AIDS 2006 and beyond

The International AIDS Society (IAS) commends Richard Horton (Aug 26, p 716)1 for his provocative analysis of the XVI International AIDS Conference (AIDS 2006), which took place this past August in Toronto, Canada. Critical analysis and debate—two of the hallmarks of the conference—can only strengthen our collective response to this crisis. Yet Horton's claims that the conference is “disengaged”, and that the opportunity to produce a road map for the future was “squandered”, as outlined in the ten points of his Comment, merit a response from the IAS as lead organiser of these meetings.

In 2005, the IAS undertook the first comprehensive review of the conference (the Future Directions project), consulting broadly with our stakeholders in an effort to maximise the reach and impact of the conference. The recommendations from those consultations—among others, to improve the quality of science, to broaden diversity, to facilitate cross-disciplinary links and dialogue, and to strengthen the focus on youth—began to be implemented in the planning for AIDS 2006 and will be implemented more fully in the planning for AIDS 2008. We are also strengthening the conference's role as an accountability mechanism, a focus reflected in the conference theme, Time to Deliver, that has implications across disciplines and settings.

AIDS 2006 highlighted many key policy issues, from HIV diagnostic testing to the growing feminisation of the epidemic, to the need for better coordination between HIV and other disease programmes such as tuberculosis, hepatitis, and malaria. Conference sessions also proposed strategies for addressing the desperate shortfall of health-care workers in the developing world, and drove home the message that scientific evidence should prevail over political expediency in critical areas such as harm reduction for injecting drug users and outreach to vulnerable populations such as sex workers and men who have sex with men.

In my inaugural speech as incoming IAS President, presented at the close of the conference, I was clear about IAS's agenda, both within and beyond its conferences, for fostering collaboration and accountability: “More than ever, it was confirmed during this week that prevention and care are two faces of the same coin. More than ever, biomedical and behavioural scientists have the challenge and opportunity to work together with people living with HIV and community organizations toward our common goals. Of course, all the knowledge, the innovative research, the new tools, will not be effective without the political leadership that is essential to halting this disease; we must keep pressure on the G8 leaders to follow-up on their commitments to achieve universal access to prevention, care and treatment by 2010.”

All stakeholders and all countries need to be held to account for their action, or inaction, on HIV/AIDS. Unlike the UN and some donor mechanisms, the conference has neither the mandate nor a formal mechanism to establish a road map for specific targets or to hold specific countries accountable for action on HIV/AIDS, as suggested by Horton. Nevertheless, it does provide an important forum for drawing attention to the successes and failures of governments, with Russia, South Africa, the USA, and Canada among the many countries whose responses and policies received the scrutiny of the international community in Toronto. In the planning of AIDS 2008, to be held in Mexico City, the IAS aims to provide further opportunities during the conference to review progress in countries and across regions.

Horton's dismissal of Bill and Melinda Gates and Bill Clinton as distracting “celebrities” negates the strong leadership of these individuals and that of their foundations in contributing to the global response. This includes negotiating significant price discounts for antiretrovirals in the developing world; investing in vaccines, treatments, and new prevention technologies; and lending their influence to increasing awareness of HIV/AIDS globally. The drawing power of these leaders—both for conference delegates and international media—helped to ensure that the conference's key messages were delivered to a global audience.

Substantial effort was made to include an eminent African in the opening session of the conference. Unfortunately, the Liberian President withdrew from delivering a keynote address as a result of the decision by the Canadian Prime Minister not to attend. Nevertheless, in sharp contrast with Horton's claim that the IAS “inadvertently silenced a great continent”, more Africans spoke in sessions at AIDS 2006 than ever before.

While Africa continues to bear the brunt of the epidemic, HIV incidence is rapidly increasing in many other parts of the world. Eastern Europe and central Asia, parts of southeast Asia, and areas of Latin America, the Caribbean, and the Pacific Islands are all experiencing burgeoning epidemics, and the conference must continue to be international in scope. It will also continue to highlight global successes, such as the recent and striking increase in antiretroviral availability in many developing countries, and where we are falling short, such as the persistence of HIV-related stigma and discrimination.

Global action on HIV/AIDS in recent years has the potential to revolutionise global public health. It is no longer acceptable for poor countries to be denied access to new treatments and other technologies simply because they cannot afford them. The IAS agrees that each of Horton's ten questions are essential issues; all of them were the subject of formal and informal presentations, discussion, and debate at the conference.

We are pleased that Horton acknowledges the “remarkable and inspiring diversity” of the conference, which has evolved enormously from a small scientific meeting in Atlanta in 1985 to a global platform for advocacy, research, and capacity-building. An unprecedented number of delegates came to Toronto in 2006. The IAS is gratified that people continue to vote with their feet. We are committed to improving the conference and strengthening its role beyond a 5-day event to becoming part of an ongoing cycle of education, networking, promotion of best practice, and advocacy in the fight against HIV/AIDS.

We declare that we have no conflict of interest.

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