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XV International AIDS Meeting

July 12, 2004 By Erika Check This article courtesy of Nature News.

The biennial international AIDS conference is a scientific gathering, a chance for politicians to network and an activists’ rally all rolled into one. This year, 15,000 people from 160 countries have headed to Bangkok, Thailand, from 11 July to 16 July to

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Day 6: The right people?

This conference had already seen a slew of celebrities this week: Richard Gere, Ashley Judd, and Kofi Annan, for starters. But none of them - indeed, perhaps no one else on earth - can work a crowd like Nelson Mandela.

At today's closing ceremonies, Mandela told us that he'll be 86 years old in two days. He has already announced his retirement from public life. However, he said, "I cannot rest until I am certain that the global response is sufficient to turn the tide of the epidemic." He implored world leaders to give more money to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Many new donations have been announced during the past week - from the European Commission, Thailand, the United Kingdom, Australia, Canada, and the Gates Foundation, But Mandela implored everyone to do more. "Allow me to enjoy my retirement by showing me that you can rise to the challenge," he said.

Mandela drew a standing ovation, of course. He moved many people to tears, even though they were sitting hundreds of feet away from him in a stadium-sized arena.

It will be difficult to top that act in 2006, when the conference moves to Toronto. Indeed, grumbling about the International AIDS Conference is a popular pastime nowadays. People complain that there's no new science and too much political posturing; too much talk and not enough action. All those things may be true.

But a lot goes on here that doesn't make the newspapers, and sometimes that's what actually inspires people to try harder after they leave. At the risk of sounding cheesy, I have to say that I've met some incredibly inspiring people in Bangkok. Like Joia Mukherjee, a doctor who works in one of the poorest parts of Haiti. She helped ensure that Haitians continued to receive AIDS drugs during the disintegration of the Haitian government this spring. Or Zachie Achmat, a South African activist with HIV who refused to take antiretroviral medications until his government provided them to its citizens. He finally went on the drugs when his friends implored him to. Or a young Ugandan man, Ndiwalana Tonny. He works with a group called Aidchild, in Masaka, which cares for orphans who get kicked out of the regular orphanages because they have HIV.

Two days ago, Ambassador Randall Tobias, the top US global AIDS official, said in an interview that we should think hard about the value of this conference before 2006. "I think we need to evaluate ...whether or not the right people are coming who really have a need and a reason to be here," Tobias said.

I wonder who "the right people" are. This conference is still far too expensive for too many people. But this year, it was less exclusive than it has been in the past. More people attended than ever before, and many more of them got scholarships. If Tobias had taken the chance to leave the podium and talk to some of the 20,000 delegates in the hallways this week, he might have decided that many of the right people are already here.

Day 5: The battle for drugs

When you hear that the United States is spending $15 billion to fight AIDS around the world, you might wonder why some people here are calling the US stingy. It's true that the US spends way more than anyone else on AIDS. But the critics say petty political restrictions are actually undermining the cause.

One sticking point is that the US promotes abstinence, which I wrote about on Monday. The other huge issue is generic drugs. To people in developed countries, "generic drugs" are the substitute medicines you buy to save a few dollars at the pharmacy. But to AIDS patients in developing countries, generics mean a lot more. A year's worth of brand-name AIDS drugs costs $700 in most poor countries - even at specially reduced prices. The generic versions cost about $150.

However, if you get US AIDS money, you're not allowed to buy generic drugs with it. You have to buy the brand-name drugs. This is a big problem in developing countries, say people who work with AIDS patients. Joia Mukherjee is a doctor with Partners in Health, a Boston-based group provides free health care in many poor countries, including Haiti. Mukherjee said yesterday that her group refused to take US money, partly because, she says, "If we had to buy brand name drugs, we would have to treat five times fewer patients."

Mukherjee says that US representatives in Haiti advised her to take the money, but use it for something other than drugs. She would then have to use money from other sources to buy generic drugs. Mukherjee finds that hypocritical. "They're advising us to use the very drugs they say aren't safe," she says.

