|Sweeney and Hattis confer during conference|
Advisory Council member Frank Hayes participated in a different role, as one of almost 1,000 volunteers helping the conference to run smoothly (see separate posting above).
President Obama did not personally appear at the conference, which disappointed many participants. However, he provided a video message, hosted a reception at the White House honoring persons living with HIV, and his administration was represented by HHS Secretary Katherine Sibelius, Secretary of State Hillary Clinton,and others. Former President Bill Clinton also made an appearance, representing his foundation, which has done a great deal to make HIV/AIDS drugs available at more affordable cost to populations in developing countries.
MEETINGS AND TESTIMONY
Since several of the Beyond AIDS recommendations are directed at the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and Health and Human Services administration (HHS), Hattis arranged meetings with leaders of those agencies.
|Fauci and Hattis discuss NIH and Beyond AIDS recommendations|
In fact, it turned out that the leaders of each agency thought that another agency should do this. Beyond AIDS will need to continue to work to encourage a joint effort for this publicity and physician education.
|Fenton chats with Hattis at CDC display area|
|PACHA members hear testimony, July 25, 2012|
The PACHA hearing was also an opportunity for a brief introduction to Dr. Grant Colfax, the new Director of National AIDS Policy at the White House, who will be responsible for updates to the National AIDS Strategy. Dr. Colfax's last employer had been the San Francisco Department of Public Health, which received an award from Beyond AIDS in 2008 for innovations during Dr. Colfax's tenure. Two previous directors of that office, Jeffrey Crowley and Dr. Joseph O'Neill, were also contacted during the conference.
|Hattis meets with Valdiserri on HHS coordination for HIV/AIDS|
OPTIMISM AND CAUTION
Many of the speakers at the conference spoke optimistically of "a generation without HIV," based on progress in a number of countries (though not so far in the U.S.) in reducing HIV incidence; and also on the promise of "treatment as prevention." The concept that treatment could help control the epidemic had actually first been written up some 15 years earlier by Hattis as a faculty member at Loma Linda University, together with one of his medical residents, Dr. Holly Jason Kibble (see posted articles on the Beyond AIDS Web site of 1996 and 1997, and history of of concept in the Beyond AIDS position statement). Over just the last few years, increasing evidence has built up that adequate treatment indeed can reduce infectiousness to the point that it can be a powerful weapon in stopping the spread of the disease.
|Condom Demonstration and Display at AIDS Conference|
POLITICAL CONTROVERSIES AND ISSUES
Every international AIDS conference has involved political protests and expression by activists, mostly from the gay communities in the U.S. and a few other countries. Beyond AIDS has often disagreed with some of the positions of these activists, while agreeing with others. In the early years, activists had demanded more rapid development of effective drugs for AIDS, which was laudable. However, they had also opposed HIV reporting, an area of strong disagreement. Beyond AIDS was in the forefront of a ten-year political struggle, ultimately successful, to achieve HIV reporting in all 50 states.
At this year's conference, there seemed to be four main political protest issues that were frequently heard, and the first two of them (but not the last two) run counter to Beyond AIDS philosophy:
1) So-called "criminalization of HIV." This related to complaints about cases in which some HIV positive persons have been prosecuted for intentional transmission or for exposure of others without either informing their partner or taking precautions. The argument was that this would deter HIV testing (just as activists once claimed that reporting would deter testing, a prophecy which did not come true). The slogan was "Take a test, risk arrest," which ironically discourages that very testing. Sean Strub, the founder of Poz Magazine, advisor to the Positive Justice Project, and maker of a film entitled "HIV is Not a Crime," was the leading advocate of this position.
2) Fear that an emphasis on treatment as a public health measure would result in mandated treatment, with forced exposure to toxic drugs. Ironically, some of the same activists who demonstrated years ago for research and development of effective drugs are now afraid of being corralled into taking them. Strub even called for written consent before anyone could receive treatment for HIV/AIDS.
Fortunately, this issue seemed to be a significant concern of only a small minority at the conference. Beyond AIDS strongly supports encouraging patients to start on treatment as soon as possible, both for their own benefit and to prevent transmission. On the other hand, there was general agreement at the conference that treatment ultimately remains voluntary and an issue to be discussed by patients and their health care providers; and that "human rights" concerns should be considered in developing policies on mass early treatment as a prevention strategy.
3) U.S. visa restrictions that still prohibit persons who have been sex workers or used injection drugs within the last ten years. There was general consensus that this prevented attendance by some potential international delegates who might have provided insight about dealing with those populations, and a group of sex workers from India held their own conference in protest. Beyond AIDS has no policy opposing easing or allowing exceptions to this restriction, which seems excessive.
4) Laws in many countries that make homosexual behavior illegal, forcing gays underground and making it difficult for public health programs to reach them and to enlist their support for testing and treatment. Beyond AIDS opposes discrimination or stigmatization for either sexual orientation or HIV infection.
|Weinstein, flanked by West and Smiley, at AHF Rally|
|AIDS Quilts, with Rally Stage in Background|
The AIDS Healthcare Foundation (AHF) staged a rally at the Washington Monument on July 22, under the leadership of its President Michael Weinstein, the day before the conference began. The theme was "Keep the Promise," implying that the federal government should maintain and increase the support of HIV treatment just when it needed to be expanded and could be the key to reversing the epidemic.
A large stage was erected, large swaths of AIDS quilts were on display, and an impressive array of speakers including Andrew Young, Al Sharpton, Tavis Smiley, and Cornel West; and entertainers Margaret Cho and Wyclef Jean. Unfortunately, the rally drew only hundreds rather than the hoped-for thousands of participants. However, the crowd was enthusiastic, and carried that spirit forward to the conference that followed.