This August will mark the XVI International AIDS Conference - when more than 20,000 researchers, health experts, NGOs and activists converge on Toronto. Now a bi-annual tradition, the week-long international AIDS conference is a far cry from its first incarnation in 1985 as a scientific gathering to better understand this new disease. It is a multidisciplinary conference, led by the Geneva-based International AIDS Society (IAS) and organized by a consortium of international NGOs, networks of people living with HIV/AIDS, and UN agencies.

A Program Overview
The 2006 AIDS conference will focus on the most current issues, including accelerating research to end the epidemic, expanding and sustaining human resources such as strengthening health systems, intensifying involvement of affected communities, and building new leadership. Following on the heels of the recent UN High Level HIV/AIDS Meeting in New York, AIDS 2006 will cover a lot of territory with a dizzying number of concurrent sessions on research, advocacy and, of course, politics.

Selected from a record number of nearly 13,000 submissions, the conference will highlight pivotal new research covering fresh findings on the origins of HIV-1, studies on immunological resistance to both the virus and to drugs, new data on the complex intersections between TB and HIV, and the later impact of single-dose nevirapine on pregnant women. Evidence will be a common theme in approaches to prevention and scaling up access to treatment and care. Empowering women and girls will be featured in numerous sessions, as will the relationship between HIV, poverty and development, and the importance of sexual and reproductive health rights for women, including commercial sex workers.

The program will explore issues affecting men who have sex with men and other vulnerable populations, including aboriginal people and injecting drug users. It will emphasize the greater involvement of people living with HIV/AIDS and the importance of new leadership in regions with emerging epidemics. Two special sessions will offer a retrospective of the first 25 years of AIDS and AIDS activism, while also exploring the major priorities toward ending the epidemic.

Does the Conference Still Matter?
Perspectives from Some Longtime Conference-Goers
Even as 20,000 members of the global health community come together in Toronto, with nearly as many issues of top concern, it may still be useful to ask: Does this conference still matter? How does it measure up to past conferences? Is it worth the cost and effort in helping to advance the fight against HIV/AIDS?

Perspectives and experiences from public health and medical professionals, activists and conference organizers, run the gamut. Dr. Helene Gayle, co-chair of AIDS 2006 and president and CEO of Care International, is clear: "It is one of the most important gatherings for the release and discussion of key scientific developments in the fight against HIV/AIDS." But the U.S. government, the largest single funder of HIV/AIDS programs globally, has significantly reduced its support and participation in the conference.

An informal survey of longtime HIV/AIDS leaders and IAS conference-goers produced the following:

Dr. Farley Cleghorn, director of the Washington, D.C., Center for HIV/AIDS at Futures Group, attended the 2nd International AIDS Conference held in Paris in 1986. He has no doubt that every one of these conferences has been significant. But he also wonders how we maintain value so that the costs of such a large meeting are translated into an equally big payoff. What are the results?
"We still need them," said Ugandan-born Sophia Mukasa-Monico, senior HIV/AIDS advisor with USAID/Nigeria, recalling the 1998 Geneva conference where serious discussions on creating a global funding mechanism for HIV/AIDS began. From those early discussions, the Global Fund for AIDS, TB and Malaria was born and who knows what new inspiration could emerge from AIDS 2006.
Shaun Mellors, a South African with the UK-based NGO International HIV/AIDS Alliance and a key member of the 2000 Durban organizing committee, had some strong memories from the earlier conferences - in Berlin, Amsterdam, Yokohama - before treatment was available. "We (people living with HIV) always came to the conference with the expectation of receiving news about a cure or treatment. We checked to see who was still alive, became frightened if they were not there, or if someone had lost weight or discovered a new opportunistic infection or a new look. He calls up, as if it were yesterday, a memorable moment in 1992 at the Berlin conference when a speaker asked all the HIV positive people in the audience to stand up … "about 20 of us stood up," he said. Acknowledging the personal benefits, he returns to the present and wonders if the international AIDS conferences are not getting too big to be effective. The size and scale of the epidemic and the responses are now spawning new specific conferences, he said. "You have the IAS pathogenesis conference, the home and community care conference, the microbicide conference, the vaccines conference," and others. Are we losing the forest for the trees? He asks.
Another long-time conference organizer and HIV/AIDS policy advisor in Mexico, Canadian-born Ken Morrison recalls 1988 Stockholm when it was primarily a medical and research conference. His drop-in suggestion booth for NGOs led to the community forum the following year at Montreal and has been part of every subsequent conference. Morrison believes the personal benefits of conference participation are undervalued, pointing as evidence to professional networking renewing commitment, questioning yourself and your work, learning something new, and establishing friendships and collaborations.
Stu Flavell, a longtime HIV/AIDS activist and recent coordinator of the Global Network of People Living with HIV/AIDS (GNP+), recalls 11-year-old HIV-positive Nkosi Johnson's speech at the 2000 opening ceremony in Durban, South Africa. "It was stunning to listen to this young boy challenge his intransigent national leadership. This moved him well-beyond the image of some sort of pathetic poster child to the knife's edge in cutting at the blather coming out of the South African political leadership."

