International AIDS conferences — held since 1985, first annually and now every other year — are cacophonous, confusing, crowded, interesting and exhausting events. For a week, experts give plenary lectures updating listeners about the biology, epidemiology and treatment of HIV infection. New research is presented in 15-minute lectures, in poster sessions held in cavernous halls, and in late-afternoon symposiums. Activists meet, train and exhort. Drug and device companies show their wares. The famous and the unknown speak.
Each conference distills the mood, the news and the symbolism of its moment in AIDS history. In memory they call up feelings of despair, surprise and solidarity.
Berlin, in 1993, was the nadir. Scientists and activists heard that treatment with AZT alone did not prolong life and that the AIDS epidemic was devastating Africa’s societies and economies.
Vancouver in 1996 brought evidence that “triple therapy” — three anti-retroviral drugs taken daily — could stave off death and restore many people to health. In 2000, the conference in Durban, South Africa — the first in an African country — drove home the inequity in treatment between rich and poor countries.
By the Barcelona conference two years later, it was clear that Africans and Haitians could successfully take the complicated regimen of pills — and benefit from it — just like Americans and Europeans. That unsurprising finding left no excuses for not bringing AIDS care to the developing world other than lack of will, effort and money.
Each conference is in search of a take-home message. This one’s has yet to emerge. It may be that places such as the District of Columbia (HIV prevalence of 2.7 percent) have lessons to learn from places such as Rwanda (HIV prevalence of 2.9 percent), whose response to the AIDS epidemic has been widely praised.
For the moment, the message of the conference here is simple: I’m back.
Look for the words “amplification” and “implementation” to be a big part of talk this week.
They are boring, polysyllabic words. Not like “sex,” “drugs” and “death,” which were the key words of some AIDS conferences. But they are words that signal success.
The world today knows how HIV is transmitted, what can be done to prevent its spread and how to treat someone once it is diagnosed. The issue is no longer what to do but rather whom to do it for, where, how quickly and at what cost.
That’s where “amplification” and “implementation” come in. How much do we want to amplify our successes? What is the strategy for implementing our hard-earned knowledge? Those are the big questions.
The greatest scientific achievement in the past 22 years is combination anti-retroviral therapy (ART), with wide usage beginning in 1996. A patient takes three drugs that block one or more steps in HIV’s replication. That drives the virus to undetectable levels in the bloodstream and allows the immune system to restore itself to health.