Dispatches from the International AIDS Conference: Day 3
We've been getting a lovely gentleman named Ernesto who, it turns out, has English skills about on par with my Spanish skills. We've joked, in our broken sentences and wrong verb tense and wildly limited vocabularies, that we are having our own little language lessons every morning. We gently correct each other and generously make valiant guesses about what each other is trying to say.
Ernesto saw my conference bag and asked if I worked in HIV, which got us talking about the epidemic. There is a chance I completely missed what he said, but I'm pretty sure it was that he thinks the problem is that people think AIDS is over. They don't really talk about it or even think about it. He thinks there should be more in the media.
Of course, I agreed. I said I thought that the silence allows people to remain ignorant and in denial that AIDS is all around us. Ernesto agreed.
The conference is intense. People say that every international AIDS conference has a "feel." I would describe this one as edgy. These are not hopeful times in the world of HIV/AIDS – vaccine efforts are back to the starting gate, for every two people who start antiretrovirals (ARVs) three people are newly infected, the target to provide universal treatment by 2010 will not be met and the goal to reverse the epidemic by 2015 is all but out of reach. These dire realities have a way of permeating the air.
There are pieces of good news, like the fact that fewer people are dying of AIDS for the first time. It's good news on its face, needless to say, but it feels a little like the emperor's new clothes. People feign encouragement but it feels like underneath we all know a number like that is fragile and may well be temporary, given that we have no handle on this thing.
The number of people getting access to treatment is lagging behind the number of people newly infected. This has created some dissention among global advocates, researchers, policymakers and activists. Some feel that the investment in treatment is not paying off and that more money should be put toward the highest goal, a cure. Others feel that the development of health systems infrastructure and the management of other life-threatening diseases are being sacrificed to the investment in HIV treatment.
Every activist I know feels that these are false enemies. It's not hard to see the investments made in HIV/AIDS treatment as a means to raise all boats. Successful AIDS strategies will require better health care structures and management tools for diseases like TB and malaria, so there is great danger in pitting one against the other, especially when they often affect the same people.
To use a George W. Bush expression, we need to make the pie higher. We don't need to cast off one strategy for another – we need them all and we need them fast.
There's been a fair amount of focus on criminalization issues at this meeting. Eighty-six countries consider sexual activity between men illegal, for starters. Regardless of where one stands on homosexuality, it's hard to protect the public health if the very people you need to reach are underground and completely closeted because their life is illegal.
I could go on about the criminalization of HIV all over the world (including several states in the U.S., land of the free) but it's late and I'm not up to describing in detail the reality that there are many places around the globe that are not safe for me to be or go, based on my HIV status… even if the virus is completely suppressed by medication and can only be transmitted through extremely intimate routes.
Some big news of the conference is that the Centers for Disease Control announced here that HIV infection rates in the U.S. are 40% higher than what they've estimated for many years. The newly released rate is 56,300 new infections a year.
The CDC says it's all about new detection methods that distinguish new infections from ones that are newly diagnosed but perhaps long-term infections. It feels a little like a sleight-of-hand game, in which we're supposed to be so glad they now have this new assay and these more reliable numbers that we don't notice the rising infection rate, the need for a radical re-tooling of prevention efforts, and the absence of a national AIDS strategy – something we ask other countries to do if they get funding through the President's Plan for AIDS Relief (PEPFAR) but don't do ourselves.
One scandal in this story is that the CDC has sat on these numbers for months. It's an outrageous situation that has clearly irritated some of the global partners. UN officials, for example, have not minced words about their shock and dismay at the lack of leadership and responsibility by the U.S. It doesn't help that the U.S. was one of 40 countries that failed to report to UNAIDS on its response to AIDS at home and has systematically reduced funding to fight domestic HIV/AIDS over the last several years.
The backdrop of this scandal is a recently released report by the Black AIDS Institute, Left Behind! Black Americans: A Neglected Priority in the Global AIDS Epidemic. It's a blistering indictment of the U.S. HIV/AIDS efforts and highlights, among other sobering facts, that more black Americans have HIV than the total HIV-positive populations in seven of the 15 countries that get funding from PEPFAR.
All in all, we've got ourselves one fine – and tragic - mess.
Date Published: 08/12/2008