Reflections on AIDS 2014

August 15, 2014

Reflections on AIDS 2014

Melbourne, July 20-25, 2014

Introduction

The International AIDS 2014 Conference, held in Melbourne, Australia from July 20-25, left very mixed impressions.  The tragedy of Malaysia Airlines flight 17 cast a shadow over the event, and profoundly shaped the atmosphere and discourse.

The most salient, substantive takeaway from the conference was that there is a remarkably clear consensus on what the priority approach needs to be in working towards achieving an AIDS-free generation by 2030.  This consensus became apparent across multiple presentations: by Ambassador Deborah Birx, U.S. Global AIDS Coordinator; Mark Dybul, Director of the Global Fund; Salim Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa; Michel Sidibé, Executive Director of UNAIDS; and others.  

Over and over again, we heard about the need to make full use of the expanding prevention tools now at our disposal, systematically retool approaches to target investments intensively at the local or subregional level where the epidemic is concentrated, and dramatically improve empirical data on local population impacts to guide future investments.  Rural girls and key populations – men who have sex with men, commercial sex workers, and injecting drug users – remain high priorities, especially in the face of the acute, worsening threat of the proliferation of laws and policies that are fundamentally homophobic, criminalizing high-risk behaviors and compromising access to key populations.  Perhaps most importantly, there was a palpable realism that major new donor flows will not emerge and countries themselves need to step up much more seriously to support and fund this effort.

This was not a conference torn apart by major controversy.  Quite the contrary: it featured a unified, mature community focused on carrying the work of implementation forward, led by a seasoned leadership with exceptional longevity.  The overall outlook was constructive and forward-looking.

While the conference was successful in drawing 30% of its delegates from the Asia-Pacific –while also maintaining robust African participation – it did not attract Asian leaders or signal any sense of a new momentum within the region.  The absence of high-level Asian participation was a disappointment.

The main story for AIDS 2014, however, was MH17.

The shooting down of flight MH17 on July 17 resulted in 298 deaths.  On the plane were six International AIDS Society (IAS) delegates, including the renowned Dutch HIV/AIDS researcher Joep Lange and his partner Jaqueline van Tongeren, as well as 37 Australian citizens and permanent residents.  Suddenly, the International AIDS Conference and its host nation had each been involuntarily thrust into the unfolding, violent geo-political crisis surrounding eastern Ukraine.  There was no escaping that reality and its aftermath as the Conference unfolded. 

What specifically did this mean?

First, MH17 generated a massive spike in the global media coverage of AIDS 2014, when otherwise coverage of an IAS conference in Australia – on the far periphery of the global epidemic – likely would have been modest.  The burst of media attention was bolstered by an initial, erroneous report that 108 IAS delegates had been killed.  The recurrent story line was the tragic loss of lives and the human impact upon the HIV/AIDS community.  Far less was the focus on the conference itself: its debates, discoveries, or major policy or programmatic developments. 

Second, the MH17 tragedy had a disorienting and dulling effect on the first days of the conference; a quiet somberness hung over the delegates, opening events, and early panels.  At the same time, the HIV/AIDS community rebounded through its remarkable resilience, its capacity to absorb, reflect, and move forward.  Speakers repeatedly invoked the memory of Jonathan Mann and his wife's deaths on a flight in 1998, and pledged to serve the legacy of those IAS delegates and others who had been lost through a renewed commitment to end HIV/AIDS.  They drew on the community's shared experience of loss, irrational cruelty, and violence.

Third, a turning point in the week was former President Clinton's speech at midday on Wednesday, July 22 – another key moment at which international media coverage suddenly intensified.  Eloquent, poised, and humble, he cleared the air and lifted the spirits of the conference.  His speech defined the moment, attributing MH17 to "the dark forces of our interdependence" and appealing to everyone present not to weaken their resolve in the face of the tragedy.  He emphatically supported the Dutch, American, and Australian position that shooting down MH17 was a crime that required accountability, one that could not be excused simply because the pro-Russian militants, likely with Russian support, might have mistakenly shot down the wrong plane.  He segued from that vital point to appeal to the assembled HIV/AIDS community: it had an obligation to honor the service and lives of those lost.  "We have to remind people that the people we lost on that airplane gave their lives to the proposition that our common humanity matters a hell of a lot more than our interesting differences." 

Fourth, the loss of 37 Australian citizens and permanent residents consumed and united Australians.  It provoked outrage.  It left little space for high-level Australian political participation in AIDS 2014.  An overwhelming focus was the nation's grief; 1,200 of Australia's leaders, from the political, faith, business, and other sectors, gathered on Thursday afternoon at St. Paul's Cathedral, a short distance from the conference across the Yarra.  Australia's geo-strategic imperatives were a powerful preoccupation: to assert Australia's voice in New York at the UN Security Council, and to press forcibly for its forensic experts, the Dutch counterparts, and others to get to the crash site to secure the bodies and remains. 

Fifth, behind the scenes at the conference, Russia's role greatly aggravated preexisting tensions and uncertainty over the future of HIV/AIDS programs and policies in Russia and former Soviet states.  In its seizure of Crimea, its escalating violent confrontations with Ukraine, and its increased efforts to intimidate and draw other former Soviet states more tightly into its circle, Russia under Putin has raised serious fears of regression on HIV/AIDS: that the window is closing on international research and programmatic collaborations, including harm reduction, and that stigma and violent discrimination is worsening against men who have sex with men, commercial sex workers, and injecting drug users.  The public health battlegrounds are hardening in Central Asia, the Baltics, Ukraine, and Russia itself; how to approach     these challenges politically remains uncertain.

There was no way to foretell that this geo-political tragedy would descend upon Melbourne.  The story of MH17 became the dominant frame for the Conference, and it will inevitably define how AIDS 2014 will be remembered in the future.  But while the Conference itself was overshadowed by the events in Ukraine, the real story of AIDS 2014 is a unified understanding of how we can work toward an AIDS-free generation in the coming decades.  Indeed, the tragedy reaffirmed a will and determination to stay the course, demonstrating the remarkable resilience and humanity of the global HIV/AIDS community.