21 July 2009

The Political Power of Science

By Robin Gorna, Incoming Executive Director of the International AIDS Society

"Aren't conferences just a big waste of money?"

Only a couple of my friends have failed to understand my over-whelming excitement at being appointed as the new IAS Executive Director - and when I left the opening ceremony late Sunday night, I knew I'd never struggle again to explain.

I've been to nearly every International AIDS Conference, but never before made it to the IAS Conference on HIV Pathogenesis, Treatment and Prevention. The opening ceremony line-up looked familiar - a healthy mix of politicians, activists and researchers, with great cultural performances thrown in. What threw me was the depth of scientific detail, and the fiery spirit of activism from all key speakers.

Stephen Lewis took Scientists as Activists as his topic and delivered a barnstormer of a speech describing how the policies of Nazi Germany, nuclear war and climate change have all been altered by science speaking truth to power. No stranger to controversy, few would expect anything less of Stephen Lewis. More significant, was how all of the scientists showed their activist side. Nobel Laureate Françoise Barrè-Sinoussi concluded her highly technical review of viral reservoirs by changing into a Treatment Action Campaign (TAC) "HIV Positive" t-shirt.

Prof. Barrè-Sinoussi discovered the virus and is now mobilising young basic scientists to join her in the quest for a cure - and on the way she had a slap on the wrist for the global community. This is not the moment to scale back resources from AIDS: "HIV is not in recession."

A constant theme from all speakers was the real concern that AIDS has dropped off the global political agenda. And what was striking about this focus and the strong advocacy was that it was so firmly rooted in evidence. Stephen Lewis highlighted the toxic, false debate that is raging between those who want to put resources behind health systems, arguing that AIDS has had too much. He called on us all to contest the size of the pie, not squabble about the size of pieces. And made it plain that his advocacy was always derived from what scientists of all disciplines had found. Vuyiseka Dubula, Secretary General of TAC, and a woman living with HIV, pointed out that steep rises in maternal and child mortality in South Africa are both due to HIV. The evidence shows that getting women on HAART and scaling up PMTCT will tackle all three health-related MDGs. Yet political interest in MDGs 4 and 5 (reduce child mortality, improve maternal health) is in the ascendancy, while commitment to MDG 6 (combat HIV, malaria and other diseases) is on the wane.

This shift in priorities is so ill-timed given that we are getting ever closer to knowing what is needed to halt and reverse HIV and AIDS. Evidence presented by IAS President Julio Montaner at the opening showed that treatment with HAART reduces morbidity, mortality and incidence. In 2005 the G8 committed "to develop and implement a package of HIV prevention, treatment and care, with the aim of as close as possible to Universal Access to treatment for all those who need it by 2010". This simple statement mobilized the world - and all UN countries signed up later that year. Yet this year's G8 in L'Aquila seems to have dropped the ball, and speaker after speaker called on the G8 to step back up to the mark to deliver on their promises in the next 17 months.

I am proud to be joining the IAS: the world's independent membership association of HIV professionals from all sectors, committed to advancing knowledge on HIV and AIDS, and most importantly, translating this knowledge into practice. This must include tackling the policies and funding decisions that block the progress towards this end.

Conferences, a waste of money? I don't think so. What this conference opening reminded me of is the real power of the IAS: to bring people together, to broker debates and to build consensus about how best to tackle current challenges. And the conferences are also the platform to speak out and tell the world what is known and what is right. People living with and affected by HIV and AIDS have the right to evidence-based responses. And we should not shirk from speaking that truth to power.

Robin Gorna commences as Executive Director of the International AIDS Society on 1st September 2009.

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