Episode 5 - 2002–2004: The Push for Universal Access
By the time the Barcelona conference was held in 2002, the scientific programme content had grown from an initial focus on basic science and biomedical issues to include six tracks: basic science; clinical science and care; epidemiology; prevention science; social science; and interventions and programme implementation. There was greater participation by women and individuals from low and middle-income countries in the conference programme, and greater focus on research into microbicides and other female-controlled prevention technologies. The “Durban effect” from the conference in 2000 increased the importance of HIV on the world’s political stage, and the 2001 UNGASS commitments and the creation of the Global Fund as an important new stakeholder in the global architecture helped propel AIDS onto the agenda of future G8 summits. While this was enormously beneficial, it also created new challenges for the organizers who were beginning to incorporate a greater role for political leadership into the conference programme.
Former Presidents Bill Clinton and Nelson Mandela were two of the high-profile leaders to participate in the Barcelona conference. Both publicly expressed their regret at not having done more to fight AIDS during their presidencies, although both have established foundations in which AIDS is a significant focus. Clinton and Mandela reflect the growing political commitment to respond to the epidemic after 2000. Global players, including most G8 nations, significantly increased resources allocated for AIDS during this period.
The choice of Thailand as a host country not only reflected the decision taken by the IAS at Durban in 2000 to rotate the conferences between developed and developing countries, but was also an attempt to recognize the effectiveness of Thailand’s prevention programme while bringing the conference to a region of the world where one fourth of new infections were occurring. The conference theme, Access for All, reflected the goal of universal access to HIV prevention, care and treatment interventions and the enormous growth in political attention, economic resources and profile since Durban and the establishment of Global Fund in 2002.
The conference was organized with the Thai Ministry of Public Health, which had achieved significant reductions in HIV incidence as a result of a government-initiated 100% condom use initiative and public awareness campaign. Thailand was also one of the first developing country governments to scale up provision of antiretroviral treatment for people living with HIV and as prevention of mother-to-child transmission (PMTCT). Thailand also had a strong history of international scientific collaboration. Unfortunately, its success in tackling its generalized epidemic was not replicated in its approach to injecting drug users, who account for a significant portion of the epidemic in Thailand. The “war on drugs”, which the government began implementing in 2003, resulted in more than 2,000 unexplained murders of injecting drug users and the arbitrary arrests of thousands more, with negligible impact on the epidemic among this population. By hosting the conference in Bangkok in 2004, the IAS hoped to highlight the successes of the Thai experience in responding to HIV while bringing global attention to the downside of a criminal justice versus public health approach to injecting drug use.
The programme attracted leaders from a broad range of sectors, from political icons such as Nelson Mandela and Sonia Gandhi to community leaders like the TAC’s Zackie Achmat and private sector leaders like Pfizer CEO Hank McKinnell and MTV President Bill Roedy.
The Bangkok conference featured the first Leadership Programme, recognizing that the best scientific evidence and community engagement and activism would be insufficient to reverse the epidemic without energetic and sustained leadership from political and other leaders. The objectives of the Leadership Programme were to promote concrete commitments by political leaders and others in the response to AIDS. UN Secretary-General Kofi Annan, Thai Prime Minister Thaksin and women and children’s rights advocate Graça Machel served as patrons.
The IAS and its partners also piloted the Global Village and the Youth Programme in Bangkok; they have since become highly popular components of the conference programme. The Global Village is open to the general public and acts as a bridge between local communities and the researchers, health professionals, leaders and community representatives taking part in the formal conference proceedings. The Youth Programme enables thousands of young people from around the world to discuss the response to the epidemic and to generate new ideas that meet the evolving prevention, treatment and human rights issues facing young people.