A second controversy, that followed Mr. Stephen Harper’s choice to not attend, was the fact that 151 delegates who were in attendance refused to return to their home countries - instead opting to seek asylum in Canada. [3] This development seriously hurt the credibility of the conference and many suggested that the Prime Minister’s office may have been justified in its decision to not have Mr. Harper in attendance.
Canadian Prime Minister Stephen Harper, who decided not to attend the conference, was criticized by Conference co-chairman Dr. Mark Wainberg in his speech, saying, “We are dismayed that the prime minister of Canada, Mr. Stephen Harper, is not here this evening…The role of prime minister includes the responsibility to show leadership on the world stage. Your absence sends the message that you do not consider HIV/AIDS as a critical priority, and clearly all of us here disagree with you”. Canadian Minister of Health Tony Clement attended in Harper’s place.[1] Harper’s absence from the conference is the second time the Canadian head of government has decided not to attend the conference. In 1996, former Prime Minister Jean Chrétien did not attend the conference.[2]
The XVI International AIDS Conference was held in Toronto, Ontario, during the week of August 13-18, 2006. This was the third time that Canada has hosted the International AIDS Conference, after Montreal in 1989 and Vancouver in 1996. The main venue for the conference was the Metro Toronto Convention Centre (MTCC) in downtown Toronto.
One of the entrances to the Metro Toronto Convention Centre during AIDS 2006
Banners of the AIDS 2006 conference could be found along many streets near the conference centre. Shown here is Front Street, just outside the conference centre.
The conference theme was Time to Deliver. The conference was focused on the promises and progress made to scale-up treatment, care and prevention.
In particular:
Accelerating research to end the epidemic
Expanding and sustaining human resources to scale-up treatment and prevention
Intensifying the involvement of affected communities
Building new leadership to advance the response
Activities included cultural, youth and outreach programmes as well as a Global Village, which served as an international gathering place with displays of culture, food, community, and a marketplace.
Events open to delegates and the public included The International AIDS Vigil, a public memorial to all those who have died of HIV/AIDS. The Vigil took place on at 9 PM on August 17 at Yonge-Dundas Square, Toronto.
Well-known attendees and speakers included Governor General Michaëlle Jean, Stephen Lewis (the United Nations special envoy for HIV/AIDS in Africa), Bill and Melinda Gates (for the Gates Foundation), Richard Gere, Alicia Keys, and Bill Clinton.
On the third day of the conference Professor Dennis Altman of Melbourne, a leading figure in the arena of international HIV/AIDS politics since the 1980s, delivered the Jonathan Mann Memorial Lecture. His theme was “structural interventions and vulnerable communities,” particularly men who have sex with men, injecting drug users and sex workers. But he was not confined by this topic. He said of the late Professor Jonathan Mann, in whose honour the lecture is named: “One of the things I liked about Jonathan was his willingness to offend when doing so would confront people with the consequences of their actions.”
Altman pointed out that the tendency to blame rich countries and pharmaceutical companies for the failure to stem the rising tide of AIDS ignored that the fact that “even poor countries can afford to support good prevention efforts, as Uganda and Cambodia remind us.” More to blame, he said, was the failure of governments and religious leaderships to face up to the practices that facilitated the spread of HIV.
“The greatest tragedy of HIV/AIDS is that we know how to stop its spread, and yet in most parts of the world we are failing to do so,” Altman said. He cited what he called the deliberate neglect by governments, the unwillingness to speak openly of HIV and its risks, and the “hypocrisy with which simple measures of prevention are forestalled in the name of culture, religion and tradition,” as the major reasons for the continued spread of the epidemic.
Altman was particularly critical of the failure to remember the lessons learned by the gay male community during the first decade of the AIDS epidemic, particularly the need for affected communities to be at the centre of the response to AIDS. He called for an end to restrictions on the discussion and promotion of condoms, and an end to silence about homosexuality, sex work and drug use in many countries.
