IAPAC Monthly - Vol. 8, No. 2, January 2002
Scott Wolfe

It has been said of anniversaries that they are like martinis - after a few you do not bother to count them. Not so, says José M. Zuniga, President of the International Association of Physicians in AIDS Care (IAPAC), who commemorated IAPAC's seventh anniversary February 5, 2002, with a Web-facilitated conference linking IAPAC staff in Chicago, Toronto, and Johannesburg. Zuniga's bottom-line message: There is no more urgent time for IAPAC to marshal resources - human and financial - and expand the association's advocacy and medical education initiatives worldwide.

Two days after commemorating IAPAC's anniversary, and as he did in January 2001 (a year after assuming IAPAC's presidency), Zuniga agreed to take part in a question-and-answer session to reminisce about the year past as well as to forecast IAPAC's future.

IAPAC was founded February 5, 1995. You joined IAPAC as Deputy Director in 1997, and assumed IAPAC's presidency in 2000. Obviously, a great deal has transpired in the last seven years, including changes in vision, mission, and executive leadership. How do you contrast and/or compare IAPAC from its inception to today?

The five years I have devoted to IAPAC and its mission have been both challenging and rewarding. I have been privileged to, as Deputy Director, forge an international presence for IAPAC; and more recently as President [and Chief Executive Officer], to further focus the association's vision and expand our reach and influence.

Outside of an ongoing commitment to advocate human rights and universal access to HIV/AIDS care, IAPAC today bears little resemblance to IAPAC in 1995, and, indeed, to IAPAC in 1997. In fact, the association evolved tremendously in the last two years alone, given IAPAC's push to maintain a presence in the most AIDS-ravaged regions of the world. Still, I believe that the spirit through which IAPAC's founders established this association - reflected in former UN Secretary General Dag Hammarskjöld's quote, "To let oneself be guided by a duty from the moment you see it approaching is part of the integrity that alone justifies responsibility." - lives on in the work accomplished each day by IAPAC's members and staff.

In January 2001, you communicated to IAPAC's members about the association's efforts in 2000 and listed some fairly ambitious goals for IAPAC in 2001. Did IAPAC achieve those goals?

From the medical education perspective, IAPAC exceeded its goals in 2001. IAPAC-Headquarters (IAPAC-HQ) in Chicago published four topic-specific supplements to our peer-review journal, JIAPAC, as well as two patient guides--Anemia and HIV Infection: What You Should Know, and HIV Treatment: Simpler Times Ahead. IAPAC published more than 50,000 copies of our much sought after "pill poster" [based on the US Department of Health and Human Services' Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents].

Beyond publishing, the association hosted the successful IAPAC Sessions 2001 - a two-day, by-invitation clinical symposia bringing together HIV/AIDS thought-leaders from throughout the United States to debate pressing, and often contentious, clinical management issues. In addition, IAPAC maintained a comprehensive Web Site [www.iapac.org] that continues to receive upwards of 1 million "hits" a month.

That's not all! Our IAPAC Southern Africa Regional Office (IAPAC-SARO) in Johannesburg coordinated dozens of physician and other healthcare provider trainings throughout South Africa on the use of Pfizer's Diflucan [fluconazole] as part of that pharmaceutical company's two-year donation of the drug to South Africans living with HIV/AIDS. Our colleagues also coordinated monthly Web conferences as part of our ongoing I-Med Exchange program in Botswana, Lesotho, South Africa, and Swaziland. As important, IAPAC-SARO staff advised South Africa's Department of Health and other national, regional, and international entities on HIV/AIDS education, care, prevention, and research issues related to Southern Africa.

On the advocacy front, IAPAC pushed very aggressively to maintain the momentum created through years of advocacy around expanded and accelerated access to HIV/AIDS therapies for men, women, and children living with HIV disease, with special emphasis on those living in developing world countries. IAPAC had a prominent seat at the table at national and international meetings alike, most notably two World Health Organization (WHO) international consultative meetings on antiretroviral therapy in resource-limited settings.

As for infrastructure-related goals such as membership, IAPAC was successful in maintaining a strong dues-paying individual and corporate membership base - this despite incredible economic pressures as a result of the global recession beginning in the second quarter of 2001. I should note that these pressures also resulted in a reluctant postponement of plans to establish additional regional offices last year - a setback I feel confident can be overcome in 2002.

In addition to the economic recession felt worldwide, there was the extra stress associated with the September 11, 2001, terrorist attacks on the United States. How was IAPAC affected by these tragic events?

September 11, 2001, was a defining moment for our world.

IAPAC-HQ staff in Chicago huddled in my office that morning watching the mind-numbing events unfold; images beyond our comprehension flashing on the screen of a television set normally tuned to CNN. Never could we - and from startled calls we received from colleagues worldwide within hours of the attack, neither could individuals residing outside of the United States - have imagined such incredible barbarity and its resultant bloodshed.

