.  Currently, laws around the world criminalise a wide variety of conduct by people with HIV, including unwitting exposure by untested positive people, spitting and mother-to-child transmission.

Julian Hows presented a joint THT and GNP+ survey of European and Central Asian laws which showed that six more countries in central Europe and Asia have criminalised transmission since 2004.  Similar increases are being seen in Africa, leading to several speakers to refer to 'criminalisation creep'.

So why is this a problem?  Everyone I heard today agreed that these laws serve no useful purpose.  Research shows clearly that they do not reduce the rate of onward transmission but do increase levels of stigma and discrimination for people with HIV. 

Susan Timberlake from UNAIDS proposed an alternative view.  "The role of the law is to enable universal access to HIV treatment, prevention, care and support" she said.  "Punitive laws are on a collision course with universal access."

Anne Gathumbi from Kenya was on the UNAIDS panel.  She observed that these laws were supposedly designed to protect women, but instead, have been used against them.  Women are often the first in a family to learn their status through ante-natal HIV testing, and this often also exposes them to domestic violence as a result.

Justice Edwin Cameron, the only openly HIV positive High Court Judge in South Africa summed up the position perfectly, calling the laws desperately misguided.  He said "These laws are bad and this conference should take a stand against them".  It seems highly likely it will.

If you'd like to know more, see THT's briefing on this website www.tht.org.uk/prosecutions or www.unaids.org

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I've just been on a short trip round the world - or to the global village on the conference site.  Everything goes here - I've seen pole dancing, wrestling, traditional healing and painting.  I've bought Oaxacan jewellery, admired dressing gowns from Tanzania and joined the party at the Mexican tequila stand. 

Stand still for long enough and the whole world will go past you, including Mexican style funeral demonstrations against drug pricing and random acts of guerilla dancing (should that be a Flash Dance?) from Dance 4 Life whose slogan this year is 'Actions speak louder than words'.  Their drums speak louder than anything else.

Serious discussions between community delegates from around the world compete with Star Whores and Hairdressers Against AIDS, offering free styles to delegates.  The queues are huge. 

It's enormous fun.  Just as soon as I've finished here, I'm going right back over there.  Arriba!

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Tuesday 5th August

If yesterday felt rather like a battle - millions of footsoldiers needed; dragons to be slayed; magic bullets (or lack of them) - then today seemed more like a journey. 

Mine began at a press conference on the future of vaccine research, hosted by the International AIDS Vaccine Initiative (IAVI) to launch its blueprint for the future.  I heard from Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS that combination prevention is making progress, but we need a vaccine to stop HIV.  Seth Bernstein, CEO and President of IAVI stressed that vaccine research is never a straight line and that we must expect failure along the way.

Dr Omu Anzala, Director of the Kenya AIDS Vaccine Initiative described the race for a vaccine quite literally.  "I come from a country where we are well known for running long distances.  When you start off there are a lot, but eventually there is just one.  The marathon is still on" he said.  I borrowed his marathon analogy to ask if the panel could hazard a guess as to when the race might be won.

"A time line is hard to predict" said Seth Bernstein, "but I hope we have an answer sooner than the next century or I won't live to see it.  We're going to have breakthroughs, but when is impossible to predict."

There are a number of recommendations in IAVI's blueprint, and sustainable, predictable finance will be vital, as well the ability to attract a new intake of scientists to HIV vaccine research. What is also clear is the determination and confidence of those involved today.

Bernstein said the search for a vaccine is the greatest scientific and humanitarian challenge of our times.  "It keeps me going, knowing it is important and right, and science will prevail" he said. "We'll get there."

For more information, see www.iavi.org

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My next stop was at the World Health Organisation (WHO) press conference to launch its comprehensive guide for low and middle-income countries on how to achieve universal access to HIV/AIDS treatment, care and support.

On the panel this time was Canadian Health Minister, Tony Clement, who hoped it would "serve as a compass to guide us on our journey".

We heard from the Ethiopian Heath Minister, Teodros Adhanom, (whose own journey was difficult due to the infamous gridlocks in Mexico City) about the considerable achievements in his country in recent years.  Ethiopia is likely to achieve universal access to treatment and prevention by 2010 he said.  Just 900 people with HIV who needed treatment had access to it three years ago, now 150,000 do. 

The availability of treatment has been an incentive for people to take an HIV test with 3.8 million doing so last year.  "Our progress creates hope for individuals" he said, "which creates national hope." 

Dr Teguest Guerma, Associate Director at WHO said "We're on the road to universal access to treatment.  We will get there, maybe not by 2010, or 2015."

We wish them all bon voyage.

Find out more at www.who.int/hiv

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My final stop took me to the Lancet presentation of their series on HIV prevention in collaboration with UNAIDS.  Anyone arriving late to this particular destination was disappointed - it was so popular that they had to close the door, shutting scores of delegates out.  I got a seat, and heard an engaging and inspiring panel discuss their papers on HIV prevention. 

There are six papers on the history and challenge of HIV prevention; boimedical interventions, behavioural strategies, structural approaches, making prevention programmes work; and coming to terms with complexity.  It's fascinating stuff.

It's not possible to do justice to them here, so may I respectfully suggest readers undertake a journey of their own to www.thelancet.com to see for themselves?

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Monday 4th August

Conference begins with urgent pleas for better HIV prevention and access to treatment

Risk reduction programmes can reduce HIV prevalence, said a leading epidemiologist at the opening plenary of the World AIDS Conference, but the evidence is still limited to a handful of countries.

Geoffrey Garnett, from Imperial College, London, used modeling of the HIV epidemic to map how it could be expected to behave in a new population.  Similar modeling from urban Zimbabwe, concluded that the decline in prevalence could be attributed to a 50% reduction in new partner acquisition or a similar uptake of condom use.