“As the epidemic grows we have many reasons to be angry, particularly at the hypocrisies of most governments and most religious leaders,” Altman concluded. “We ignore the ways in which fundamentalists of all faiths perpetuate the gender and sexual inequalities that fuel the epidemic. But anger that is not supported by analysis, and that does not lead to action, is wasted and self-indulgent.”
The XV International AIDS Conference is organised by the International AIDS Society (IAS) and the Thai Ministry of Public Health as the local Host. The co-organisers of the conference are UNAIDS, three international community networks: ICW, ICASO, GNP+ and TNCA, a conglomerate of Thai AIDS NGOs.
Starting with Bangkok the IAS has established a central conference secretariat to organise the International AIDS Conferences as well as the HIV Pathogenesis and Treatment Conferences. The Local Host Secretariat is located in Bangkok to coordinate the work of local subcommittees. The Community Program Secretariat is located in Bangkok to handle capacity building, outreach and the community aspects of the program.
Representatives from the organisers and co-organisers form the basis of the Conference Organising Committee (COC). The Chairs of the conference represent the IAS and the Local Host. The COC in turn appoints two chairs each for the Scientific Program Committee (SPC), Community Program Committee (CPC) and Leadership Program Committee. The Committee Chairs serve on the COC. The SPC, CPC and LPC are then composed of leading representatives from a variety of fields who bring a diverse expertise to the conference planning process.
The XV International AIDS Conference was held in Bangkok, capital of Thailand, from July 11 to July 16, 2004. The main venue for the conference was the IMPACT Muang Thong Thani convention centre at Nonthaburi, north-east of downtown Bangkok. It was the first international AIDS conference to be held in Southeast Asia. International AIDS conferences have been held regularly since the first one in Atlanta in 1985.
At the opening ceremony on the evening of July 11, the main speakers were the Thai Prime Minister, Thaksin Shinawatra, and the Secretary-General of the United Nations, Kofi Annan. The opening was screened live on Thai national television.
Thaksin, whose government had been criticised by foreign observers for its harsh attitude to injecting drug users, surprised the conference by pledging to adopt a “harm minimization” approach to AIDS prevention among drug users, and to work co-operatively with non-government organizations, including the Thai Drug Users’ Network. AIDS activists suggested that Thaksin had been promised greatly increased funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria if he adopted a more flexible attitude.
Annan, in a forceful speech, praised Thaksin and also the President of Uganda, Yoweri Museveni, who was seated in the front row, for their leadership in developing strategies for fighting AIDS in developing countries. But he said that much more was needed, including a radical change in attitudes to women in many countries, since HIV infection is now increasing more rapidly among young women in developing countries that in any other population group. Annan said the empowerment of women, particularly in African and Asian countries, was the key to preventing the further spread of HIV infection.
The conference was attended by more than 20,000 delegates and a large contingent of local and international media. Many people with HIV/AIDS and delegates from developing countries were subsidized to attend the conference by governments, the United Nations, other international organizations and drug companies.
The United States, however, significantly reduced its official presence at the conference as compared to previous conferences. The Department of Health and Human Services, which spent US$3.6 million to sent 236 people to the XIV International AIDS Conference in Barcelona in 2002, spend US$500,000 and sent only 50. The move was seen as a response to events in Barcelona, when Health and Human Services Secretary Tommy Thompson was shouted down by protestors.
The co-chairs of the conference were Dr. Vallop Thaineua of Thailand and Joep Lange of the Netherlands, president of the International AIDS Society, which was the formal host organization. The content of the conference was run by three program committees, the Community Program Committee, chaired by Senator Mechai Viravaidya and Donald De Gagne, the Scientific Program Committee chaired by Professor Prasert Thongcharoen and Professor David Cooper, and the Leadership Program Committee chaired by Pakdee Pothisiri and Debrework Zewdie.