Indeed, for those who continue to attend the international AIDS conferences, the value is immeasurable. The conferences continue to be extraordinary interdisciplinary meetings dealing with the pre-eminent public health issue of our time. Says Flavell, "Yes, they are circuses, but you need a lot of rings to handle the wide range of issues arising from this single virus. It encourages one to think more holistically about HIV."

He argues that the IAS is attempting to restructure the conference to keep its scientific edge, while recognizing its interdisciplinary role. "Otherwise," he says, "the doctors and researchers will go to their meeting, the political types will go to theirs, and the cross-pollination critical to creative solutions will be greatly suppressed."

The Role of Protest
Protest has been part of the conferences almost from the start. For many conference-goers, taking action highlights people's sense of frustration and fear in the face of HIV/AIDS. It also serves to mobilize and inspire. For others, of course, it divides when it should unite.

Scientists and public officials have long been the targets, but beginning in Geneva (1998) and loudly in Bangkok (2004) pharmaceutical companies have taken the big hits. Protests have ranged from peaceful protests to spray painting and vandalism directed against the elaborate corporate displays (many larger than houses) in the commercial venue of the conference.

World Bank director of the Global HIV/AIDS program, Debrework Zewdie, has attended nearly all the international AIDS conferences and recalls the earlier activism. In particular, she remembers San Francisco in 1990 where activist groups stopped the U.S. government representative from speaking. That was a turning point for these conferences, she said. "The protest was done very tastefully just by standing up and making noise with key chains!"

"Heartbroken" by the young patients he was seeing as a young physician in Trinidad, Cleghorn says that the activism of young gay men advocating for themselves opened his eyes. But at the Washington, DC, meeting the following year, "I was stunned to see physical violence erupt during a demonstration against Ronald Reagan, with police wearing yellow gloves to arrest people. It was the same day I gave my oral plenary talk at the meeting."

For further information, contact: rmacinnis@internews.org

1st Conference - 1985, Atlanta, USA
In April, more than 2,000 people attended the 1st International AIDS Conference held in Atlanta. Three major topics of discussion were the new HTLV-III/LAV test, the situation with regard to AIDS internationally, and the extent of heterosexual transmission.

"Some experts are skeptical that AIDS will spread as rapidly among heterosexuals as it has among homosexuals. Yet other experts, taking their cues from data emerging from preliminary studies from Africa showing equal sex distribution among males and females, are less sure."

- The New York Times

Immediately after the conference, the World Health Organization (WHO) organized an international meeting to consider the AIDS pandemic and to initiate concerted worldwide action.

2nd Conference - 1986, Paris, France
In the opening speech of the International AIDS Conference, Dr. H. Mahler, the director-general of WHO, announced that as many as 10 million people worldwide could already be infected with HIV.

5th Conference - 1989, Montreal, Canada
ACT UP and its Canadian counterparts, AIDS Action Now! and Réaction-SIDA, stormed the 5th International AIDS Conference in Montreal. Up until that June day, the conference was a members-only event for the AIDS establishment, a chance for scientists to meet their peers and share research. PLHIV/AIDS were presented mainly as abstractions.