Garnett concluded that combining prevention techniques including promoting condom use, safe access to circumcision and investment in health promotion, has a greater impact on prevalence.  "There are no magic bullets" he said.

Jaime Sepulveda from the Bill and Melinda Gates Foundation believes it's likely that many prevention programmes are costing too much, targeting the wrong people and being implemented poorly, yet they are still cost effective.  "Even our current inefficient systems pay for themselves, and we should be investing much more." he said.

Sepulveda believes the turning point in the epidemic will come when more people start HIV treatment in a year than are newly diagnosed, highlighting the huge scaling up of treatment access needed to achieve it.  Currently, new infections out-pace those newly on treatment by five to two. Alex Coutinho from the Infectious Disease Institute of Makerere University said that few countries will achieve universal access by the target date of 2010.  He gave a startling example of the effectiveness of treatment on health care systems in Malawi. "Two percent of people with HIV on treatment were health care workers, and through their combined work time, they were able to provide HIV treatment and care for a further 50,000 people." said Coutinho.

Elsewhere, singer Annie Lennox lent her voice to Oxfam's call for urgent action on global access to treatment.  Holding two photographs of a seven-year-old girl, she graphically showed the difference that
treatment can make to individual lives. 

Lennox called on the media to move away from its fixation with celebrity.  " Please make everyone aware of what's happening in the real world" she said.  "The timebomb is ticking."

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Clinton says health system reform is key

President Clinton today called for integrated healthcare, citing as an example someone living with HIV and TB.  "Why should he go to two clinics, to see two doctors, with two strategies to deal with one person who's got enough problems as it is" he said.

Clinton also called for a renewed focus on HIV in weathly countries, particularly since the recent credit crisis.  He said one quarter of people living with HIV in the US are as yet undiagnosed, and African Americans account for half of all HIV diagnosis. "If African Americans lived in a separate country, it would be 16th in the world for HIV prevelance."

Clinton likened HIV to a dragon that "doesn't stalk this world alone". He cited its companions as "ineqalities of income, healthcare and education" and called on millions of millions of foot soldiers to defeat it.

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Vaccine trial could offer treatment breaks

A new therapeutic immunisation designed to help existing HIV patients enjoy drug and side effect free periods was announced today. 

Barry Peters, Head of the Academic Unit of HIV and STDs at the Guys & St Thomas' site of Kings College London said "A successful immunotherapeutic HIV vaccine would give patients and doctors enormous advantagers over current treatments, both in developed and developing countries. 

"Even if this vaccine is not the final answer, it could help the march towards a successful immunotherapeutic HIV vaccine"

Lisa Power, head of policy at Terrence Higgins Trust said "Any advance that gives people more treatment choices and delays the progress of the virus, is a good thing.  We are not yet clear whether this vaccine will work, but we'll know by the end of next year."

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Breaking news for Tuesday 5th August

- The International AIDS Society will discuss the potential of HAART therapy as an aid to HIV prevention.

- The International AIDS Vaccine Initative is holding a session on AIDS vaccines: where do we go from here?  With Peter Piot, Seth Berkley, Alan Bernstain and Omu Anzala.

More on these stories tomorrow!

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Sunday 3rd August

Here we are, along with 25,000 delegates from around the world, at the biggest ever World AIDS Conference, this time in Mexico City.  As ever, THT's small team at the conference will bring you the behind-the-scenes news from the conference floor every day through this conference diary.

Although the conference officially opened this evening with a moving and dazzling ceremony, many of the 25,000 delegates here have already been hard at work since last week at the global MSM Forum pre-conference seminar.

It's a reletively recent addition to the confernce programme, and focuses on the HIV pandemic's ongoing impact on men who have sex with men (MSM).

Marc Thompson, THT's Deputy Head of Health Promotion reports:

Friday 1st August

Once I’ve got over the wide range of places delegates have come from it's straight into the opening plenary delivered by David Wilson of the World Bank. Lots of graphs, facts and figures are presented, which make my head spin. One thing is clear, the epidemic continues to disproportionately affect men who have sex with men across the world. David points out that whilst Africa and the Caribbean still have high prevalence amongst heterosexuals, in every other region MSM are the group still overwhelming affected by HIV. What is also striking is that MSM are under recognized in the African epidemic.

David is followed by Peter Piot, Executive Director of UNAIDS, Due to step down later this year. Peter reminds the delegates that homophobia continues to fuel the epidemic and presents the startling figure that 1 in 20 MSM globally have no access to HIV prevention, treatment or care.
Many of the delegates in the room could be arrested for simply giving a condom to another man in their home countries. This is truly shocking and humbling. 
The afternoon is taken up with a wide range of workshops and networking.
The highlight of my day is discussing with two guys from Singapore a resource from New Zealand that uses the action men figures from THT’s Below the Belt and the Manual. They giggle and comment that they’d never be able to produce something like this in their country and how lucky we are.
After speaking to them, several other delegates and reflecting on the plenary I realise how true this is.

Saturday 2nd August

Todays keynote speech is delivered by Jeff O’Malley from the UN development fund.
Jeff breaks with tradition and doesn't deliver the usual power point slides. Instead he reminds us all that as prevalence continues to rise amongst MSM, we must not forget that it was the gay community in the early days of the epidemic that lead the way in prevention and care. It was the communities response that made MSM visible and it is this spirit and will to fight for equal treatment that will put us back on the agenda. Jeff’s speech is rallying call to all present, the IACS,  governments, the UN to not forget ‘The Invisible Men’
The seminar closes with a standing ovation for a young gay man from Cameroon, who talks about his experience of delivering outreach to gay men in his country and the challenges he faces.
It makes a night in a London gay bar seem like a walk in the park.

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