Bay Area Reporter - August 23, 2002
Michael Lauro, Survive AIDS Writers Pool

University of California Dr. Fred Hetch presented data obtained from the San Francisco "options" project that followed HIV+ patients and their lovers. Some resistant HIV strains were found to transmit and infect partners. This information became a sensational international news story about a new mutant resistant virus looming. The actual data showed that resistant virus infection was very treatable and patients who presented with resistant virus had higher T cells-- indicating that such virus might actually cause less initial damage to the newly infected immune system. Local AIDS activists in San Francisco suggested the presentation was intentionally hyped, overblown, and calculated to create a needless media firestorm. Some even suggested that gay men in San Francisco may want to reconsider participation in the program if this is the manner in which the data is manipulated.

The Germans once again provided some of the most compelling prevention visuals we have ever seen. Their booth in the exhibition hall was swamped with people hoarding postcards, posters, and bar coasters with explicit and effective men having sex with men (MSM) graphics. It made this activist want to gather up all those federal monitors who resently descended on the Stop AIDS Project in San Francisco along with the so-called activists who invited the feds into our bedrooms, remove the wide stick stuck up their collective ass, and replace it with a broom for them to fly to Germany to see how relatively anemic American HIV prevention efforts really are.

Finally, L. Yvonne Stevenson reported a 13% condom failure rate when used for anal sex. She noted that 15% still use saliva as a lubricant with condoms, about 8% put lube inside the condom, and 15% fuck greater than 30 minutes with the same condom. According to the CDC, condom use by teenagers in the U.S. stands at 58%, up 12% since 1991.

Activism

Would it really be an international AIDS conference without AIDS activists? Activists, especially those from Philadelphia, Oakland, New York, Paris, and South Africa, arrived in Barcelona with an agenda and repeatedly brought it through the doors of the exhibition hall and even onto the lecture hall stage during a political lecture by U.S. Health and Human Services (HHS) Secretary Tommy Thompson.

The first major demo came as activists entered the exhibition hall crammed with high-tech PHARMA booths plying their wares, surrounded the Roche booth, taped it off with neon yellow tape stamped in black with the word "caution," and demanded to speak with the highest ranking Roche official attending the conference.

I left the end of a PHI lecture when I heard the noise to find myself in the new and uncomfortable position of an observant on the wrong side of the fence. With the decline of San Francisco treatment activism over the past few years, I committed to attending this conference to gather as much information as possible, leaving my battered whistle back in San Francisco. Yet, I confess to being more than a bit uneasy in my new role, feeling guilty for not being able to wear two hats simultaneously.

As activists literally began negotiating with a Roche vice-president hastily summoned to the center of the activist-ringed booth, I suddenly remembered my B.A.R. press pass, grabbed my reporter's notebook, and jumped the tape to record the discussion. Better, much better.

Confronted by members of ACT UP Paris, John Iverson from ACT UP East Bay, South Africans Mark Heywood and Nomfundo Dubula from the Treatment Action Campaign, they sought reductions in the price of Roche's drug nelfinavir on par with reductions made by other drug companies for AIDS meds in South Africa. According to the group Doctors Without Borders, while other drug companies lowered the cost of their AIDS drugs some 70% in southern Africa, Roche's best was only 50%.

This confrontation followed a nonresponsive meeting held with Roche representatives in South Africa one week before the conference began. Nelfinavir is priced so high that, according to Roche's own internal reports, virtually no one accesses it, even those South Africans with drug insurance. Sales of the drug there amounted to only a few thousand rand per year.

The group also demanded that Roche perform its PCR (viral load) testing for children in Africa without profit. Given the reductions by other drug companies in Africa, the costs of diagnostic testing such as the PCR testing Roche controls can exceed the cost of frontline AIDS medications, now estimated at only $100. (US) per month. Other cheaper alternatives to HIV serostatus, CD4, viral load, and resistance monitoring tests may soon offer some relief in this area.

Finally, activists were upset by the access delays for Roche's drug, T-20. Roche's vice president David Reedy said he was not fully unaware of all these issues but agreed to look into them quickly. Admittedly, T-20 is a very difficult drug to produce compared to other AIDS meds and the company has been faced with production problems for this drug. They've even had to build a new plant to produce the complicated 26-step drug.

Activists did get Reedy to agree "not to contest any generic copies of Roche wholly-owned drugs that come to market at a lower cost in seven of the poorest and hard hit nations of southern Africa." He also agreed that Roche would "issue non-exclusive voluntary licenses to generic companies" to allow this process to move forward.

On another day, activists had a giant 40 foot replica of a Coke bottle poised at the entrance of the exhibition hall with the word greed plastered down its side. The issue here is that it takes hundreds of thousand of workers in South Africa to bring Coke to market, including bottlers, truckers, and white-collar workers. But, by outsourcing most of the blue-collar functions whose uninsured workforce is primarily black and estimated 20% HIV+, Coke effectively washes its hands of its corporate responsibility to provide its "workers" with health insurance. Coca Cola, therefore, only provides insurance to a limited white-collar, predominately HIV negative, white workforce.

There were a few other smaller protests. However, the last major demo and the one which received the most media attention was directed at U.S. HHS Secretary Tommy Thompson. Activists from the Health Gap Coalition, ACT UP members from Philadelphia & New York stormed the stage and effectively drowned out the cabinet secretary speech by chanting "where's the ten billion?"-- a reference to the U.N. estimate of the U.S. fair share to the global AIDS fund. At present, the U.S. is only committed to about $500 million.

Louis Sullivan, a former HHS director in the Reagan administration and himself the target of similar actions over 15 years ago, was seated in the front row. The subsequent media coverage produce a storm of hate mail into the ACT UP/New York website, including these indelicate comments: "As far as I'm concerned, the more of you freaks that die from aids (sic), the better off this world will be." Another wrote that "in the good old days they would have shot ass hole groups like you on the White House lawn." Go Texas. But my favorite comment was: "If you FAGS quit puttin' it up your INFECTED asses, AIDS would be under control. More money??? HELL NO!!! You want to reduce AIDS in the U.S.? Drop a fuckin' h-bomb on SF."

Public Policy

Veteran AIDS advocate Brenda Lein from Project Inform, a national AIDS treatment organization based in San Francisco, gave a great presentation on the problematic state of U.S. AIDS research not well-suited to confronting an epidemic. We need only look to the often tangential presentations in Barcelona to notice how we have abandoned the focus on a "search for a cure."

One presenter from Argentina also reviewed the savings associated with reduced medical care, lab work, testing and meds when using STI as part of a treatment strategy. If privately insured, the cost can average over $10,000 (US) compared to $4,100 if publicly insured and between $800 -$1,600 for the STI patient.

Closing Ceremonies

Nelson Mandela and Bill Clinton both spoke at the closing ceremonies on Friday. Like the opening ceremonies, I skipped them. Clinton apologized to the crowd for not doing more to fight AIDS (like screwing us on needle exchange I suppose), saying he would hold himself accountable to the AIDS community in the future. One conference insider privately confided that the former president collected $150,000 for this speech.

Perhaps Clinton can get an early jump on his promise and turn all that money over to the Global Fund to Fight AIDS.
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