Canadian Medical Association Journal 1996; 155: 21-27
© 1996 Canadian Medical Association (text and abstract/résumé)
The theme of the conference is "one world, one hope." These words were chosen to counteract our tendency to dwell on the things that divide us: ethnicity, nationality, sex and sexual orientation, lifestyles and areas of expertise. The four simple words are meant to conjure the image of the world's population working together despite differences and to articulate the common goal of AIDS researchers and health care workers everywhere: to prevent and cure this catastrophic disease.
As at previous conferences in this series, the program has been built around four central tracks: basic science; clinical science; epidemiology and public health; and social and behavioural science. The program spans the entire spectrum of AIDS research, ranging from molecular and cellular biology to clinical investigation and practice, public policy and community intervention. For example, among the 16 plenary lectures will be one entitled "Molecular Biology and Drug Development" and another entitled "Empowerment, Community Mobilization and Social Change in the Face of HIV/AIDS."
In addition, thematic "pathways" have been woven into the program structure to allow delegates to follow one area of interest from the viewpoint of various disciplines. Three topics that have emerged as issues of global concern have been chosen: "Women and HIV," "Living with HIV" and "Development and HIV."
Several other session types will be featured at the Vancouver conference. These include debates, meet-the-expert sessions and a broad range of skill-building workshops. The workshops are founded on the belief that the true value of any conference is the information that delegates take away with them to apply and share with colleagues at home. The skill-building workshops, aimed primarily at delegates from resource-poor settings, will include such sessions as "Developing a Peer Education Program" and "Designing a Simple Epidemiological Survey." Meet-the-expert sessions will cover such topics as "Field Techniques for HIV Diagnosis" and "Syndromic Management of Sexually Transmitted Diseases."
Aside from these innovations, what is really different about this year's conference? It appears that for the first time in a long while the conference will convene with signs of hope in the air: not the unrealistic hopes and unbridled expectations that often left delegates bitterly disappointed in the past, but a sense that, collectively, we are beginning to make important inroads against the pandemic. This year delegates participating in basic science sessions will discuss our increased understanding of the HIV life cycle as providing the groundwork for new approaches to therapy and will review recent progress in vaccine development and in the implementation of field trials. Delegates in the clinical science track will review important advances in combination therapies using protease inhibitors and provide valuable information on viral-load measurements as an aid to day-to-day treatment decisions. Experts in epidemiology and public health will present exciting new data on the prevention of mother-to-child transmission of HIV, the impact of preventive measures against sexually transmitted diseases on incidence rates of HIV infection, needle-exchange programs for users of injection drugs and the development of female-controlled methods to prevent HIV transmission. In the social and behavioural science track, the themes of human rights, capacity building and community mobilization will underscore sessions on the impact of HIV infection at the personal, familial, community and national level as well as sessions on innovative and effective strategies to prevent HIV infection.
However, let no one conclude from reports of progress in these areas that the worldwide AIDS crisis is in any way behind us. On the contrary, the urgency of the AIDS pandemic has never been greater. Delegates to the XI International Conference on AIDS will come from the four corners of a world in which AIDS has afflicted at least 4.5 million adults and children and in which an estimated 18.5 million adults and 1.5 million children have become infected with HIV. Sub-Saharan Africa and, more recently, Asia have been the hardest-hit regions, but the epidemic is a global one. The virus continues to spread explosively in countries such as Thailand, India and Myanmar and in vulnerable populations throughout the world. Industrialized countries are witnessing epidemics among young gay men, users of injection drugs and marginalized populations. Despite recent advances in treatment we have not reached the near-term objective of making HIV infection a chronic, manageable illness, and we are far from our true goal of finding a cure. Moreover, most of the treatment advances that have already been made are not available to most people with HIV infection around the world.
Thus, we find ourselves at the crossroads of hope and urgency. But can hope and urgency coexist? Is there any room for optimism in a world in which 6000 people become infected with HIV every day? Perhaps the answer can be found in a shift in our attitude toward HIV infection. Five or 10 years ago we were already living in a world in which thousands of people were becoming infected every day, but at that time there seemed little we could do about it. Like the spinning of the planets, the epidemic seemed to be driven by natural laws beyond human control. The treatment of those already infected was of limited benefit. Powerlessness bred hopelessness.
Now the general mood is different. As a global community, we know we can lower incidence rates of HIV infection through programs to control sexually transmitted diseases and through other interventions -- when the resources are available. We know we can lower mother-to-child transmission dramatically when the necessary interventions are accessible by those at risk. We know we can stop the spread of HIV among injection-drug users when the necessary programs are implemented. We know we can significantly extend and improve the lives of people living with HIV infection when the necessary treatments are provided. We no longer feel that the AIDS pandemic is out of our control; we have begun to feel that the tools we need are within our grasp. Now it is a question of resources.
It is therefore alarming that at this very juncture political leadership around the world is drifting toward indifference. Some governments, including that of Canada, refuse to make a commitment to the extension of AIDS programs. They embark instead on a cynical strategy of pitting people with one disease against people with another by suggesting that every dollar spent on one disease is necessarily a dollar less for another. This can distract health advocates from the real problem of a general downgrading of health care and health research as priorities for public spending. Delegates to the XI International Conference on AIDS will discuss the need to show solidarity in reminding governments that health care and health research must continue to be given high priority. As we stand at the crossroads of hope and urgency, this is precisely the time to redouble our efforts, not to abandon them.