Days after the attack, several IAPAC-HQ staff had donated blood and/or made charitable contributions. And, as we came to learn, several IAPAC members in New York City were among the countless heroes offering aid to the victims of the World Trade Center disaster. September 11 will live in our minds as a day of great universal tragedy and collective pain. I feel, too, that September 11, will be recalled as a day when we remembered our humanity. That day reversed a sense of alienation from one another... indeed, as Nobel laureate Oscar Arias reminded us, "... the art of being humane will be the artistry of maintaining our future."

On a more professional level, yes, IAPAC was affected by the events of September 11 - from postponing two events, to suffering financial impact as donors targeted charities tied directly or indirectly to the tragedy in New York and Washington, DC, to a seeming loss of importance/relevance in the vortex of terrorism-related public attention and concern.

I am happy to report that IAPAC successfully rescheduled our postponed events, individual and corporate donations have picked up, and we have succeeded in our many efforts to remind a global community that AIDS remains a threat to the fabric of our societies.

Were there any pleasant surprises for IAPAC in 2001 ?

I would rank as an extremely pleasant surprise former US President Bill Clinton's acceptance of our association's invitation to make a major address, and receive our 2001 Dag Hammarskjöld Award, at IAPAC's Honoring Our Heroes event. You cannot help but feel exhilarated when the former leader of the Free World, and today a major citizen-activist on the AIDS front, say the words, "I am here because I support the work of the International Association of Physicians in AIDS Care - physicians working on behalf of people living with HIV and AIDS around the world."

There has been great movement on the international front related to the fight against AIDS in the developing world. What has been IAPAC's role in creating and maintaining momentum, as well as in catalyzing actions in response to the great needs associated with the AIDS pandemic?

We entrust nonprofit and nongovernmental agencies with society's most important functions - educating our minds, uplifting our souls, and protecting our health and safety. Throughout the past seven years - but especially since 1997 - IAPAC has been at the forefront of advocating a human right to healthcare. Much in tune with the late Jonathan Mann, who was a founding member of IAPAC, our association has been consistent in communicating that public health and human rights share a common challenge - each primarily concerned with ensuring the conditions in which people can be healthy.

In April 2002, IAPAC will host our 5th International Conference on Healthcare Resource Allocation for HIV/AIDS in Rio de Janeiro, Brazil. As we have done through four previous conferences, IAPAC will again focus the multiple players - physicians, public health experts, government officials, private sector representatives, patient advocates, and (most important) people living with HIV/AIDS - on a never-ending task of prioritizing scarce healthcare resources to the benefit of a greater majority of our most vulnerable citizens.

Of note, and beyond our annual International Conference on Healthcare Resource Allocation for HIV/AIDS, IAPAC has maintained contacts with key thought-leaders and decision-makers along the chain of public health response to the AIDS pandemic. I am proud of our relationships with the European Commission, Joint United Nations Programme on HIV/AIDS (UNAIDS), Pan American Health Organization (PAHO), and the World Health Organization (WHO).

And, I am anxious to expand our relationships with other institutions, such as Ministries of Health the world over, through which the momentum created by pledges of commitment at bilateral and multilateral levels, as well as at the civil society level, may lead to concrete actions of benefit to tens of millions of people living with and affected by HIV disease.

IAPAC has articulated ambitious plans on several different fronts in 2002. What would you name as the association's highest priorities?

From the medical education perspective, our highest priority is to implement programs to ensure that HIV/AIDS care providers - and not just physicians - have the cutting-edge information necessary to make optimal use of available medications and diagnostic technologies.

From the advocacy perspective, I rank our access-to-care agenda as a high priority. We must ensure that many more patients globally are able to obtain healthcare services and life-saving drugs and technologies. This means advocating lower drug prices, government restructuring of healthcare delivery systems, and increased accountability at every level along the chain of public health response to the AIDS pandemic.

Our No. 1 priority on the clinical care front, especially in developing world countries, is to ensure that the healthcare provided to people living with HIV/AIDS is of the best quality, meets the highest ethical standards, and acknowledges the dignity and value of human life.

And, there are infrastructure-related issues to prioritize, among which increasing our global membership base, further diversifying our Board of Trustees and staff, and expanding our reach through additional regional offices rank as high priorities.

Where will the next regional office, or offices, be located?

IAPAC's Board of Trustees, whose members I laud for their unwavering commitment to and support of the association's mission, approved in December 2001 the establishment of an IAPAC European Regional Office (IAPAC-EURO) in Paris. This regional office would be charged with implementing IAPAC's advocacy and medical education initiatives in Western and Eastern Europe. We hope to open IAPAC-EURO in July 2002, with a major announcement made at the 14th International AIDS Conference in Barcelona [July 7-12, 2002].

