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The AIDS Conference Conundrum

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Of all the heart-wrenching scenes I witnessed at the 18th International AIDS Conference, the most disturbing had to be on the last day when the Conference volunteers went about the exhibition halls rounding up mountains of abandoned books, brochures and flyers.

“It’s all rubbish now,” I gasped to myself as I watched whole piles of materials disappear into vast recycling bins.

The chatty teenage volunteers, donned in bright yellow T-shirts, probably thought nothing of it. But I thought differently.

What a waste.

The amount of money spent in producing and shipping those things to Vienna is a figure I don’t want to even try to imagine, lest I become even more upset than I already am. I was a culprit too, leaving a tall stack of books on my hotel room bed as I tried to weigh out (figuratively and literally) which would be most useful to take back home. Feeling horribly guilty about abandoning the materials, I considered leaving the housekeeper a note to say not to throw away the books and instead hand them out to friends and family. But something told me that a ‘first world’ country with a decimal  HIV prevalence figure might not take too much interest in books around reforming sexual and reproductive health rights policy in the patriarchal global south.

Maybe they might. But I thought against the idea and did what many people did in hotel corridors, lobbies and at airport check-in desks these past few days.

I dumped the books.

I had never been to one of these big HIV conferences before but went into the experience with a healthy dose of scepticism (not wholly premised on the fact that people dump stuff of course, since I’d heard about that before).

One of my strong beliefs was that a gathering of 20 000-odd people (19 300 participants, to be exact) with 248 sessions, 127 satellite meetings, 279 Global Village activities, 151 exhibits, 19 plenary sessions, 18 special sessions and enough daily sponsored after hours parties featuring copious amounts of free booze – all happening in 6 days – would lead to excited chaos and eventually, apathy.

In a post mortem on the Conference, the international agency, Oxfam, called it a disappointing conference whose tone was set by the host nation, Austria, when it indicated  that it would not contribute a single cent towards the replenishment of the Global Fund to fight AIDS, TB and Malaria(GFTAM).

According to a presentation made by Paula Akubigizwe of the AIDS and Rights Alliance for Southern Africa (ARASA), the 2010 Conference delegates’ collective presence contributed an estimated total of 45 million Euro to Austria’s GDP – a figure that was equivalent to 20% of the total GFTAM Round 9 allocation to southern Africa for the response to all three diseases.

I don’t need to point out the irony for you.

I also don’t really need to point out the irony in the fact that the next conference takes place in Washington DC, moving further and further away from the hotbed of HIV which unequivocally remains sub-Saharan Africa. (Out of 18 such events held, the 2000 Durban Conference represents the only time the Conference has ever taken place in Africa.) I was simply appalled by the conversation I overheard among a group of men who each proclaimed they had been to at least three or four of these conferences and yet, had never so much as attended a single session.


We really need to think about what we are doing here, what real response and responsibility means to each one of us on a personal level. But here are my questions.

Do these big conferences actually work or are they simply glorified talk shops? Should we even be contemplating having a 19th and a 20th and, God forbid, a coming-of-age 21st International AIDS Conference?

The course of the epidemic remains very region-specific so that talking about condom negotiation to women in Sweden can be about as meaningless as talking about harm reduction to a group of Zimbabweans. Yes, it’s important to know all of this information, but on a practical level, it mostly remains useless.

And while we heard at the Conference about the alarming growth of the HIV pandemic in Central Asia and Eastern Europe, particularly among injecting drug users and sex workers, we forgot that two-thirds of all people living with HIV are in sub-Saharan Africa; women who get HIV by merely having sex with their husbands and babies who are born with no chance to reach their fifth birthday.

But this isn’t sexy enough.

And so we’ve taken to catchy phrases like ‘treatment as prevention’ or the edgy sounding ‘Treatment 2.0’ coined by UNAIDS. According to UNAIDS, the new Treatment 2.0 platform – which includes HIV testing scale up and strengthening community mobilisation as some of its pillars -  can reduce new HIV infections by one-third if treatment is provided to everyone who needs it.

But that’s what makes it more sexy than practicable.

I don’t need to tell you how many countries are falling short of providing universal access to anti-retroviral therapy (ART) for people whose CD4 counts have dipped below the 200 threshold.  Thus the 2009 World Health Organization (WHO) recommendations to up CD4 thresholds to 350 for treatment initiation for people with HIV remains a pipe dream for many.

And in many parts of the world, the thought of initiating people who aren’t even already infected with HIV onto treatment is a mere fantasy.

But let my scepticism not completely override the successes scored at this year’s Conference. South Africa, once the joke of the global response to HIV and AIDS proved that it has well and truly shaken off its demons and come to the party. No better proof of this could have been given than by the standing ovation afforded to Health Minister, Dr. Aaron Motsoaledi in one of the plenary sessions when he admitted that the task ahead was comparable to climbing Mount Everest, but needed to be carried out anyway. And also, a breakthrough in microbicide research with the CAPRISA 004 trials. With 39% effectiveness in reducing a woman’s risk of becoming infected with HIV, the female condom might soon be finding company with another female controlled device. Admittedly, the trials are still in the preliminary stages but when one of the key researchers, Dr. Quarraisha Abdool Karim, smeared a little of the clear odourless gel onto my palm, I felt like I was literally holding the future in my hand.

But the real winner?

That is unquestionably Austria and the historical city of Vienna, whose people largely went about their way oblivious to the impact that a gathering of HIV scientists, campaigners and programmers would have on the nation’s future.

Wouldn’t it have been so much more of a meaningful impact, I wonder, if we’d actually taken the conference somewhere that really needed it?

3 comments to “The AIDS Conference Conundrum”

  1. Comment by Emilar Vushe:

    Thanks Fungai for a well thought out article!

  2. Comment by Jennifer Lentfer:

    I wonder of those 20,000 experts, how many have actual “on-the-ground” expertise? How many participants have cared for their dying neighbor and counseled a child who has lost a parent? Let me say, not enough.

    A mapping exercise sponsored by UNICEF identified over 1,800 community-based organizations focused on orphans and vulnerable children in Malawi alone (Network of Organizations working with Vulnerable and Orphaned Children in Malawi, 2005). The myth of “no capacity” about small and local organizations in the HIV/AIDS discourse does not do justice to their efforts. Clearly these under-recognized and under-resourced folks have knowledge and expertise could be invaluable to the multi-billion dollar(!) fight against HIV and AIDS, but where were their voices?

    Certainly the International AIDS Conference organizers have made great strides in recent years to include more participants from marginalized communities and developing nations, but how these participants’ voices are actually heard among the cacophony of such an event remains to be seen.

    Thus, we have to ask—what is the cost to all of us when so many of the best minds and perspectives from the community-level are left out of navigating the paradox of universal access? This is where we clearly need all the help we can get.

    Read more at: http://www.how-matters.org/2010/07/21/the-real-experts/

  3. Comment by Lyn van Rooyen:

    You verbalise so many of my concerns so accurately!. I would really love to publish your report on our website at http://www.cabsa.org.za if you don’t mind. Many of the community based and larger organisations doing such wonderful work which Jennifer refers to are users of our site and will benefit from your report. We aim to be ‘knowledge intermediaries’, especially for the faith sector.