Bangkok Post - July 20, 2004
Mark Van Landingham

Thailand is an upbeat setting for this largest regular gathering on perhaps the most unfortunate of modern human tragedies. HIV has now infected an estimated 58 million people worldwide, killing 20 million of them. The number of new infections continues to increase, with worrisome new trends in Asia and continued bad news in Africa. Progress in making treatments available to those who need them has been excruciatingly slow; and those who work to slow the spread of the virus have similarly little to cheer about.

Except for Thailand. Widely predicted in the early 1990s to follow the course of some of the worst-case scenarios that have played out in sub-Saharan Africa, Thailand has dramatically reduced the number of new infections over the past decade, from around 140,000 annually in 1991 to less than 20,000 currently. No one fully understands why, and so this was a central topic of discussion in the corridors.

There is much to criticise about these conferences. Registration fees have become exorbitant _ now $1,000 for most attendees, a price that is surely out of step with the conference's stated theme, Access for All. The scientific quality of the presentations is significantly less than that found at more academic venues. And protesters sometimes prevent divergent points of view from being presented.

At a previous International Aids Conference in Amsterdam, one symposium I participated in that sought to focus attention on promoting safer sexual practices among men was effectively shut down by an organised effort from feminists who felt that women were left out of that particular session's theme. In Barcelona, a session that was given a mandate to explore the future course of the epidemic degenerated into a shouting match between critics and supporters of the Catholic Church's work in Africa. Dissenters sometimes went overboard last week, too, by trying to disrupt speeches from the key United States government representative and the head of a major pharmaceutical company.

But even with such shortcomings, the International Aids Conference presents a unique opportunity for those who are fighting in the trenches against this awful disease to rub shoulders with the researchers who study it and the leaders who develop and implement policies to combat it. It is invigorating to witness the enthusiasm, commitment and dedication; and insightful to hear the criticisms.

The opportunity to level such criticism in such close quarters and in such direct fashion, in contrast to much more muted criticism expressed in other venues, may be one of the biggest advantages of such a gathering of decision-makers and front line workers in the same space.

Much of this criticism, fairly or not, was directed towards the United States, especially towards our government. American Aids policy under the current administration was seen by many here to be more influenced by ideology than science, more interested in protecting American corporate interests than in relieving the plight of those affected by the epidemic, and more focused on talk than on action.

The fact that less than a $1 billion has been released of the $15 billion President George W. Bush pledged in his January 2003 State of the Union address to fight Aids reinforces such impressions. Moreover, such impressions are forcefully presented not only by participants in the conference but also on the opinion pages of influential regional newspapers. An editorial last week in this newspaper notes that the failure thus far to follow through with such promises was in fact the inspiration for this year's conference theme.

The contrast between the US government's approach to Aids with that of the host country is stark. Thailand responded with strategies that have been demonstrated to work _ ie, aggressive condom promotion campaigns, frank and innovative sex education, an honest recognition that individuals engaging in illegal behaviour that facilitates transmission, such as commercial sex and intravenous drug use, must be given the help they need and not be driven underground, and substantial funding outlays to finance all of the above.

While the current Thai administration has been less deft in its handling of the continuing epidemic, especially among drug users, it appears that Thailand successfully seized a critical window of opportunity to short-circuit its burgeoning epidemic.

One hopes that Thailand's success will inspire the menagerie of political leaders, researchers and front line workers who gathered here to mine and employ what can be learned from this rare achievement to other settings. One also hopes that the conference will inspire American political leaders to make promised funds available without delay, to resume our position of leadership in the fight against this epidemic, and to focus our energies on approaches that are validated by science, rather than current political fashion. Goodness knows, such inspiration is sorely needed.

- Mark Van Landingham, PhD, is associate professor of international health and development at Tulane University's School of Public Health and Tropical Medicine.
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