International AIDS Society Newsletter, no. 16

IAS
INTERNATIONAL
SOCIETY
The XIII Internationa AIDS Conference
thoughts from Durban, South Africa
Quarraisha Abdool Karim and Salim S Abdool Karim, Medical Research Council,
PO Box 17120-296 Umbilo Road, Congella 4013, Durban, Tel: [phone], Fax: [phone]

The upcoming International AIDS Conference
to be hosted in July 2000 in Durban heralds a
historic moment in the context of the
HIV/AIDS pandemic. Almost two decades into
the pandemic this will be the first time that the
conference will be hosted in a developing country. Not any developing country, but a developing country in sub-Saharan Africa - host to
almost 70% of the global burden of HIV infections. Whilst there have emerged in the two
decades numerous and diverse AIDS conferences and meetings, the International AIDS Conference still remains the most important gathering of scientists, activists and media in an
unparalleled spirit of solidarity and the only
conference that totally captures the attention of
the public for the duration of a week. The
expectations within and outside sub-Saharan
Africa for Durban 2000 are high. The theme of
the conference "Break the silence" sets the stage
to confront and respond to the many challenges that face us as a global community in our
struggle against AIDS.
As with previous conferences the programme
for the week has been set out by a panel of
international experts and participants can look
forward to high quality plenary presentations,
oral and poster sessions on cutting edge science, skills building sessions, and provocative
debates, round-table sessions and symposia.
But what will the XIII International AIDS Conference mean for the people of South Africa and
Africa?
South Africa had a relatively late introduction
of HIV but is currently experiencing an "explosive" spread of HIV. HIV infection amongst
antenatal clinic attenders rose from 0.76% in
1990 to 22.8% in 1998. It is estimated that
approximately 4.2 million South Africans are
currently infected with HIV, accounting for a
disproportionate 10% of the global burden of
infection. The HIV epidemic in the Province
of KwaZulu-Natal is estimated to be two years
ahead of the rest of the country. With the hosting of the conference in Durban, KwaZuluNatal, the rest of the world will be exposed to
the reality of a raging HIV epidemic.
South Africa, until the early nineties, was isolated from the rest of the world because of apartheid. With the establishment of a democratically elected government in 1994 it is once more
part of the global community. With the hosting
of previous conferences in Europe and Canada,
participation of South Africans was limited due

to the high costs related to travel outside of
South Africa. The XIII International AIDS
Conference provides a unique opportunity to
expose large numbers of South African scientists, activists and policy-makers to the diversity of opinion and the latest in HIV science.
Whilst each country's response to the epidemic
is shaped by its own reality there is a certain
amount of universal wisdom that has been
gleaned in the past two decades on what works
and what does not in terms of HIV prevention,
care and support. The exposure to this wisdom
through the comprehensive conference programme, both scientific and community, that
covers and shares a huge amount of information generated from empiric studies to experiential, will help South Africa come to terms
with successes and failures of others. It is hoped
that this will help to strengthen the response to
the epidemic in South Africa.
The generation of new knowledge in the context of the HIV epidemic has been unprecedented. The conference serves to consolidate and
profile these achievements. Part of this success
can be attributed to the collaborative efforts
between scientists and activists throughout the
world. The conference provides an opportunity to boost AIDS research in South Africa.
South Africa is unique in having on the one
hand high incidence rates of HIV infection and
on the other a strong research infrastructure.
Whilst there exists in South Africa a critical
mass of highly skilled and dedicated scientists
already making a contribution at the national
and international level in the field of
HIV/AIDS, the urgency and magnitude of the
situation requires a strengthening of international collaborations. With the re-entry of South
Africa into the global community some of these
collaborations have already started; such as the
establishment of two National Institutes for
Health (NIH) funded HIVNET sites in South
Africa and possibly the newly established HIV
Prevention Trials Unit (HPTU) and HIV Vaccine Trials Unit (HVTU) sites in the near future.
Another example of successful collaboration
within and outside of South Africa is the South
African AIDS Vaccine Initiative (SAAVI).
SAAVI is a South African government/private
sector initiative to fast-track the development
of an HIV vaccine. Its international collaborators include the NIH, UNAIDS, IAVI and the
EU. Through this local/international collaboration the HIV vaccine agenda has progressed
rapidly in the past year to the point where we
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anticipate early clinical trials on a clade C specific product to be initiated within the next 6 -12 months.
Generating new knowledge is the first step in
responding to the epidemic in a rational and
systematic way. Translating research findings
into policy and action pose major challenges as
it is influenced by a number of factors such as
political will, economic conditions, existing
infrastructure and acceptability of the intervention by the providers and users. For the first
time in the history of the International AIDS
Conference there will be a fifth track dedicated
to sharing and addressing issues related to policy, programmatic and human rights. South
Africa is currently grappling with policy formulation on a number of fronts. The conference
could play a role in helping South Africa refine
and develop its AIDS policy.
Previous conferences without fail have highlighted the disproportionate burden of HIV
infection in developing countries, and subSaharan Africa in particular - being in the midst
of this reality is quite a different experience. As
the differences between North and South and
developed and developing countries grow this
first-hand experience is timely to strengthen
global solidarity against a common threat to
humanity and human development. As long as
HIV continues to spread it remains a threat to
every one of us.
Sub-Saharan Africa is the only region in the
world where more women compared to men
are infected with HIV. The trend of increasing
vulnerability of women is being observed
throughout the world. The imperatives for
options for women to reduce their risk of acquiring HIV infection that goes beyond rhetoric is
one silence that has to be broken in Durban.
The power of 10,000 participants coming together with one common goal cannot be
underestimated. The opportunities for networking (formal and informal), renewing old
friendships, establishing new ones during the
conference are limitless and fills us with renewed vigor and inspiration to continue with
our struggle against AIDS.