Several AFAO staff members attended the 15th International AIDS Conference in Bangkok, 11-16 July 2004. Some short reports are available on this page, with more coming online soon. Longer reports will be published in the next issue of HIV Australia (October 2004).

About 50 Australian community sector people attended, including 11 Indigenous attendees.

Key Messages and Outcomes Don Baxter, Executive Director, AFAO

Overview and gossip Andy Quan, International Policy Officer

Reflections on human rights John Godwin, AFAO Policy Analyst

Indigenous presentations Michael Costello, Indigenous Project Officer

Scarlet in Bangkok Janelle Fawkes, President, Scarlet Alliance

Please check back in again soon for more reports.

Last Updated 20 September 2004

Also of interest:

For clinical care reports from the conference, see the ASHM website.

Launch of AusAID International Policy at the Asia-Pacific Ministerial meeting.

Key messages & Outcomes

By Don Baxter, Executive Director, AFAO

• The key message that “Asian countries can still avoid major epidemics if they focus on where the infections are happening now – among IDU, sex workers, gay/MSM and migrant/itinerant workers” - came through loud and clear. The challenge will be persuading Asian governments to develop and implement effective, targeted prevention programs with these communities
• The need for empowerment of women was clearly articulated – including by quite a range of men
• Kofi Annan’s strong, repeated statements about the need for firm and forthright political leadership were welcome – though compromised by the lack of political leaders turning up at the Conference
• The AFAO-initiated Pre-conference Satellite on Rises in HIV infections in Major Gay Communities was successful and rated by some participants as the best thing at the conference
• There was in effect a stream of sessions on gay/MSM communities in Southeast Asia, allowing a something like a sustained discussion to develop through the Conference

Treatments and Prevention

• Tensions in the Treatments/Prevention nexus were largely dissipated among participants – though there are no guarantees that Asian governments will take up the challenges in the prevention area, choosing instead the less problematic treatments access area
• The lack of progress in the science of vaccines and few developments of major significance in HIV treatments: both not unexpected
• Microbicides, however, showing significant progress with several agents moving into efficacy trials
• While HIV treatments scale-up has been slow it is gearing up. The three major challenges now are:

1. Continuing resistance by the US, backed by major pharma companies, to allow any substantial provision of generic drugs
2. Key looming issue: what to do about second-line therapy (as many people in developing countries are beginning to develop side-effects to the second-rate first line combinations currently in use)
3. Main barrier is no longer money but sufficient skilled personnel to clinically manage people living with HIV/AIDS.

• The distortion of prevention focus caused by the US government’s emphasis on abstinence
• The money is still not there: only about 50% of the US$10b. per annum that is needed for treatments and prevention

Key Strategy shift for AFAO

• Reduced emphasis on Treatments Access – the money and energy are now flowing;
• Increased emphasis on HIV prevention among Asia/Pacific’s increased risk populations

Since the Conference the AFAO International Team held a planning day, focussing on a range of issues including:

• Undertaking a mid-term review of AFAO’s International Strategy in light of performance to date and the BKK Conference
• Developing a plan to propose to AusAID on strategies and actions it should take to assist gay/MSM programs develop in East and Southeast Asia
• Liaising with Scarlet and AIVL with a view to undertaking a similar exercise for injectors and sex workers

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Elephant at the conference. Photo: Michael Costello

An overview and gossip

By Andy Quan, International Policy Officer

Thousands upon thousands swarm in different directions, dodging each other where the flow of people traffic intersects. They yell hellos and consult their programs looking vaguely lost, slightly rushed. Most of them are carrying the same bag, and all are wearing similar tags around their necks.

Yes, it’s the Bangkok International AIDS Conference (IAC): 17,000 delegates (with over 3,300 on scholarships), 3,000 journalists, a budget of $USD 17 million, hundreds of volunteers, and a lot of coffee.

“Like Durban, Bangkok could be a watershed event,” Dr Joep Lange, President of the International AIDS Society, told delegates at the Opening Ceremony of the XV International AIDS Conference. But in the end, the conference fell short. There were no particular advances announced in either scientific or political terms. The hoped for momentum leading from the Declaration from the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) has failed to materialize. The Global Fund, a previous cause for excitement (a concrete mechanism to fund AIDS work) as well as advocacy (to get more funds), has settled into its work with both praise and criticism, but is now not seen as a solution on its own. The shine of a possibly effective HIV vaccine has been tarnished by recent unsuccessful trials, and no new breakthroughs announced. In recent years, Seth Berkley of the International AIDS Vaccine Initiative (IAVI) toned down vaccine optimism. “This is a marathon, not a sprint.” But his words are apt for the whole of the response to the epidemic.

