Transcriptions – Broadsheets – After AIDS 2012

Tracking AIDS Conference 2012

“Overwhelming” was the common descriptor for AIDS 2012 from delegates who I encountered, as well as those reflecting upon the conference on-line.  With 23-25,000 attendees, and between the events, constituencies, protests, networking, and the literature and other material passed out, it proved difficult to find anchors at this five-day gathering.  Despite this, there were particular ideas and initiatives promoted in the lead up, during, and immediately following the Conference. The topics are boosted through the high-profile status of the AIDS Conference, and by the popular media access afforded to those who gathered.

I track the issues in the usual on-line sleuthing, and add in coverage by the International AIDS Society as well as my attendance during the first days.

1.         Before the Themes, a Picture of Conference Happenings:

Who was there? A better question might be, who was noted not to be?  While the Washington DC location was celebrated for signaling the lifting of the US travel ban for people with HIV, it was not lifted on sex workers and drug users. As a result, non-American members of these groups were excluded from attendance.  As KFF summarized based on coverage in the Science Speaks blog, the exclusion set off a petition, conference protests, and the staging of alternative conference events in Kiev, Russia, and Kolkata, India.  Melissa Grant also documented these issues on 7/22 and 7/24 for The Nation. In addition, Mia Milan writes for South Africa’s Mail and Guardian of the low presence of nonwestern journalists.  She notes sitting on a media panel of 10 as the lone African representative. She contrasts this, however, with the increased number of “African voices” on Conference panels.

Descriptions of conference proceedings mention the following spaces. On the below-ground floor at one end of the convention center was the ‘Global Village,’ the only area free and open to access and called the ‘grassroots zone’ by a video journalist for The Body.  These halls consisted of colorful civil society booths, some of which sold crafts to fundraise for their organizations.  Large screens broadcasted presentations from the closed sessions, and various events were held around the halls.

On the Conference’s opposite end were the exhibition halls featuring corporate, government, and large philanthropic organization booths.  Rather than raising money, they gave items away – mostly snacks, from what I could tell. The Chevron booth generated buzz, as one of the Global Fund’s first corporate partners who continues to be giving away large amounts of money to Fund-related initiatives.

Between these zones were poster and panel sessions where members of the HIV/AIDS community and other prominent voices (celebrity, politician, and other) presented their work.  Presentation summaries are now circulating (see UCSF blog), as well as clips of note-worthy sessions; e-health chose to highlight Stephen Lewis on treatment for HIV positive 0-3 year olds, a session on nutrition, on the uptake of HIV home-testing kits, and the South African Deputy President’s remarks.

Traveling between the sessions were opportunities to view art installations and performance groups, and drink lots of Starbucks coffee.

2.         Measuring Activism

A topic recently taken up on Transcriptions, the Conference also explicitly raised the topic of activism.  A blog post at Health Affairs commented that the conference offered spaces where power could be ‘contested.’  Indeed, one post notes various marches and protests (see this photo on the Global Fund website) throughout the week.  An anti-circumcision group camped out across from the center’s main entrance.  And protestors interrupted Hillary Clinton’s address calling attention to US trade negotiations to limit generic drug production (the issue is described in the Health Affairs blog).

Yet, waning activism is also of concern in the days following.  “Clinton at the AIDS Conference: ‘we have to deliver’” on the Gates Blog cites to a posting in the New Republic observing that the conference was less fired up than in previous years (note that comments posted to that article take issue with it).

Another sighting of activism is found in the speeches by global health players who used their addresses to figure them as central to HIV/AIDS history.  Newly appointed World Bank President Jim Kim said in his address that the HIV activists “led the way – putting pressure on politicians and drug companies to act,” and UNAIDS’ Michael Sidibe echoed Dr. Kim.  In a noteworthy move, Hillary Clinton used the protest that started up during her talk as a way to also sign-post the importance of activists to the HIV/AIDS response.

These moves may reveal a strategy playing out to co-opt activist discourse and infuse it with support for state-sponsored campaigns like the AIDS-Free Generation heavily promoted by the US State Department.  Drawing on the prominence of the activists may be an attempt to counter what may be (or is imagined to be) the setting-in of ‘HIV/AIDS fatigue,’ as was hinted at in a PBS AIDS 2012 wrap-up interview, posted at Insite.  A prominent editor from the science journals states that a current “challenge” in the movement is to maintain enthusiasm and, in turn, funding levels.  In view of this admission, even the ramped-up language  of ‘cure!’, ‘End AIDS!’, and ‘AIDS Free Generation!’ finds a new valence,  one that uses these labels to connote not only what’s possible, but attempts to inspire feelings about them, which will lead to particular forms of action.