The US says that since it hasn't approved any generic AIDS drugs in the United States, it can't buy generic drugs for other countries. "It is a moral imperative that families in programmes funded by the United States in the developing world have the same assurances as American families that the drugs they use are safe and effective," US Global AIDS Coordinator Randall Tobias said in a speech last night. But critics accuse Bush and Tobias of kow-towing to drug companies, which regularly give Bush's political party about three times as much money as to they give to his rivals. Tobias himself is a former executive at drug giant Eli Lilly.

In May, however, Bush's officials said they had created a new process so that the US Food and Drug Administration could approve generic AIDS drugs quickly. Aid recipients could buy these specially approved drugs with US funds. But no company has yet submitted a proposal to the FDA. Generics maker Ranbaxy, based in New Delhi, is represented here at the meeting. Atul Chhabra, manager of its HIV project, told me today that the companies are waiting because the FDA hasn't told them what the new process requires. I called a US representative of another major generics maker - Cipla, also based in India - and he basically said the same thing. "The moment they clarify the situation, the companies will start moving," Chhabra said. But, he added, that probably won't happen until January or February next year at the earliest.

This just isn't good enough, say recipients of US aid. Mark Isaac is with the Elizabeth Glaser Pediatric AIDS Foundation, which is using US money to give AIDS drugs to children and families in Ivory Coast, Zambia, Tanzania and South Africa. "All parties need to move quickly to show the new process is going to work instead of engaging in finger-pointing," Isaac says. Sadly, that just isn’t happening at the moment.

Day 4: Wrongfully accused

Sud Lor has been cleared!

Bangkok's The Nation newspaper reports today that the elephant that killed a man on Monday was actually an animal named Plai Thongdee - not Sud Lor, who had been blamed for the attack.

Thongdee's mahout, Pheng Yeerum, turned himself in to police today. He said that his elephant had killed 59-year-old Somsak Klongkaew after Somsak got drunk and started yanking hairs from Plai Thongdee's tail.

"Plai Thondee became irritated by Somsak and wrapped his trunk around the victim before tossing him. The throw resulted in Somsak's death," Pheng said, according to The Nation.

Pheng apparently then freaked out and led Plai Thongdee away, to a corral that houses Sud Lor and the other elephants which have been performing for us at the conference. But Plai Thongdee himself was not one of the hired performers. In fact, he and his mahout are poor and sometimes had to beg from tourists to make a living, The Nation reports.

I was very curious to know what the mahouts thought of all this. So today I headed out to the Moo Ban Chang - the Elephant Village, where the conference elephants live during the day. It's a few minutes' walk away from the convention center and across a busy road.

Well, the Elephant Village certainly didn't seem like a dangerous area filled with violent beasts. All of the animals were very neatly attired in red headdresses, jackets, and tusk decorations. One reached its trunk out to me, but I think he was just looking for a handout of sugar cane. It was really hot outside, so one of the baby elephants was drowsily dousing himself with water from a hose. And most of the others were ambling around the corral giving rides to the few conferencegoers who had trekked over.

I talked to a Czech woman there named Lenka Pilovsova, who explained that she is working with the elephants during a two-month break from her post as a molecular biologist at the Masaryk Univeristy in Brno. Lenka explained that Thai elephants have a huge problem: they have all lost their jobs. Most of them used to work in the logging industry in the forests of Thailand. But now the loggers use machines instead, and the elephants are out of luck and on the streets. Most of their mahouts either abandon them or take them out begging, as with Plai Thongdee.

Lenka said the mahouts try very hard to take good care of their animals. Which is why, according to Lenka, the mahouts at the Elephant Village were not surprised to hear that Plai Thongdee had killed Somsak for pulling his tail. "They all know that if you don't treat the elephant well, it can be a dangerous animal," Lenka said.

Day 4: The dark side

By now, if you're reading anything at all about this meeting, you're probably catching on to the fact that many, many people here are angry at the United States. Protesters and irate conferencegoers slam any US official who dares to show his or her face in public here. Maybe that's why the top US official at the conference, Global AIDS Coordinator Randall Tobias, sent an underling named Mark Dybul to stand in for him at a debate session on Monday.