Still, as stated in an Australian-penned speech delivered by Dr Jim Yong Kim, head of WHO’s AIDS Department, we must do “everything possible… to finally dance with this epidemic at its own pace”; though so far, “by…measures of human life, the ones that really matter, we have failed.” The ambitious WHO plan to reach three million people with treatment by 2005 received much attention at the conference, but has been reframed, not as an achievable goal but, as a tool to drive us towards an eventual goal

A positive outcome of the conference could be increased attention to the Asian epidemic, as well as a response to it that is targeted and more effective. Epidemiologist Tim Brown showed that the key factors in Asian epidemics are condom use with sex workers and visits to sex workers. Delaying the epidemic among injecting drug users buys time to prevent sex worker epidemics. Meanwhile, there is significant evidence of rises in infections among homosexually-active men in the region. His conclusion: we can control Asian epidemics but need much higher levels of prevention, and to work directly with vulnerable groups.

There were also strong calls for attention to women’s vulnerability to infection. UN Secretary-General Kofi Annan gave a speech during the opening ceremony on the impact of HIV/AIDS on women and girls and called for greater education and empowerment of women. The need for microbicides and the lack of the promotion of the female condom were also prominent news items. Calls were also made to consider children’s and youth issues.

Some of the most well attended sessions during the week drew crowds not because of their content but because of their potential for drama and entertainment. Basically any session with an American government representative or a pharmaceutical CEO was guaranteed an audience of protesters and those who had come to watch the protesters. The issue of the week was the Bush administration’s promotion of abstinence and fidelity.

Meanwhile, the obligatory protests took place: ACT-UP trashed the pharma stands in the exhibition hall according to a schedule and threw fake blood at photos of world leaders (leaving the mess for the local cleaners to deal with.) Act-UP Paris shouted at the French government representative delivering a speech for President Chirac. They were thanked, after 5 minutes, by Joep Lange, president of the IAS, for their intervention and asked to let the proceedings continue.

A new track at the conference was specifically on leadership, 90 program sessions and 44 “meet the leaders” sessions matched heads of businesses with political leaders and celebrities like Richard Gere, Ashley Judd and Rupert Everett, the discussions were reported as dynamic and well-attended. However, a summit of world leaders to precede the conference was abruptly cancelled because the nine invited leaders failed to commit. Also, little was reported on the second Asia-Pacific Ministerial Meeting on HIV/AIDS that took place on 11 July.

My favourite anecdote from the conference relates to the reported USD$1 million spent on posters and billboards, highly visible throughout Bangkok. What a waste that they simply reported that the conference was happening: no awareness or education messages on HIV/AIDS were included. But how funny that it was reported in the news that one of the billboards fell on the car of the Minister of Finance. Activists joke that it was the first time he’d heard of the conference.

Amusement was also had at the closing ceremony when a giant video presentation included a speech by Kofi Annan that called for attention to vulnerable communities including men who have sex with men. However, the video suddenly went into a loop with Annan exhorting repeatedly “have sex with men… sex with men… sex with men… sex with men.”

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Reflections on human rights

By John Godwin AFAO Policy Analyst

Each day of the Conference saw activists from a range of vocal constituencies engaged in impassioned protests. The issue that was given most prominence by the Thai press was the broad based critique of the Thai Government’s draconian drug control policies, and the harm those policies are causing to HIV prevention and care efforts.

As at Barcelona and Durban in previous years, treatment access remained a defining issue at Bangkok. Given that the theme of the Conference was Access for All, issues relating to equity of access to both prevention and treatment were given strong coverage both in plenary presentations and on protesters’ placards.

South Africa’s Treatment Action Campaign and AIDS Law Project used conference sessions to draw attention to developments unfolding during the week of the Conference, as the South African Medicines Control Council moved to deregister nevirapine for use in monotherapy (used to prevent mother to child transmission of HIV).