A future Broadsheet will attend to the circulation of these new terms, but we can already identify traction in the establishment (spoiler: see language adopted by the AIDS Alliance).

3.         Beyond Partnership

Taking ‘partnership’ language a step further, African countries were praised throughout the week for “putting away money” towards healthcare, as reported by PlusNews.  Celebrating African leaders for coming up with their own strategies to fund HIV/AIDS interventions is a position that’s been promoted by the UNAIDS for awhile; just before the Conference began, Huff Post ran an op-ed (7/17) by UNAIDS’ Michael Sidibé stating, “Astute African leaders are striving to ensure … a new paradigm of partnership for sustainable health development — a partnership that is led by Africa, for Africans, through African-sourced solutions.” At AIDS 2012, other prominent speakers like Bill Clinton joined and perhaps bolstered UNAIDS’ position.

4.         Special Populations: Women and Children

Framing HIV/AIDS in terms of populations of risk, vulnerability, and equity is nothing new, but take note of the particular headliners from this Conference: women and children.  Those working on serving these populations were ‘energized’ at AIDS 2012, as reported in the UCSF blog.  AIDS Map links to coverage about this group too.  An article synthesizing statements made throughout the conference showcasing women includes: women as long-time champions of the struggle; women as oppressed and therefore needing specific interventions (see the roadmap); and women as gateways to address the needs of “vulnerable families” and others. KFF also links to coverage on Huffington Post’s Global Motherhood blog echoing these issues.

In line with Kathleen Sebelius’ address to AIDS 2012 noting the gender and HIV/AIDS dimension, the US Health and Human Services announced its release of $68 million for U.S.-based HIV programs focused on linking HIV+ black women to care and treatment (see praise for this in an article by Phil Wilson on for The Body).

5.         Funding Rationalities

How to fund the newly-elaborated multi-pronged strategies dominates the discourse.  The ‘reality’ of the cost of coverage despite global recession is widely noted (AIDS MAP has thorough coverage, including this well-researched piece), as well as discussions about the trade-offs between HIV/AIDS funding versus other global health priorities (see the World Bank sponsored debate and this Bloomberg Businessweek article).

An earlier Broadsheet noted that funding discourse is intensifying a corporate-rationalist logic. Not only must interventions work, but they must work better than others to demonstrate “value for money” and “high impact interventions,” (cited by KFF, 7/19).

In fact, the language of comparative advantage as a targeted approach was used by Global Fund manager Gabriel Jaramillo interviewed from AIDS 2012.  In one passage, he says,

Once we know where the opportunities are, then we can talk to our partners to see who is going to take care of them. We can also motivate the countries to come to us for specific funds for very specific populations because we know they will be very effective. We will be geared to make that investment because the returns are so huge, and that is what my donors what to hear. They want to know from me that I know where we are putting that money and I understand what kind of impact we are going to get. I am very targeted at what I am doing, and that’s the name of the game now. Money is scarce, donors are more demanding. Rightly so.”

Setting aside the fiction that interventions always follow the plan, two issues to highlight: one is confirmation of the increasingly Fordist, improve-the-production line mentality on display.  The other is the attachment of such logic to donor expectations, defined as promoting confidence that they will have a good ‘return on investment’ for their contributions.  By foregrounding the donor, we might ask questions like: What are the effects of donor expectations on the production of interventions, in imaginary and real terms, for governments, agencies, and people on the ground the world over?  And, to the point of activism being praised and promoted as I described above, how is it figured with/against this notion of donors driving the agenda? Is this Global Fund-speak, or indicative of larger donor-related institutional logics and arrangements?

6. Miscellaneous

How new are the AIDS 2012 messages?  Listening for overlaps took me to the US Global AIDS Coordinator, Eric Goosby’s interview at AIDS 2010. There, he iterates many of the points that were central to this conference: the focus on women and children, and an community and family improvements; ‘country ownership’; and prevention as treatment. What hasn’t lasted? Microbicides, for one –the promise of 2010 does not have a presence at coverage in 2012.

I end with a small but critical observation from the proverbial soap box.  Transcriptions aims to foster cross-disciplinary conversations, pushing all of us forward at the intersections of biomedicine, public health, and the social sciences.  A blog posting like this one reminds us of our challenges.  While the writer’s scientific review is well-executed, his offerings on the “social/political” side of the Conference undermines the importance of those very issues.  Side-trips to museums and smug remarks about the activists’ volume will not foster our dialogue in productive ways.  We need better ways of taking each other, and these pressing issues, seriously.