Title: A Week in Bangkok

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Section/SPIG: HIV/AIDS

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I was fortunate to attend the XV International AIDS Conference held in Bangkok, Thailand, from July 11 – 16, 2004. There were nearly 20,000 attendees from over 120 different countries who participated in the six-day conference. Bangkok is a culturally diverse city of nearly 10 million inhabitants. The city includes many beautiful Buddhist temples, the king’s residence and governmental offices, gleaming new office buildings as well as impoverished areas. The Thai people are warm and friendly. They made the attendees feel welcome and comfortable.

Although there have been 14 international conferences prior to this one, in my opinion, this was the first time attendees could obtain a true sense of the global health impact of the pandemic. Past conferences focused on issues of importance to the United States and had less of a focus on developing countries. While some of this was still true, many of the panel presentations I attended had no representation from the United States. This provided me with the opportunity to learn from presenters from sub-Saharan Africa, India, China, Russia, Vietnam, Thailand, Haiti and other parts of the world that have been hard-hit by AIDS. The issues and concerns they have are very different from what we face in the United States. As a public health professional, this was both useful and important information. The statistics provided by epidemiologists from the World Health Organization and other groups were sobering – nearly 40 million people infected worldwide, with an estimated 5 million new infections during the past year.

There was a clear distinction between countries that have ready access to life-saving anti-retroviral therapies (like the United States) and those who cannot afford these medications. In fact, much of the political activism associated with the conference had to do with how to provide medications to resource-poor countries. Pricing of the medications is an obvious concern, but the issue is complicated by a lack of trained health care staff to administer the medications, as well as other infrastructure issues. There are other concerns that were voiced about the safety and efficacy of unlicensed generic drugs made by companies in India and elsewhere. There was little discussion of vaccine development, which was disappointing. There are some new directions that are being pursued in terms of attempting to eliminate the virus from viral reservoirs, but there is a clear recognition that there is no “magic bullet” in sight, and we are in for a long haul to conquer AIDS. There were several promises of funding that were made by the Global AIDS Fund, big pharmaceutical companies and the governments of several developing nations that have been significantly impacted by HIV/AIDS. One ambitious but obtainable goal is to provide antiretroviral therapy to 5 million HIV-infected people worldwide by 2005.

There were no significant clinical breakthroughs announced at the conference. While some attendees might not agree with my assessment, we did not have newsworthy scientific findings that could compare with the announcement of the success of protease inhibitors and combination or HAART therapy from the XI International Conference held in Vancouver in 1996.

It was a pleasure to listen to Nelson Mandela, Secretary of the United Nations Kofi Annan, and Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases. Upon my return to the United States, I was surprised by how little attention the conference received in both the print and broadcast media. Like most people who have been involved in fighting this battle for a long time, I look forward to the day when international conferences on AIDS will no longer be necessary because we have found a cure for this terrible scourge.