In addition to the familiar territory of treatment rights debates, behavioural prevention issues regained centre stage driven by heated discussions on the role of abstinence in prevention programs. Human rights played a critical role in informing these discussions, with anti-abstinence advocates presenting the compelling argument that abstinence programs are dangerous in that they ignore the realities of women’s lives.

The rights of participants in clinical trials were raised by sex workers, who took to the stage to protest the involvement of the drug company Gilead in the trial of the use of Tenofovir in pre-exposure prophylaxis in Cambodia.

Chinese groups announced the arrest in July of HIV activists in Henan, who had been protesting government inaction on providing care and treatment for people infected due to lack of regulation of the blood supply. Four HIV positive activists were detained after they tried to protest about inadequate services for people living with HIV/AIDS.

In corridor discussions, Sunil Pant of Nepal’s Blue Diamond Society alerted delegates to legal action that had recently been commenced in the Supreme Court of Nepal, which seeks to force the Government to prohibit groups such as the Society from promoting homosexuality or the rights of men who have sex with men (MSM). The Society works with MSM and transgender communities on HIV prevention and rights issues.

The Conference provided an effective platform for these issues to be raised in a public way: within the formal conference sessions, at media conferences and staged media protest events, and in corridor discussions between activists from around the globe.

But despite the heat generated around this diverse array of rights issues, the irony is that only slight attention was given to human rights within the formal conference program itself.

The most prominent demonstration of this failing was in the opening plenary. The speech of HIV positive Thai drug user Paisan Suwannawong was relegated to the end of the ceremony. As a result, his speech was not delivered in the presence of the Thai Prime Minister Thaksin Shinawatra, Kofi Annan or the majority of delegates. He was denied access to national TV coverage. When finally allowed to speak, Paisan addressed not only the dire human rights threats confronting drug users as a result of Government policies in Thailand, but also referred to the threats to rights of sex workers, men who have sex with men, migrant workers and undocumented citizens.

Of course there were many affirming moments when rights issues were appropriately highlighted during formal sessions. At the opening session, Kofi Annan, in a plenary shared with the Thai Prime Minister, called for stronger leadership by “respecting and upholding the human rights of all who are vulnerable to HIV/AIDS – whether sex workers, drug users or men who have sex with men. That includes their right to treatment, if infected.”

Perhaps the most positive aspect of the conference structure from a rights perspective was the establishment of the Global Village, an area set aside for informal gatherings. The Village gave conference attendees an opportunity to meet people who were not attending the conference such as local sex workers and drug users in an unstructured environment that lent itself to open communication.

Useful human rights resources from the Bangkok Conference

UN Office of the High Commissioner on Human Rights Recommendations on integrating human rights into HIV/AIDS responses in the Asia-Pacific region http://www.un.or.th/ohchr/issues/hivaids/ExperMeeting_2004/index.html

Canadian HIV/AIDS Legal Network Regime Change? Drug Control, Users' Human Rights and Harm Reduction in the Age of AIDS and Prisoners' Health & Human Rights in the HIV/AIDS Epidemic http://www.aidslaw.ca/bangkok2004/e-bangkok2004.htm

APN+ (Asia Pacific Network of People Living with HIV/AIDS), AIDS Discrimination in Asia, http://www.gnpplus.net/regions/files/AIDS-asia.pdf

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Indigenous presentations

By Michael Costello, Indigenous Project Officer

The Bangkok International AIDS Conference had good representation from Indigenous Australia, with individuals representing AFAO, the National Association of people living with HIV/AIDS (NAPWA) IPN+, Northern Territory AIDS & Hepatitis Council, Victorian Aboriginal Community Controlled Health Organisations and Marie Stopes International.

Two Australian Indigenous presentations were made at the conference:

• a poster presentation on the development of the new AFAO Sistergirl resource – Keep Yourself Covered; and
• an oral presentation by Marie Stopes International on a project they have been working on over the last couple of years, “A condom social marketing initiative for Indigenous Australians”.

Of particular interest was a poster presentation from New Zealand by Clive Aspin titled “The role of takatapui identity in preventing HIV transmission in Maori gay men in New Zealand”. The poster reported on interim findings of research on Maori men’s sexuality and the implications for transmission of HIV, among those who identify as takatapui. Takatapui identity is the favoured form of identity for increasing numbers of Maori men, and incorporates both sexual and cultural aspects of identity. The poster suggested that if takatapui identity is beneficial in health protection, health promotion activities need foster sexual and cultural identity. The presentation concluded that this research has considerable implications for other minority Indigenous populations who live within majority cultures.

