BANGKOK, July 19 (UPI) -- The XV International AIDS Conference closed in much the same way as the previous two -- Nelson Mandela made a stirring call to arms, children sang and delegates lit candles in a darkened arena.
This year's closing was different in one way, however: For the first time, speakers were not calling for more money, but for a coordinated way to spend it.
About $6 billion is now available, said Peter Piot, head of the United Nations Joint Program on HIV/AIDS.
That still is less than half of what experts think will be needed by the end of next year, but it is enough that Piot was able to declare: "I truly believe that for the first time there is a real chance that we will get ahead of this epidemic."
The task ahead is to "make the money work for people," he added.
Piot did not directly mention the United States, but throughout the conference several policies championed by the Bush administration became lightning rods for protest:
-- The administration's decision to establish its own funding -- the President's Emergency Plan for AIDS Relief, or PEPFAR -- to fight the disease instead of tossing billions into the pot of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Most countries contribute to this fund, but President George W. Bush has decided to launch his own $15 billion program, which is entirely separate.
-- The fact that much of the money in PEPFAR is tied to programs that preach sexual abstinence as a prevention scheme, despite a lack of scientific evidence such abstinence programs work.
U.S. supporters of abstinence campaigns point to success in Uganda's ability to reduce AIDS infections markedly in that hard-hit, East Africa nation. President Yoweri Museveni has strongly advocated abstinence as a prevention effort, but others suggest that Uganda has succeeded in reducing its AIDS prevalence from 30 percent to 5 percent through vigorous campaigns for prevention, reduction of stigmatization and relative national stability since Museveni came to power in the late 1980s.
In general, the U.S. position of insisting on the ABCs of prevention -- Abstinence, Be faithful to one's partner and use Condoms properly -- rarely works among girls and women who are raped, are faithful to husbands who infect them and have little say on condom use in most of the developing world.
-- A belief that PEPFAR is simply a conduit to move billions of dollars to Big Pharma for high-priced, antiretroviral drugs instead of buying cheap, effective generics. The human immunodeficiency virus, which causes AIDS, is an organism called a retrovirus.
-- The decision by U.S. Secretary of Health and Human Services Tommy Thompson to severely cut U.S. participation at the conference was viewed as an obvious attempt to punish the conference for his personal treatment two years ago in Barcelona, when protesters drowned out his speech.
The decision could be viewed as a "cut-off-your-nose-to-spite-your-face" act because 19,843 people attended this year's meeting, making it the best-attended International AIDS Conference in its history, which dates back to 1985.
Thompson's decision -- derided as "petty politics" by Dr. Catherine DeAngelis, editor-in-chief of the Journal of the American Medical Association -- also left reporters scrambling to find someone to answer charges leveled at the administration's policies. The staff cutbacks wiped out all newsroom personnel for the two main U.S. delegations -- the Centers for Disease Control and Prevention and the U.S. Agency for International Development.
When AIDS Ambassador Randall Tobias, the highest-ranking U.S. delegate, started his talk, protesters shouting slogans delayed his speech about 15 minutes. Unlike Thompson, though, Tobias was able to address a largely supportive audience at the conference.
Following Thompson's speech debacle, the International AIDS Society adopted new rules that specifically threatened expulsion from future meetings if protesters did not let people speak. Dr. Joep Lange of the Netherlands, presiding officer of the Bangkok meeting, said the new rules allowed for protests but also preserved the right of all views to be heard.
On the money front, Piot said AIDS donors must work together.
"The reality is ... scores of AIDS donor missions, numerous evaluation meetings, rival coordination mechanisms, an epidemic of workshops and meetings, and piles of paperwork," he said. "Fragmentation has real costs, in money and in lives."
Canada's Stephen Lewis, the U.N. ambassador for HIV/AIDS in Africa, said the switch from clamoring for money to clamoring for better ways to spend it is "a complete change from Barcelona."
Part of the reason for the sea change, Lewis told United Press International, has been the World Health Organization's "3 by 5" program, whose goal is to have 3 million, HIV-positive people treated with anti-HIV drugs before the end of 2005.
"Suddenly, there's a sense that we have a program to put in place ... a sense that you've got to reach the target," Lewis said. "And there's some money available to do that."
The problem with 3 by 5, however, is the program is well behind schedule. Scarcely 400,000 people are being treated, with less than 18 months to go before the end of the goal. More ominous: Only 15,000 people out of the 100,000 people needed to administer 3 by 5 have been trained and just 5 percent of the clinics where treatment will be given have been identified.
Nevertheless, Lewis said he thinks we'll see a "veritable explosion" in treatment early in 2005 -- supporting the contention of WHO officials, who think scale-up of the program will jump in geometric fashion as soon as the foundation for drug delivery is in place.
Lewis said the continuing, "underlying tensions" between the international community and the U.S. government are worrisome. Nevertheless, the sense that there is now enough money available to make some real progress was underscored by two major financing announcements on the last day of the meeting:
-- The European Union announced it would add 42 million Euros (about $52 million) to its Global Fund contribution. Including the contributions of the E.U. member states, that makes it the second largest AIDS donor.
-- The Bill and Melinda Gates Foundation gave $50 million to the Global Fund.
Still, even Mandela registered an indirect criticism of the United States, calling for "everyone to help fund the (Global) Fund now." Mandela said he is retired and by rights should not be on the podium at all.
"However, the fight against AIDS is one of the greatest challenges the world faces," he said. "I cannot rest until I am certain that the global response is enough to turn the tide of the epidemic."
Mandela, who celebrated his 86th birthday Sunday, said "there could be no better birthday gift" than a new commitment to action against AIDS.
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Michael Smith and Ed Susman cover medical issues and research for UPI Science News. E-mail [email protected]
