One world. One hope. That was the theme of the XI International AIDS Conference, held in Vancouver, Canada, several years ago. The words came to mind while I chaired a session on innovative models of care provision at the XIII International AIDS Conference, held July 9-14, 2000, in Durban, South Africa. Not because I saw "one world" represented around me at the conference venue in Durban, but because I saw the opposite.

The presenters at my session were from the United States, the Philippines, and Uganda. In other words, they were from two worlds: one where antiretroviral therapy is the standard of care, and the other where even palliative treatment would be a godsend for many HIV-infected people.

I point this out not to reject the call for unity that was implicit in the Vancouver theme, but to explain why I think the Durban conference will be remembered as our first tangible step in attaining that vision of unity. If communities around the world are to come together in the fight against AIDS, we must first start by acknowledging just how deep the inequities between us truly are.

Durban provided a unique opportunity for physicians, researchers, healthcare leaders, activists, and HIV-infected people to begin having that difficult conversation--and the conversation flourished. All around me, I saw representatives of both "worlds" sharing information, ideas, and hope with each other. Some mighty international partnerships have already come out of the XIII International AIDS Conference, and I know that more are in the works.

The International Association of Physicians in AIDS Care (IAPAC) announced several such partnerships at and following the Durban conference. These include our partnership with Abbott Laboratories to advance our work in Romania through the Step Forward ... for the World's Children initiative [Editor's note: See the article from the August 2000 IAPAC Monthly] and our strategic alliance with the Southern African HIV Clinicians Society, through which we plan to expand our medical education efforts in the Southern Africa region.

Durban also called our attention to some of the beacons of hope that are cutting through the darkness of the international AIDS epidemic. Amid the many reports of frighteningly high infection and mortality rates, there were also reports of promising developments in healthcare delivery. I find it inspiring that even where people have virtually no financial or material resources, they persist in finding innovative ways to offer HIV prevention education, healthcare services, and social support.

It is fitting that this issue of IAPAC Monthly, which contains our full Durban conference coverage, also features statements from US presidential candidates Al Gore and George W. Bush, both of whom responded to an IAPAC questionnaire meant to define their positions on several pressing HIV/AIDS issues domestically and internationally. Will the next president of the United States do more than recognize that AIDS is one of the greatest security threats of the 21st century? Does either candidate have a vision of how to tackle the burgeoning crises created by parallel epidemics of poverty, disease, and social isolation that plague so many people worldwide, including citizens of the richest nation on this earth?

No one can deny the United States' moral responsibility to provide effective global leadership on HIV/AIDS; it is therefore of paramount importance for both candidates to consider how they might attain this goal. Are the two candidates up to the challenge? You be the judge.

Even beyond partnerships and political statements, the challenge, as former South African President Nelson Mandela so eloquently observed at the Durban conference's closing ceremony, is to move from rhetoric to action at an unprecedented intensity and scale. Not content with simply stating the enormity of the crisis, Africa's elder statesman issued the following challenge: "We need to break the silence, banish stigma and discrimination, and ensure total inclusiveness within the struggle against AIDS. We need bold initiatives to prevent new infections among young people, and large-scale actions to prevent mother-to-child transmission [of HIV], and at the same time we need to continue the international effort of searching for appropriate vaccines. We need to aggressively treat opportunistic infections, and we need to work with families and communities to care for children and young people to protect them from violence and abuse, and to ensure that they grow up in a safe and supportive environment."

If it seems unlikely that we can quickly implement such an ambitious agenda, consider how unlikely it once seemed that Mandela would walk out of prison and take the reins of a post-apartheid South African government. Because those of us who work in the HIV/AIDS field have a similarly Herculean task, we would be wise to emulate Mandela's tenacity, his commitment, and, above all, his courage.

It takes courage, after all, to maintain hope in the face of such tremendous odds. I trust that our courage will sustain us until we have indeed created one world.

José M. Zuniga is President of the International Association of Physicians in AIDS Care.

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