by Anthony Glassman

Toronto--The 16th International AIDS Conference marked a quarter century since the age of AIDS dawned, but was focused on the next 25 years in prevention efforts, treatment options and distribution of prophylactics and medications to poverty-stricken areas hardest hit by the pandemic.

The biennial conference came to North America from August 13 to 18, bringing tens of thousands of people from across the globe who work with or live with HIV and AIDS.

The three previous conferences were in Thailand in 2004, Spain in 2002 and South Africa in 2000.

Bill and Melinda Gates opened the conference with a call for development and distribution of HIV-preventive drugs.

The couple, buoyed by Bill Gates� Microsoft fortune, have donated $110 million to research in the field of microbicides to prevent the spread of HIV.

The main thrust of such research is the development of gels that women can apply vaginally to prevent infection. That would enable women in developing nations, who may have little sexual freedom, to protect themselves without their sexual partner�s knowledge, taking HIV prevention out of the hands of men who might not even know they are infected.

The couple said that their investment in research in that field and in using antiretroviral drugs to prevent HIV infection would increase, on the heels of a $500 million donation to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

While the governor general of Canada, Micha�lle Jean, opened the conference, Prime Minister Stephen Harper, a Conservative, did not attend, claiming previous obligations. He gave the same reason for staying away from the inaugural World Outgames in Montr�al two weeks earlier.

Former President Bill Clinton spoke at the conference in his capacity as the co-chair of the Bill and Melinda Gates Foundation, urging governments around the world to end the stigma attached to HIV.

The administration that succeeded Clinton�s was the target of sharp criticism throughout the conference for its dedication to abstinence-until-marriage AIDS education.

The Bush administration requires one-third of its HIV prevention dollars be used for abstinence education, a precondition that caused Brazil to reject $40 million in grants from the United States for AIDS education and prevention.

Critics pointed to the success of AIDS education efforts in Thailand, which are sex-positive and �fun.� Brothels and clubs are required to give out free condoms, and institute policies requiring their use. Houses of prostitution and massage parlors have sprouted signs saying, �No condom, no sex, no refund!�

Businesses that refuse to enforce the 100 Percent Condom Campaign are shut down.

Within a decade, the infection rate has plummeted.

Supporters of abstinence programs pointed out that some African countries, like Uganda, have willingly and enthusiastically adopted the Bush administration�s ABC approach--Abstinence until marriage, Be faithful to your partner, Condoms if the other two fail.

Critics argue that in some cultures, it is impossible to enforce that plan, especially when women have little or no say in sexual activity and could face violence if they insisted on monogamy or condoms.

HIV drugs as prophylactics

The conference also saw some good news for prophylactic use of antiretroviral medicines. Field studies of the use of Viread to prevent the spread of HIV showed fewer people seroconverted that were taking the medication than those given placebos, although scientists in the study warned that the results were too limited to draw final conclusions.

Family Health International, which is funded by the Bill and Melinda Gates Foundation, is performing the study on heterosexual women in Africa, while similar studies funded by the Centers for Disease Control and Prevention among injection drug users in Thailand and gay men in Atlanta, San Francisco and a planned third U.S. city are also underway.

Another CDC study on heterosexual men and women in Africa was changed from tenofovir, the drug known as Viread, to a combination of tenofovir and another drug, FTC, which together are marketed as Truvada.

The National Institutes of Health are starting another Truvada study in Peru later this year.

Another continuing theme at this year�s conference was the need for increased HIV testing, although the issue was contentious, to say the least.

Julian Bond, president of the NAACP, called for an increase in HIV testing among black people, since the African American community shows disproportionate levels of infection.

U.S. Rep. Maxine Waters called for mandatory HIV testing, although that suggestion brings immediate condemnation from many HIV advocates and civil liberties activists.

The main concern with mandatory testing is the resources to follow up a positive result. Advocates are concerned that mandatory testing would create an immediate spike in the number of people seeking services and treatment without a commensurate increase in the funding for programs.

Comments on the web

The AIDS Taskforce of Greater Cleveland worked very hard this year to increase the public�s access to the conference, adding both a blog and a pipeline to the Kaiser Channel�s coverage of the event.

Taskforce executive director Earl Pike went to Toronto with Chris Esmurdoc, the director of clinical services, Julie Patterson, the capacity-building manager, and Douglas Vest, a case manager. Vanessa Forros of Recovery Resources in Cleveland went with them to the conference, and the group posted regular comments on the blog, available from the AIDS Taskforce website at www.aidstaskforce.org or http://aidstaskforce.blogspot.com.

The Kaiser Channel�s coverage of the conference, complete with footage and transcripts of speeches and interviews, is available on the Taskforce website and at www.kaiserchannel.org.