The Leadership Program section of the Conference was, however, thrown into doubt by security concerns. On July 7 the Thai government cancelled a meeting on HIV/AIDS for national leaders planned as part of the conference. The leaders of 13 countries and United Nations Secretary-General Kofi Annan were invited to the summit, which was to be hosted by Thai Prime Minister Thaksin Shinawatra, but only one national leader and Annan accepted.
As at previous international AIDS conferences, both local and international organizations staged protests about various aspects of HIV/AIDS policy at the Bangkok conference. Activists protested during the opening of the conference to call attention to what they said were failures by governments worldwide in fighting AIDS. Tight security prevented any disruption to the ceremony, although Prime Minister Thaksin was heckled during his speech by some sections of the audience.
The protests were co-ordinated by Thailand’s AIDS Access Foundation. They called for increased worldwide access to antiretroviral treatments and greater financial support for treatment and prevention. Activists said that the United States and other Western nations were backtracking on funding pledges made at the Barcelona conference.
In medicine, the window period for a test designed to detect a specific disease (particularly infectious disease) is the time between first infection and when the test can reliably detect that infection. In antibody-based testing, the window period is dependent on the time taken for seroconversion.
The window period is important to epidemiology and safe sex strategies, and in blood and organ donation, because during this time, an infected person or animal cannot be detected as infected but may still be able to infect others. For this reason, the most effective disease-prevention strategies combine testing with a waiting period longer than the test’s window period.
The window period takes no more than 6 month
Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations
Unexplained severe wasting or severe malnutrition not adequately responding to standard therapy
Pneumocystis pneumonia
Recurrent severe presumed bacterial infections (e.g. empyema, pyomyositis, bone or joint infection, meningitis, but excluding pneumonia)
Chronic herpes simplex infection; (orolabial or cutaneous of more than one month’s duration)
Extrapulmonary Tuberculosis
Kaposi’s sarcoma
Oesophageal candidiasis
Central nervous system toxoplasmosis (outside the neonatal period)
HIV encephalopathy
Conditions where confirmatory diagnostic testing is necessary
CMV infection (CMV retinitis or infection of organs other than liver, spleen or lymph nodes; onset at age one month or more)
Extrapulmonary cryptococcosis including meningitis
Any disseminated endemic mycosis (e.g. extrapulmonary histoplasmosis, coccidiomycosis, penicilliosis)
Cryptosporidiosis
Isosporiasis
Disseminated non-tuberculous mycobacteria infection
Candida of trachea, bronchi or lungs
Visceral herpes simplex infection
Acquired HIV associated rectal fistula
Cerebral or B cell non-Hodgkin lymphoma
Progressive multifocal leukoencephalopathy (PML)
HIV-associated cardiomyopathy or HIV-associated nephropathy
Conditions where a presumptive diagnosis can be made on the basis of clinical signs or simple investigations
Moderate unexplained malnutrition not adequately responding to standard therapy
Unexplained persistent diarrhoea (14 days or more )
Unexplained persistent fever (intermittent or constant, for longer than one month)
Oral candidiasis (outside neonatal period )
Oral hairy leukoplakia
Acute necrotizing ulcerative gingivitis/periodontitis
Pulmonary TB
Severe recurrent presumed bacterial pneumonia
Conditions where confirmatory diagnostic testing is necessary
Chronic HIV-associated lung disease including brochiectasis
Lymphoid interstitial pneumonitis (LIP)
Unexplained anaemia (<80g/l), and or neutropenia (<1000/µl) and or
thrombocytopenia (<50 000/µl) for more than one month
Hepatosplenomegaly
Papular pruritic eruptions
Seborrhoeic dermatitis
Extensive human papilloma virus infection
Extensive molluscum contagiosum
Fungal nail infections
Recurrent oral ulcerations
Lineal gingival erythema (LGE)
Angular cheilitis
Parotid enlargement
Herpes zoster
Recurrent or chronic RTIs (otitis media, otorrhoea, sinusitis)