Amsterdam: High Temperatures, frayed tempers and Venezuela in Collapse



AIDS 2018 saw some of the highest temperatures in recorded Amsterdam's history. The same could be said about the frayed tempers of conference participants. At times, it was an unbearable grind just to walk from one end of the RAI (the conference center) to the other. You didn't want to bump into the myriad of people you know, for fear that they would bite your arm off, or you theirs, over issues that would otherwise elicit at best, a raised eyebrow. 

Commentators like the European activist Gus Cairns, and the Foreign Affairs journalist Laurie Garrett have captured the data and broad public health context of the Conference, and I strongly recommend reading their reviews.  Today, I'm back in Middle Earth (to the uninitiated, the South West of England, not New Zealand), where true to Hobbit form, it is raining and cold. So over a glass of wine, I'm ruminating on these last ten days.   

By nature, I am a pragmatic pessimist. My overwhelming sense of the imminent apocalypse is routinely tempered by the random acts of kindness of others.  And indeed in Amsterdam, there were things to be impressed with: The U=U campaign (Undetectable = Untransmissable -  if you have HIV and you are undetectable because of sustained effective treatment, you cannot sexually infect someone else) is realizing its potential to be the driving HIV community movement that unites us all. Bruce Richman's passion and enthusiasm is boundless, and I hope he is sitting on a beach, sipping a margarita, feeling quietly proud of what he and his colleagues have achieved.  There were some extraordinary poster presentations from South East Asia - outlining the most creative, innovative ways communities are implementing PrEP.  Behind nearly all of these, was an inspiring, young community doctor, Stephane Ku (who is interviewed in an upcoming podcast).  The inspiration of global political leaders, like Congresswoman Barbara Lee, who fights unrelentlessly the wave of populist intolerance sweeping our countries. And of course, the camaraderie of seeing, hugging and getting drunk with other Global AIDS fighters always inspires. Thank-you, Charlie Tredway.

But. No presentation, no poster or protest can escape the reality that AIDS is roundly defeating us, outsmarting our complacency and the chronic underfunding we have allowed in the last decade. If I have to hear another US government official explaining how all we have to do is squeeze more efficiency out of this or that existing program.We cannot let ourselves fall for a false choice between funding AIDS over another public health crisis - when we should fund both. In the AIDS community, we cannot fight ourselves over funding this behavioral intervention over that biomedical intervention - when we need to do both. 

I left Amsterdam quietly alarmed that it may be too late now.  The chance to suppress HIV out of existence has been passed up, and the best we can hope for now is that we can contain the extent to which HIV resistance overcomes our new therapies. And pray for some future scientific breakthrough.

The only way I can can come close to understanding the conference is through capturing moments I had with friends and colleagues over the last week. 

Peter Piot, of the London School of Hygiene and Tropical Medicine, the founding Executive Director of UNAIDS, and a profound mentor to me, savaged the "90 90 90" goals (90 per cent of all HIV people tested, 90 per cent of them being initiated into care, and 90 per cent of those becoming undetectable).  What should have been, at best, a short-term advocacy message, has become the driver of many national and international policies for the last few years that have wasted time and effort, and have avoided entirely the key populations most affected by HIV.  Peter nailed it succinctly: "Existing approaches are leaving numerous populations behind. 10-10-10 will determine the future of the epidemic."

Not for the first time, AIDS 2018 opened my eyes to an unsavory, and unspoken prejudice that stalks global AIDS - well, it stalks international development in general, actually. It is White Liberal Racism. Most of the time, I truly don't think we recognize it in ourselves, but one panel session stood out to me. Made up largely of white, northern people, the panel expressed frustration at how hard it was to sustain the particular programs they were developing for the local community. Before closing the session, they nodded at each other wisely that new ways had to be found to empower African women.

Later, that evening, the South African Vuyiseka Dubula answered that question with a firmness and directness you would expect from her "You want to empower us? Give us our land back."

Then there is Venezuela. I really do not know where to begin. The facts, in so far as we know them, are these:  With the collapse of basic services and governance under the country's socialist government, the national AIDS program, once a global model of good practice, has all but ceased to exist. Pharmacies are empty of most commodities, including HIV medicines.  In other words, the country's 73,000 people eligible for HIV treatment, face immediate stock outs, no treatment for opportunistic infections, and a profoundly uncertain future. Activists like Mary Ann Torres and Jesus Aguais have fought over the last two years to bring the world's attention to this catastrophe. ICASO launched a report "Triple Threat" outlining a plan, that with the Global Fund and PAHO, would begin addressing this appalling humanitarian crisis. Will it happen? The Fund is committed, and activists are finally a little more optimistic that the informal buyers clubs that have sought to save lives and avert disaster may develop into larger population-based strategy. But. Where has our activism been? Our global solidarity?  Our attention is demanded on many fronts. Venezuela requires much more of us. And I urge you to visit the ICASO website, and see how you can help. "Nothing for us, without us" means all of us. 

An issue that has aroused great passion is the choice of Oakland and San Francisco as joint hosts for the AIDS 2020 conference. The US does not offer a warm welcome to the international AIDS community, to put it mildly. Visitors from drug using and sex worker communities, particularly with criminal records, face intrusive hostile receptions, and their safety and wellbeing may potentially be put at risk. The International AIDS Society faces a profound conundrum in finding alternative sites with the capacities and budgets to accommodate the 17,000 or so souls that make this conference their home for a week. One of the smartest observations came from  JD Davids who has been deeply involved in advocacy efforts to find an alternate country willing to host the conference. He has been critical of my own stance, which is, while unhappy with the decision, just to get on with it. He observed, with deep anger, that if an alternative can not be found, Oakland and San Francisco have to create a political conference that confronts the exclusion of key populations directly. And I believe him to be absolutely correct.

Elsewhere, another comment critical of the venue for AIDS 2020, engendered in me a fury I have not felt since the 2016 US Presidential Election.  AIDS 2020, it was argued, should not be held in Oakland and San Francisco because we live in "Trump's America". Inside me welled a refusal that my America would, under any circumstances, be conceded to the current occupant of the Presidency mired in collusion and corruption  So much of the opposition has its roots in the Bay Area, not least Congresswoman Lee, that AIDS 2020 must be the Conference, not of Trump, but of the Resistance.

Finally, Im going to make a cheesy pitch for the first "Power and The Plumley" podcast, in which Lisa Power and I, after over twenty five years of friendship and activism, take a sardonic, but hopefully optimistic take on AIDS, Development and the terrible state of global politics these days.  The first episode will go live in a few days (once I have worked out the editing app). We were both struck by how AIDS 2018 saw so may new, young activists are taking the lead.  As we looked through the photos to promote "Power and The Plumley" (which I promise are hysterical) she texted me, "We're the been there, done that, prepared to have another go at it crowd."

See you in 2020. Wherever that ends up being.