In addition, there are plans for establishing an IAPAC North America Regional Office (IAPAC-NARO) exclusively tasked with implementing our initiatives in Canada, Mexico, and the United States. All I can add to that statement is that our members should stay tuned for more news on this front in the coming months.

In March 2001, IAPAC announced the launch of a Global AIDS Learning & Evaluation Network (GALEN) meant to train, evaluate, and certify developing world HIV care providers. What progress has been made to date in advancing GALEN?

We have long known that education and training of medical and allied health professionals are important issues in healthcare system development. And, especially in fields of medical science experiencing rapid change, such as the unofficially recognized field of HIV medicine, we know that continuing education and skills building are a fundamental necessity to maintain professional standards and improve quality of care provision.

IAPAC's GALEN is an attempt to deliver on the promise of training and evaluation along a consensus-based core curriculum of basic and advanced HIV medicine, and documentation of core clinical competencies linked to a core curriculum. IAPAC has recruited key people within the HIV medical community, including John G. Bartlett (Johns Hopkins University), to author each of the 12 GALEN learning modules. IAPAC's GALEN Committee - co-chaired by D. William Cameron (Canada) and Elly Katabira (Uganda), and truly international in scope - is playing a crucial peer-review role. And, IAPAC is working closely with the WHO to cement a role for GALEN within a WHO mandate to expand access to HIV/AIDS care in the developing world. I remain convinced that GALEN will have a major impact on the delivery of HIV/AIDS care wherever the program is implemented, but especially in resource limited settings in the developing world.

You are now beginning your third year as president of IAPAC. With the benefit of historical perspective, what are the greatest challenges facing IAPAC in the coming years?

I can identify two great challenges for IAPAC, which my colleagues and I are wrestling today:

One challenge revolves around a pressing need to form collaborative consortia with like-minded institutions and, in that way, mitigate the "turf wars" and institutional politics that pervade our movement today and hamper progress. There is a great deal of replication and redundancy within the "AIDS industry." This must end if we are to make better use of the scarce resources available to wage our war against this insidious disease. And, there is too much unnecessary "competition," leading to confusion within our respective constituencies, as well as our prospective supporters and donors. This, too, must cease lest we cripple each other.

The other challenge relates to the fact that we can ill-afford to advocate solely an HIV/ AIDS agenda. Advocating a global health agenda is essential to bridging the gap in global health inequity. This is a challenge given that our respective movements - for example, poverty, infectious diseases, and child health - have tended to march to the tune of cause-specific drummers.

The reality is that global health priorities - each intertwined, one with the other - must include addressing poverty (1.3 billion people subsist on less than US$2 a day); child health (one-third of all deaths in developing countries are in children under age 5); maternal health (about 500,000 women die each year from pregnancy-related causes, most of which are preventable); malnutrition (micronutrient deficiency affects some 2 billion people worldwide, with serious sequelae including premature death, poor health, blindness, and growth stunting); infectious diseases (given the experience of HIV and the reemergence of infectious diseases previously thought to be under control); and chronic diseases (worldwide, some 7.2 million deaths occur from ischemic heart disease and another 4.6 million from strokes).

IAPAC's membership campaign for the past two years has had as its theme, Strength in Numbers. With that in mind, in what ways do you wish to see IAPAC's members take an active role in the association's activities in 2002?

The exceptional humanity and idealism of physician-activists has helped to advance the cause of people living with HIV/AIDS worldwide. Their individual acts of courage, dedication, and compassion make the world a better place for us all, and serve to remind us of the continuing place of human commitment in the high tech world of modern medicine.

Physicians and allied health professionals become IAPAC members because they possess a deeply held commitment to helping others. Helping others is, in fact, IAPAC's raison d'être. Thus, I wish to further involve our members in strategic planning, program development and implementation, and, as important, membership recruitment. There is, indeed, strength in numbers. The more members IAPAC counts on, the better positioned we are to advance the association's goals of educating physicians, other healthcare providers, and patients; advocating the human rights of patients; advancing an ethical HIV medical research agenda; and ensuring that patients obtain the best care possible.

Our members must be integral participants in shaping IAPAC's future. As I said last year, ultimately, the people who make the greatest difference are on the front lines of the epidemic. Through their collective wisdom and experience, IAPAC can work with our many partners to ensure that people living with HIV/AIDS, and those health professionals charged with their care, may benefit from the upcoming "explosion" of social and scientific creativity, of constructive discrimination between what demeans and what gives dignity to life and confirms our humanity. I believe that together we can free ourselves from being "slaves" to disease and circumstance and recapture the essence of being humanely alive.

Scott Wolfe is Director of Communications and International Relations at the International Association of Physicians in AIDS Care.

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