Interestingly enough, it turns out that Dybul came to Tobias's office straight from the lab of Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases. Fauci is widely regarded by many activists, scientists, and government officials as one of the "good guys" in the fight against AIDS - he has been pushing for more AIDS research for decades. So activists regard Dybul's move to Tobias's office as a major betrayal. "He's gone over to the dark side," one long-time activist said after the Monday session.

Dybul fielded a huge array of indignant questions and tirades against US AIDS policies on Monday. Everything from, "We are sick and tired of the United States using this conference as a PR platform," to "200 million? That's crap!" referring to the US contribution to the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria. Dybul, the deputy chief medical officer for Tobias's office, stayed very calm, cool, and collected, but you couldn't help but get the feeling that he had been sent to the wolves.

Fauci told me yesterday that Dybul worked in his lab as a scientist for years before moving to Tobias's office when it was created last year. Officially, said Fauci, Dybul is on a temporary assignment to the State Department. But on Monday, Dybul had this to say about his new job: "I've been doing HIV/AIDS work for 20 years, and I'm so incredibly proud to represent President Bush and the American people on this," Dybul said. "It's an opportunity I've been waiting for 20 years."

Doesn't sound like he'll be going back to the lab any time soon.

Day 3: Elephants - but no traffic - on the streets

Sadly, our conference has become entangled with a local tragedy. The Thai newspapers reported today that a man was attacked and killed yesterday - by a rampaging elephant. The animal was apparently one of about 20 elephants that starred in the opening ceremonies for our conference on Sunday night.

According to the papers, the elephant attacked and killed 55-year-old man named Somsak Klangkaew, a construction worker who had been living under a highway overpass. The police then conducted a forensic investigation by testing the dirt samples under many elephants' feet and matching them to the site where the man was killed. The investigation implicated a 19-year-old male elephant named Sud Lor, which translates as 'Absolute Handsome'.

The animals seemed so cute and docile on Sunday night, parading down the street outside the conference center, decorated with pretty paper flowers on their tusks and anklets on their chubby legs...

Sud Lor's mahout - his keeper and trainer - said that the elephant was feeling "strong sexual urges" yesterday, according to the English-language newspaper The Nation. The newspaper also reported that the mahout, Virapong Somwang, defended his animal from the police, protesting that Sud Lor was very well trained and would never hurt anyone. Virapong even sank to the ground in front of Sud Lor, the paper reports, "sarcastically asking it to gore him". In response, the paper says, "Sud Lor kneeled down near [Virapong] and cried."

The papers also answered a mystery that had been nagging at me for days. I had heard before the conference that horrendous traffic often clogs Bangkok's streets, especially at rush hours. But every morning when we pile in buses to head out to the conference center, the streets are way less congested than they are back home in Washington, DC. In fact, I haven't seen a single traffic jam since I arrived.

Now I know why - apparently the prime minister let all the kids off from school, for the duration of the entire conference. Lucky kids!

Day 2: The humble condom

With cutting-edge antiretroviral drugs and new vaccines at the top of the AIDS agenda these days, it's surprising - almost shocking - how much this conference has focused on an ancient, low-tech device: the humble condom.

Condoms were around long before AIDS existed. Yet here we are, more than 20 years after the start of the AIDS epidemic, arguing about whether condoms stop the spread of AIDS. The issue has come up at this conference every time there is a discussion about the US programme on AIDS - and that's pretty often, because the United States spends more on global AIDS programmes than any other nation.

One session today was set up as a formal debate between ABC (abstinence until marriage, be faithful to one partner, use condoms) and CNN (condoms, needles and negotiating skills). The United States under President Bush has heavily promoted the so-called ABC strategy in its foreign AIDS programmes. But ABC-haters say that American programmes tend to emphasize the A and the B over the C. And the US Congress has voted to require one-third of all global AIDS prevention funding to go solely towards A and B - abstinence and monogamy.

