THAILAND: Tension between the US and the rest of the world on a range of issues was evident at the biennial AIDS conference, writes Denis McClean
Nothing could conceal the fault- lines that still exist in the global struggle against AIDS at this week's biennial AIDS conference in Bangkok.
It's that kind of an event, where anything goes in the name of the cause, from pin-striped pharmaceutical company CEOs voicing humanitarian concern, to transvestites blowing kisses at passers-by.
Most obvious now is the tension between the Bush administration and the rest of the world on a range of issues, including funding the Global Fund to Fight AIDS, TB and Malaria; support for sexual abstinence programmes versus condoms; generic drugs versus brand name drugs, and education versus provision of clean needles to injecting drug-users.
Dr Lieve Fransen, a development expert at the European Commission, dismissed US claims to be the largest donor to the Global Fund and said European states are the number one backers of the fund, with contributions to date of €900 million, including €42 million, which she announced yesterday.
The Americans are upset about Kofi Annan's call for them to show the same leadership and commitment in the fight against AIDS as in the war on terror, and to give $1 billion annually to the Global Fund. Currently the US gives the Global Fund $200 million annually, with the rest of the $15 billion they are committing to AIDS over five years being channelled bilaterally to 15 countries through the President's Emergency Plan for AIDS Relief (PEPFAR).
Nelson Mandela did not mention US efforts once in his two plenary appearances at the conference but simply encouraged donors to support the Global Fund.
In a message to the conference, Jacques Chirac weighed in with a thinly-veiled attack on US efforts to negate generic drug agreements:
"Making certain countries drop these measures in the framework of bilateral trade negotiations would be tantamount to blackmail. Since what is the point of starting treatment without any guarantee of having quality and affordable drugs in the long term?"
The US Global AIDS co-ordinator, Ambassador Randall Tobias, had to brave a noisy demonstration in order to speak at the conference and later questioned the value of such events.
US scientists were barred by their own government from attending; only 50 official delegates showed up, compared to 230 at the last AIDS conference.
Another fault-line in the war on AIDS is the lack of recognition often given to the powerful role that HIV-positive people can play in prevention efforts.
The Thai government made a public apology yesterday to people living with AIDS for the scheduling of the HIV positive representative at the opening ceremony.
Paisan Suwannawong only got to speak once the main arena was practically empty. The HIV positive former drug-user made up for lost time yesterday.
"Access for all has been the theme of this conference and the dream of many of us here, but what have we learned from this conference? We have learned that stigma and discrimination still exists, even within the conference venue," he told the gathering to loud applause.
Equally compelling during the week was the rejection by women of the ABC (Abstain, Be Faithful, Condoms) approach as "totally inadequate" to their needs, as Mary Robinson expressed it.
There was an element of tragic farce in a sparsely attended press conference called by the Ugandan Ministry of Health to explain President Youweri Mouseveni's characterisation of condoms as "a hindrance" whose use also pre-supposed that "those who engage in condoms are always sober."
Without compelling scientific evidence Ugandan health ministry officials continue to insist, to agreement from the Bush administration and many faith-based organisations, that abstinence and fidelity were critical in bringing down the HIV prevalence rate from 18 per cent to 6 per cent over a 10-year period. They explained that condoms were not culturally acceptable in the Great Lakes region as men liked to have "optimal sex".
They were rounded on by a young HIV positive Ugandan woman in the audience who said she was infected because she had no means of protecting herself against her unfaithful husband, who also liked to have "optimal sex".
Other funding priorities tend to be overshadowed by the drive for universal access to anti-retroviral therapy for the six million people who need treatment now. Is prevention losing out in the drive for treatment?
According to a Rockefeller Foundation Report, even a partially effective microbicide could avert 2.5 million infections over the next three years.
With no immediate prospect of a vaccine against HIV infection, an effective microbicide could be available to protect women from HIV within five to seven years, according to Dr Zeda Rosenberg, CEO for the International Partnership for Microbicides, which receives funding from Development Co-operation Ireland.
"With real leadership and global investment, a safe and effective microbicide could be a reality for women in developing countries by the end of the decade.
Current prevention options are just not enough. For women worldwide, being young and married are the two most significant risk factors for contracting HIV - and microbicides are the prevention tool they desperately need," said Dr Rosenberg.