Positive anger: AIDS activists Venancius Rukero and Mark Milano address the protest rally preceding the opening ceremony in Bangkok. Photo: Paul Kidd.

The news from Bangkok is sobering. The number of people infected with HIV worldwide continues to grow. Twenty million have died over 25 years, and yet there is no sign of a cure and little expectation of a vaccine any time soon. Treatments exist, and they work, but there are real barriers to making them available to the vast bulk of people who need them.

Against this background, almost 20,000 people made their way to Bangkok, Thailand, in July for the 15th International AIDS Conference. The theme of the conference was “Access for All,” but while everyone may have agreed that this was an appropriate goal, few of those at the meeting expected that universal access — to treatments, to information, or to prevention information free of ideology — was a likely outcome of the gathering.

The conference — the largest ever — featured a now-familiar parade of politicians, advocates and celebrities calling on the leaders of the world to act.

In the opening ceremony, United Nations Secretary-General Kofi Annan said that, three years after the UN special session on HIV/AIDS, much progress had been made, but added, “we are not doing nearly well enough.”

He warned the conference of dire consequences for the Asia-Pacific region unless action is taken to prevent an African-style epidemic from taking hold.

“Here in Asia, HIV/AIDS is at a turning point,” Annan said. “How you will address this challenge will impact on the very future of the region.”

Annan said that several of the targets set three years ago at the UN special session on AIDS have not been met, and noted that women and girls are bearing the brunt of the epidemic in the developing world.

The opening of the four-day conference was marred by a perceived snub to HIV-positive people, with the only speech by a positive person, Paisan Suwannawong of the Thai treatment action group, shunted to the tail end of the ceremony, by which time the officials, celebrities, and much of the audience had left.

The last-minute change in the three-hour program was condemned by HIV activists and the Global Network of People Living with HIV/AIDS, one of the co-organisers of the conference.

The opening ceremony was preceded by a large and noisy protest by Thai and international AIDS activists, some carrying banners reading “you talk, we die.” There was widespread anger over the US$1000 registration fee for the conference, which meant that few people with AIDS from developing countries were able to attend, and disquiet over the decision of the US government to radically reduce its representation at a conference which has been strongly critical of US policies on HIV/AIDS.

One of the most energetic areas of debate at the conference was over the controversial, US-backed, ‘ABC’ approach to prevention (Abstinence, Be faithful, use Condoms). While this approach has been enthusiastically adopted in some countries, most notably Uganda, where it has been claimed to be highly effective, activists and researchers in Bangkok attacked the notion for being simplistic and sex-negative. The US government’s decision to tie substantial amounts of AIDS funding to promotion of abstinence was strongly criticised.

The decision to hold the conference in Bangkok was based on both the Thai government’s successes in combating AIDS and on the widespread view that Asia will be the new battleground of the HIV/AIDS epidemic. But Thailand’s policies towards drug users, who make up the lion’s share of people with HIV in that country, came under attack from a large contingent of Thai and foreign drug user activists.

At the conclusion of the conference, several speakers noted that some of those most vulnerable to HIV/AIDS — drug users, women and girls, sex workers and people living in poverty — had, like Paisan Suwannawong, not had their voices adequately heard.

The next International AIDS Conference will be held in Toronto, Canada in two years’ time.