Wall Street Journal - August 19, 2006
Marilyn Chase, marilyn.chase@wsj.com

And that's not even counting predictable potshots at President Bush.

Canadian Prime Minister Stephen Harper was blasted by scientists for first declining an invitation to speak here, and then delaying an expected major announcement on Canada's AIDS programs until the delegates -- 26,000 strong at final count -- got out of town.

In declining an invitation even U.S. President Ronald Reagan -- not known for his support of the AIDS cause -- accepted in his day, Mr. Harper cited a conflicting obligation to tour mines in Canada's far North. As for Canada's future AIDS programs, Mr. Harper told reporters who trailed him to Whitehorse in the Yukon that AIDS has become "unfortunately à so politicized this week that this is probably not the time to make the announcement," according to a story in Friday's Toronto Globe and Mail.

"The government underestimated this conference," said McGill University AIDS researcher Mark Wainberg, who was co-chair of the meeting where activists denounced the prime minister's absence. He said the government had underestimated pressure on Canada to support AIDS drug access, adding that he hoped Ottawa was simply re-crunching its numbers to come up with a "more generous" grant than originally contemplated.

In Ottawa, the office of the Prime Minister's spokesman reached late Friday didn't immediately return a reporter's calls for comment.

The other contretemps centered on AIDS-stricken South Africa, whose minister of health, Manto Tshabalala-Msimang, a physician, recommends that people eat African potatoes seasoned with lemon and garlic as a nostrum for the fatal virus affecting nearly one in five adult South Africans. Underlying her prescription: President Thabo Mbeki hasn't embraced HIV as the cause of AIDS. Nathan Geffen of South Africa's Treatment Action Campaign read from a court affidavit about a woman who died of AIDS after trading drugs for nutritional support.

U.N. Special Envoy for AIDS in Africa Stephen Lewis called HIV denialism, a persistent minority position in some countries, as "the lunatic fringe."

President Bush's $15 billion AIDS program, while drawing praise for its size, also took criticism for its restrictions requiring grant recipients to list abstinence and fidelity before condoms, and for requiring health workers to publicly denounce prostitutes they need to treat.

Into this conference came U.S. Global AIDS Coordinator Mark Dybul, advanced by a perky and persistent public information officer. Dr. Dybul worked the pressroom, telling any reporter who would listen that Mr. Bush's Emergency Plan for AIDS Relief isn't just rich but progressive. He told the Wall Street Journal he is planning to fund "harm reduction" for drugs users -- in the form of a clinic offering things like methadone, but no clean needles, in Vietnam in early 2007.

Despite the frequent charge that politics long ago eclipsed research at this meeting, Dr. Wainberg insisted that quality science had been upheld in areas of drug treatment and prevention. For some American activists, at least, the AIDS science portion of the conference science started with a whimper and ended with at least a small bang.

Anticipating an exhausting slog through 13,000 scientific abstracts, much familiar and all lacking real news, New York based AIDS activist Mark Harrington said on Monday that he had a familiar sense of "data vue."

By week's end, though, Mr. Harrington's mood had perked up a bit. Buoyed by early efficacy studies of Merck & Co.'s integrase inhibitor drug MK-0518, which battered back the virus to undetectable levels, Mr. Harrington said he thought this new generation of drugs might be the best thing since protease inhibitors revolutionized AIDS cocktail treatment a decade ago.

Despite strong caveats on over-interpreting early studies, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, didn't disagree. In an interview, Dr. Fauci speculated it's even possible that integrase inhibitors might one day reach HIV's most impenetrable refuge where it hides in a pool of chronically infected cells that perpetuate the disease in many patients. Scientists at a closing press conference here Friday echoed that hope.

The real star of the meeting was prevention -- which long took the back seat to treatment imperatives to save lives. Now, for the first time in memory, delegates here stopped squabbling over treatment vs. prevention, and began to speak of the two as indivisible parts of a total epidemic response. Behind this is a growing consensus that without prevention, the world can't afford to treat the epidemic affecting 40 million and growing by 4 million new infections a year.

Despite furious protests that aborted several early trials in 2004 and 2005, Gilead's experimental prevention pill tenofovir (sold as Viread), was proven safe in Ghana and is now undergoing efficacy studies in 4,600 healthy volunteers in the US, Botswana, Thailand and Peru. Microsoft founder and foundation chief Bill Gates called it potentially the next big "breakthrough."

Philosophically, the two Bills -- Gates and Clinton -- both emerged as newly minted feminists leading the charge for gender equity and policies that protect the growing number of women infected at home and abroad. Policies that rely too heavily on abstinence and fidelity won't protect a monogamous married women if their men stray and refuse condoms, they said.

To cheers, Mr. Gates courted controversy among conservatives by declaring a woman deserves protection from AIDS - whether through condoms, pills or gels - whether she is "a faithful married mother of small children or a sex worker trying to scrape out a living in a slum."

This meeting saw the debut of Melinda Gates playing a role on the biggest global event to date as her husband's partner and foundation co-founder.

Anatomical talk -- a staple of this biennial meeting -- reached a new high as prominent men discussed ongoing trials to validate circumcision as a way to reduce HIV transmission to men and their partners. Questions about who would be the first leader to personally endorse the surgical procedure, were soon answered.

"I'm circumcised," UN Special Envoy Lewis announced at the closing session Friday. While on a recent tour of Zambian copper mines, he said this revelation prompted reciprocal sharing by African men and a virtual riot of "male bonding." If the procedure is proven to work in ongoing trials, scientists said it would take massive social marketing to make others follow suit.

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