Today's session quickly degenerated into a food fight about condoms, with most of the delegates angrily attacking the ABC-ers. One delegate from Brazil stood up, declared that he hated President Bush, and vowed that Brazil would never use the ABC strategy. Another delegate from Mexico asked 23-year-old Ugandan Simon Peter Onaha, who spoke out in favour of ABC, rather personal questions about his own abstinence and whether he would promote masturbation. Onaha simply replied, "I would highly recommend the ABC strategy, because it has worked for Uganda, and it has worked for me."

Uganda as a nation has obviously made huge progress against its AIDS epidemic by using the ABC strategy. But the critics say that strategy offers little hope for many individuals elsewhere - including women, who often don't have the option to say no to sex.

Arushi Singh, a youth volunteer for the International Planned Parenthood Federation in India, hammered home the point that many women in South Asia and elsewhere simply can't ask their partners to wear condoms. And ABC leaves women married to HIV-positive men completely in the lurch - especially in cultures where wives are taught to obey the demands of their husbands. Singh said these women must ask themselves: "Can I say no to this man I respect as a god, and not face a beating, or even be thrown out of the house?" Sadly, this scenario is not rare: in some parts of Africa, the majority of women who contract HIV now get it from their husbands. These women obviously need something more than a neat-sounding alphabetical slogan to protect themselves from AIDS.

Day 1: Let the Protests Begin

The XV International AIDS Conference opened with the requisite protests today in Bangkok.

The theme for the meeting is "Access for All". But this afternoon, hundreds of activists marched outside the Bangkok convention center to protest the lack of global access to treatment and prevention programmes, especially in developing countries. The activists - mostly Thai - carried signs in Thai and English with slogans like, "Science not politics - Access to condoms for all!" and "Bush's free trade deals kill - Generic AIDS drugs now".

Three major AIDS officials met the protesters outside - Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS); Joep Lange, president of the International AIDS Society, and Richard Feachem, head of the Global Fund to Fight AIDS, Tuberculosis and Malaria. But the US representative Randall Tobias, head of the President's Emergency programme for AIDS Relief, declined protesters' requests that he go outside and receive a document listing their demands. "Why don't you just give [the document] to me here?" he asked one activist who confronted him during a press conference today.

The crowd did not stick around long enough to hear the only speech by a person with HIV
Protesters also disrupted a speech by Thai Prime Minister Thaksin Shinawatra at the opening ceremony this evening. The Thais have been praised by many global AIDS leaders for taking early and effective action against the AIDS epidemic. But the Thai government has come under fierce criticism for its position on injecting drug users, who make up one third of newly diagnosed HIV cases in the country. Thailand has banned needle exchange programmes, and activists allege that thousands of drug users have been jailed or killed in a nationwide war on drugs. When Thaksin touched on this subject in his speech, protesters stood up shouting and brandishing "Clean needles now" posters. But Thaksin still got a standing ovation from the crowd, which appreciated his pledge to provide free treatment to everyone who needs it in Thailand, and his message of tolerance and equality for people with HIV.

The opening ceremonies also featured a handful of celebrities - Miss Universe 2004, movie actor Richard Gere, and UN Secretary General Kofi Annan, who was treated more like a rock star than a diplomat by the crowd. Annan got his own standing ovation for insisting that nations must to do more to empower women and girls. "Only when societies recognize that educating girls is not an option, but a necessity, will girls and young women be able to build the knowledge, the self-confidence and the independence they need to protect themselves from HIV/AIDS," Annan said.

Sadly, the crowd of thousands did not stick around at the opening ceremonies long enough to hear the night's only speech by a person with HIV. Thai activist Paisan Sawannawong, leader of the Thai Drug User's Network, spoke out against high medication prices and against Thai policies on drug users. But he was the night's last speaker, and the Thai prime minister and most of the crowd had already left the building by the time he took the podium. Those who had stayed lamented that the situation epitomized a perennial problem in the global AIDS epidemic - and perhaps with the AIDS conferences themselves: too much emphasis on the people who already have political and economic power, and to little focus on the people who live with the disease.

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