Bay Area Reporter - August 17, 2006
Liz Highleyman

This year's theme, "Time to Deliver," puts an emphasis on ensuring that recent advances in antiretroviral therapy are accessible to all who need them, both in low-income countries and in disadvantaged communities in wealthy nations.

"We need access to AIDS drugs for every nation, including the U.S.," Congresswoman Barbara Lee (D-Oakland), who has attended the last four international AIDS conferences, told the Bay Area Reporter. "As the wealthiest nation in the world, we shouldn't have a single case of AIDS."

Prior to the conference opening on Sunday, August 13, an estimated 300 activists and delegates joined the "AIDS Treatment Now" march, sponsored by the AIDS Healthcare Foundation. Along with speakers from Africa, Asia, and Latin America describing the benefits of and need for affordable antiretroviral therapy in their countries, the U.S. and Canada were criticized for not doing enough.

Conservative Canadian Prime Minister Stephen Harper received the first of many rebukes for skipping the conference, reportedly to review military preparedness in the far north.

"Our prime minister is more interested in fighting George Bush's war than in fighting the war on AIDS," said Brian Finch of the Canadian AIDS Treatment Council.

"The role of prime minister includes a responsibility to send a message on the world stage," said conference co-chair Dr. Mark Wainberg at the evening's opening plenary. "You are sending a message that you do not think HIV/AIDS is a priority."

Prior to the plenary, activists delivered to conference co-chair Helene Gayle the "Toronto Declaration," calling for 20,000 specialized providers to treat 10 million people, 1 billion HIV tests, and $20 billion in resources.

Prevention a key theme

If the 1996 AIDS conference in Vancouver is recalled as a turning point in the area of treatment, Toronto may be remembered as the meeting that focused the world's attention on HIV prevention.

Even as HIV drugs begin to trickle down to people in resource-poor countries, it is increasingly apparent that treatment alone will not change the course of the epidemic, given the estimate that four new people become infected in the developing world for every one who starts antiretroviral therapy.

Dozens of scientific and policy sessions described advances in the areas of HIV vaccines, vaginal and rectal microbicides, male circumcision, and oral pre-exposure prophylaxis, or PREP. There was widespread agreement about the need for methods women can use to protect themselves, and the drawbacks of the abstinence-focused approach preferred by the Bush administration.

"We need to put the power to prevent HIV in the hands of women," said philanthropist and Microsoft Chairman Bill Gates, who keynoted the opening session with his wife, Melinda. "No matter where she lives or what she does, a woman should never need her partner's permission to save her own life."

"In the fight against AIDS, condoms save lives," said Melinda Gates. "If you oppose the distribution of condoms, something is more important to you than saving lives."

Last week, the Gateses announced that their foundation would donate $500 million over the next five years to the Global Fund to Fight AIDS, TB, and Malaria. They also recently made a $287 million donation for vaccine research, and pledged to make the development of a microbicide or oral prevention drug a top priority.

Bill Gates and former U.S. President Bill Clinton discussed the global response to the epidemic, and actor Richard Gere opened a conference session on the role of the media in promoting HIV/AIDS education. On Tuesday, Clinton promised that his foundation would focus on spending money as effectively as possible on prevention and access to treatment.

"Every single wasted dollar puts a life at risk," Clinton said.

Science, policy, and activism

As the biennial international AIDS conference has grown into one attended by tens of thousands of people, much cutting-edge medical research is now first presented at more specialized meetings, but there were several sessions of interest focused on refinements of antiretroviral therapy and the development of new agents, including the promising Merck integrase inhibitor, MK-0158. (Abstracts were presented Thursday, missing the B.A.R. 's deadline; highlights will be covered next week.)

In an illustration of optimism, the International AIDS Society-USA released revised treatment guidelines at the conference stating that achieving an undetectable viral load should be the goal of therapy even for those with extensive prior treatment history and resistant virus - a goal 60 percent or more of treatment-experienced individuals should be able to attain with the new drugs available now or in the future.

Practical implementation of treatment, prevention, and care programs was the focus of countless sessions, and the conference's Global Village highlighted successful examples from every corner of the world. In contrast with the United Nations General Assembly statement on HIV/AIDS issued in June, conference participants adamantly advocated for the vulnerable populations that continue to feel the brunt of the epidemic, including men who have sex with men, drug users, sex workers, low-income individuals, women, and youth.

A key message throughout the week was the need for integrated efforts. The debate of several years ago between treatment advocates and prevention proponents is long past, giving way to near-unanimous acknowledgement that the solution is multifaceted.

"We want for people to look back and say Toronto was the event where we turned the corner," said Wainberg.

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