Both the Australian Sistergirl resource and the New Zealand takatapui presentations showed remarkable similarities, because they promote the links between cultural identity, sexuality and the implications for HIV transmission.

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Launch of AusAID International Stategy

The Australian Agency for International Development (AusAID), manages the Australian Government's official overseas aid program. Alexander Downer, Minister for Foreign Affairs, launched the new AusAID International HIV/AIDS Strategy at the Asia-Pacific Ministerial meeting on HIV/AIDS held in conjunction with the Bangkok Conference. The Strategy will more than double to $600 million Australia's current international commitment. The bulk of it is reported to be going to Papua New Guinea to set up 38 new disease treatment clinics and improve prevention and education campaigns. Minister Downer also announced the appointment of Annmaree O’Keeffe as ‘Australian special Representative on HIV/AIDS’.

View AusAID report on the Ministerial meeting

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Scarlet in Bangkok

By Janelle Fawkes, President, Scarlet Alliance

While the week was filled to overload with community marches, poster halls, art, performance, demonstrations, workshops, oral presentations, and images of sex workers used by media to bring colour and life to their pages, the resounding experience of sex workers attending Bangkok was one of disparity between governments, researchers, policy makers and the experiences of the individuals who work in the sex industry of the 20 countries represented.

The conference opened with Thai Prime Minister Thaksinattributing a reduction in the rates of HIV/AIDS amongst Thai sex workers to the contentious 100% CUP (condom use policy). Within days of opening however the Thai sex worker organisation, Empower, was under attack by the media in what was clearly a misrepresentation of their peer education work.

It struck many sex workers in attendance how, not for the first or last time, the most successful HIV/AIDS prevention strategies were not acknowledged and rather were under attack in the media and by Government.

A highlight was the Symposium organized by APNSW (Asia Pacific Network of Sex Workers) where sex workers from over 20 countries spoke of the major issues affecting their communities. This session clearly identified the following three issues as those shared by the majority:

1. Police harassment
2. The anti-trafficking lobby
3. Research

The conference would not have been complete without the creative presence of the migrant sex workers. The ‘women without documents’ created a silent, but incredibly powerful reminder of those sex workers, some of whom are HIV positive, but who have no access to health services or treatment. 220 Burmese sex workers in Thailand made a paper mache representation of themselves.

Unethical research on sex workers was identified as a key issue affecting most of the sex worker communities represented at the conference, and many examples were provided of research conducted on sex workers which does not seek to either improve conditions for sex workers or respect those involved.

Scarlet Alliance members were involved in more than twelve presentations, performances, workshops, poster presentations and an exhibition.

Our popular skill share workshop was 'Whorigami- The art of towel rolling, folding and shaping”. This workshop drew on the common theme of the towels, often used as a decorative element in the work places of brothel and massage based sex workers in the Australian sex industry, to highlight the range of occupational health and safety issues which impact on a sex workers ability to negotiate safe sex and in their role as HIVAIDS and STI educators with clients.

One of the few papers accepted for oral presentation from the Australian HIV/AIDS community sector, was from Rachel Wotton, Sex Workers outreach program (SWOP) employee and the elected Scarlet Alliance International spokesperson. Her paper, “The relationship between street-based sex workers and the police in the effectiveness of HIV prevention strategies” was highly relevant considering that treatment by police was identified by all of the sex worker communities at the conference as creating barriers to sex workers working safely.

Few conference attendees could have missed “Debby doesn’t do it for free!”, A collaborative effort by 15 Australian sex work activists and artists. The work incorporated a range of mediums including installation, film, soundscape, mixed media, textiles as well as a range of performances. The contributors offered the public an insight into the lives of sex workers and their experiences, offering an alternative to the portrayal of sex workers in mainstream media.

The placement of the exhibition in a main hall, outside of the commercial and NGO areas, created a level of visibility most could only wish for. Those attending the conference were able to engage with sex workers and the issues affecting their health in a unique environment and Scarlet Alliance members and the artists themselves used the opportunity to network with and provide community education to thousands of participants over the week.

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