San Francisco Chronicle - Monday, July 8, 2002
Sabin Russell, Chronicle Medical Writer

A record 17,000 registrants poured into the sprawling conference center in this Mediterranean port city for a meeting that may offer only modest gains on the scientific front, but which will attempt to build on the political commitment forged two years ago at the prior conference in Durban, South Africa.

Assistant U.N. Secretary-General Peter Piot, who directs the world body's AIDS fighting arm UNAIDS, openly challenged world leaders to deliver on their previous rhetoric and bring at least $10 billion a year to the global battle.

"The world stood by while AIDS overwhelmed sub-Saharan Africa," he said. "Never again."

Declaring a new "era of AIDS as a global political issue," he urged that leaders who deliver on their promises of resources to fight the disease be rewarded, and that those who don't be replaced by those who will.

"We did not come to Barcelona to renegotiate promises," said Piot.

The opening ceremonies were preceded by scores of workshops, strategy sessions and meetings with reporters. An exhibition hall opened for business, populated by elaborate displays for drug-company products and more modest booths for AIDS service organizations.

Protesters who want expanded access to AIDS drugs for the developing world staged a march outside the exhibit hall before the opening ceremonies. More than 500 participated in the protest, calling for rich nations to come up with the money to pay for the drugs.

Piot had earlier told reporters it is time that "small, nice projects that work" be brought up to scale "to cover whole nations in the developing world."

PREVENTION

"Prevention is going to be one of the hot topics," said Dr. Jose Maria Gatell, a Barcelona AIDS specialist and co-chair of the conference.

A case in point is a plan unveiled by a coalition of prevention groups to quadruple spending on AIDS prevention to $4.8 billion a year. A dozen different interventions, from media campaigns to short courses of antiviral treatment for pregnant women and their newborns, were all chosen as "proven interventions."

Although the often stated goal of AIDS fighters at the conference is to "scale up" existing programs to meet the enormity of the epidemic, the conference began with some sense that the meeting itself is becoming too big and unwieldy for its own good.

"Seventeen thousand people . . . it's become a bit of a circus," said Shaun Mellors, chair of the conference's advocacy committee.

Recalling the earlier days of AIDS activism, when protesters disrupted scientific meetings to demand effective drugs, Mellors said that things had gotten too quiet since those drugs began to roll out of pharmaceutical laboratories.

"We need to make people angry again," he said.

Mellors said he was disturbed that many registrants who came from developing nations had difficulty obtaining visas from their Spanish embassies to attend the meeting.

Although Americans and citizens of European Union countries do not need visas to visit Spain, those from developing nations had difficulties that outraged some at the convention. Among the requirements for some African visitors were disclosure of their bank statements and documents showing proof of health insurance.

"We've managed to solve most if not all the problems," said conference co- chair Dr. Jordi Casabona.

The problems of conference goers pale before those facing the subject of the meeting, the estimated 40 million currently infected with HIV, most of them in the developing world.

LIFE EXPECTANCIES

Karen Stanecki, international health studies chief for the U.S. Census Bureau, released a report predicting that life expectancies will drop in 51 countries because of AIDS. Seven sub-Saharan nations already have life expectancies below 40 years, and Botswana is already experiencing a negative population growth. By 2010, life expectancy in Botswana, once an economically vibrant nation in the heart of southern Africa, will reach 27 years, Stanecki said. She added, "These are life expectancies we haven't seen since the end of the 19th century."

UNAIDS chief Piot was also particularly disturbed by the plight of Botswana, which has an adult HIV prevalence rate of 39 percent, but is economically prosperous enough that it does not qualify for some international assistance programs. "Botswana risks becoming an 'undeveloping country,' " warned Piot. He said that rules for assistance have to be changed to take into account the "AIDS burden."

Ultimately, said Piot, the AIDS epidemic threatens to destroy more than the millions of individuals who quietly die of it: "HIV is a threat to the survival of countries."

E-mail Sabin Russell at srussell@sfchronicle.com.
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