6th Conference - 1990, San Francisco, USA
Protests about the (still extant) U.S. law banning HIV-positive people from entering the country continued. There had been minor changes to the law, but at the time of the 6th International Conference on AIDS, the law was still considered to be "discriminatory and medically unsupportable." A widespread boycott of the conference responded to the law, and many people who spoke at the conference took the opportunity to voice their views. June Osborn, chair of the National Commission on AIDS, said:

"How sorry I am, and how embarrassed as an American, that our country whose tradition serves as a proud beacon for emerging democracies, should persist in such misguided and irrational current policy."

The International AIDS Society (IAS) announced that no further IAS-sponsored conference would be held in a country that restricted the entry of HIV-infected travelers. As a result of the travel policy, no major international AIDS conference has been held in the U.S. after 1990.

7th Conference - 1992, Amsterdam, The Netherlands (Boston Canceled)
The decision was taken to hold the 1992 International AIDS Conference in Amsterdam rather than its planned location in Boston, following the U.S. administration's decision not to lift entry restrictions on HIV-infected travelers.

10th Conference - 1994, Yokohama, Japan
The 10th International AIDS Conference was held in Yokohama, the fi rst to be held in Asia. No major breakthrough emerged, and it was announced that in the future the international conference would be held every two years.

11th Conference - 1996 Vancouver, Canada
At the start of the 11th International AIDS Conference in Vancouver, some scientists declared that: "aggressive treatment with multiple drugs can convert deadly AIDS into a chronic, manageable disorder like diabetes."

One doctor suggested that combination therapy in the first few weeks of infection might mean that the virus could be completely eliminated in two or three years. However, Nkosazana Zuma, the health minister of South Africa, reminded the conference delegates that: "most people infected with HIV live in Africa, where therapies involving combinations of expensive antiviral drugs are out of the question."

Limitations on the use of the drugs were also reported, such as severe side effects and the difficulty of taking large numbers of pills each day.

12th Conference - 1998, Geneva, Switzerland
The challenge of this conference was not only to discuss the advantages available for the treatment of HIV virus, but to conquer the overwhelming pessimism. The mood of the meeting was in sharp contrast to the euphoria at the meeting in Vancouver two years before.

"A series of reports about new problems with anti-HIV drugs and setbacks in vaccine trials left many participants thinking that their best hope against the epidemic was the strategy they had since it began: prevention."

- The Body

13th Conference - 2000, Durban, South Africa
This was the first time that such a conference was held in a developing country. Nkosi Johnson, an 11-year- old HIV-positive boy gave a speech at the opening ceremony of the conference and called for his government to give AZT to pregnant HIV-positive mothers.

South African President Thabo Mbeki used his opening address to stress the role of poverty, explaining the problems faced by Africa and compared the campaign against AIDS with the struggle against apartheid. "As I listened and heard the whole story told about our own country, it seemed to me you could not blame everything on a single virus," he said.

To counter the comments made by President Mbeki, more than 5,000 scientists around the world signed the Durban Declaration, affirming that HIV is the cause of AIDS.

Nelson Mandela, South Africa's former president, closed the AIDS conference with a call to action to combine efforts and save people - "History will judge us harshly if we fail to do so now, and right now."

14th Conference - 2002, Barcelona, Spain
Issues around providing HIV treatment for resource-poor countries dominated the mood and agendas of the conference.

"If we can get cold Coca Cola and beer to every remote corner of Africa, it should not be impossible to do the same with drugs." - Joep Lange, president of the International AIDS Society, speaking at the closing ceremony.

The number of children orphaned by HIV/AIDS had risen three-fold in six years to reach an all-time high of 13.4 million. It was estimated that India had the largest number of AIDS orphans of any country in the world, with an estimated 1.2 million in 2001, a number predicted to rise to 2 million in five years, and 2.7 million in 10 years.

15TH CONFERENCE - 2004, BANGKOK, THAILAND
The 15th International AIDS Conference in Bangkok focused on expanding global programs for treatment and looking at trends in prevention. Much discussion/debate over the nascent U.S. Presidential Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV, TB and Malaria, as both funding sources began providing billions of dollars in HIV programs, including ARV treatment.