Five Nights in Bangkok

One of the oddest stories to emerge from the 15th International AIDS Conference in Bangkok is that James Glassman of the American Enterprise Institute found – to his considerable shock – that the American delegation booth didn’t have a photo of George W. Bush displayed. It seems to have been the last straw. In a fine old spray of invective James derided conference attendees as a bunch of American-hating morons and ingrates. “A sicko conference” he shouts, presumably without irony.

I sort of understand. International AIDS Conferences do tend to be a bit long on rhetoric and short on action. As one observer mused yesterday, ” “For some, attending AIDS conferences is a matter of advancing careers, profiteering, gaining political advantage and fulfilling professional obligations” What category attendee Glassman might fit is anybody’s guess.

It was also a bit odd to have Nelson Mandela there pointing to the lack of attention being given to TB. It’s a bit like appearing at a diabetes conference to point to a dearth of light being shed upon multiple sclerosis. He’s a revered figure and rightly so – and TB is a major opportunistic infection in people with AIDS in South Africa – but the appalling AIDS response inertia on the part of the South African government is a major factor in the TB prevalence rate. And Mbeki continues to drag his feet. The much delayed roll-out of treatment continues to be delayed and the South African government has just announced that it will cease providing a highly effective drug used to block vertical transmission in pregnant mothers. Despite it costing them nothing and despite world medical opinion being totally opposed to the cessation. On a brighter note, the link also offers the heart-warming tale of a conference-attending elephant falsely accused of killing someone. It turns out to have been a completely different elephant who objected to a drunken guy pulling hairs out of it’s tail. On the downside, the guy wasn’t James Glassman.

Nor was it Alexander Downer who popped up to belatedly pledge more money for tackling AIDS in the Asia/Pacific reason. He was he said “passionate” about so doing. I on the other hand am pretty passionate about his colleague Tony Abbott’s decision to purge his ministerial advisory committee on HIV of anyone living with HIV – for the first time since Neal Blewett commenced the National Strategy approach to HIV back in the 1980’s. He did however find a space for Mrs Angela Assaf who is married to Mr Joseph Assaf and also for Nick Hobson who knows about helicopters. A ministerial staffer, when quizzed about the dearth of affected community representation, offered the view that “being gay wasn’t part of the selection criteria.” There’s never a bloody elephant handy when you need one.

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David Tiley
2021 years ago

Well put Geoff.

Just to add a bit more.. WAPO has an article about American participation:

“The U.S. government will send only one-quarter as many people to the huge international AIDS conference starting Sunday in Bangkok as it sent to the last one in Barcelona.

The decision to cut attendance, which comes as the Bush administration is rolling out its five-year, $15 billion global AIDS treatment plan, was reached long after many government scientists had made plans to attend the conference, which is held every two years. Dozens of scientific presentations were withdrawn, about 50 will be published only as summaries and not presented publicly, and dozens of meetings — many designed to train Third World AIDS researchers and foster international collaboration — were canceled.

The move, which officials say is to save money, is interpreted by many AIDS experts as payback for the heckling of Health and Human Services Secretary Tommy G. Thompson at the last AIDS conference and further evidence of a “go-it-alone” attitude in the administration’s global AIDS program.”

And the Guardian:

“Behind the fracas lies the gulf between the US policies on tackling HIV/Aids in the developing world and those of Aids activists who tend to dominate the big international event. Two years ago, Mr Thompson tried to give a speech at the conference in Barcelona but was rendered inaudible by noisy protests. This year the organisers have asked activists to be more civil and allow those with whom they disagree to be heard.

Although the US has put more money into the fight against HIV/Aids than the rest of the world put together, including $15bn (

TJW
TJW
2021 years ago

You’re forgetting that abstinence can also be justified, from a scientific perspective, as an effective means of preventing the transmission of HIV.

It’s not so ridiculous or unscientific.

As long as it isn’t promoted at the expense of condoms – and there will always be disagreement as to the correct balance of spending – I don’t see it as such a problem.

David Tiley
2021 years ago

This is a big debate and spills over into drug programs as well.

Just one example will suffice for now – there are many cultures in which male sex with prostitutes is considered to be acceptable and is the main way in which AIDS is spread. In that context, how can a local health program advocate abstinence and be believed? They are just moral crusaders and sometimes seen as imperialists as well.

The only solution is to tell the truth – AIDS is usually transmitted by sex. Sex with condoms properly applied will not give you AIDS. Everything else is a moral and cultural minefield.

And trying to frighten people in other cultures so they don’t have sex because you morally condemn sex outside marriage is disgraceful. Doing it with government money is worse. Preventing other kinds of programs is beyond the pale. Wrecking a scientific conference leaves me speechless.

Geoff Honnor
Geoff Honnor
2021 years ago

TJW, it’s pretty much unarguable that abstinence provides an effective barrier to sexually transmitted HIV. It’s equally unarguable that relatively very few sexually mature human beings aspire to abstinence as a viable and continuing life option – whether they claim to or not. Therein lies the problem.

To therefore insist on privileging – and selectively funding – abstinence, as the primary prevention methodology for engaging with a sexually transmitted diasease pandemic, looks to be absurdly at odds with lived reality.

The fact that this approach is derived not from epidemiological considerations, but from socioreligious ones, makes it even less convincing.

TJW
TJW
2021 years ago

Telling people that abstinence is the only way to prevent the sexual transmission of a whole range of infections isn’t such a bad thing. This might also make some Christians feel self-righteous, but it’s also a scientific fact that you will find mentioned on many sexual health websites (including state/federal government ones).

That doesn’t mean that you have to indefinitely refrain from sex, it just means that doing so, even while using condoms, carries risks. If this scares some people into something resembling a Christian-like lifestyle then I’m okay with that. I’m sure everyone has his or her own agenda here.

I guess some people start with the assumption that people are going to have sex anyway, so why even encourage them to abstain? Just skip that part and go straight for providing them with condoms and educating them on their proper use. My view, and the apparent practice of the GP’s I’ve visited in my time (as a patient), none of whom even mentioned Christianity, is to spend a considerable period of time telling the patient the risks of sex – including protected sex – before then discussing the things that can be done to minimise the risks of transmission (such as condom use). This, to me, seems not only the most preferable, but the only ethical, approach that a doctor can take. It’s in stark contrast to the ‘sex education’ booths at universities which hand out condoms, a brochure on their proper use, smile, and say, “Have fun”.

I’m sure Geoff, and maybe David (I’m not sure of your background) know more about the practical implementation of these “ABC” policies, so I won’t say more than I hope they resemble my GP consultations more than the uni ‘sex ed’ booths.

David Tiley
2021 years ago

You might be interested in another discussion of this matterial here by Chris Mooney, one of my favourite internet science writers.

I work as a writer in documentary film, by the way. I’ve done a fair few science and health projects over the years.

Geoff Honnor
Geoff Honnor
2021 years ago

The implementation of the ABC approach is the problem TJW. I see nothing but good sense in advising people that sexually transmitted diseases are spread by having sex and that – clearly – not having sex, or confining one’s sexual expression to fewer partners is safer than the reverse.

However, public health interventions are most effective when they reach people where people are, in a behavioural sense, not where you’d want them to be. There’s little point in privileging abstinence over alternative harm minimisation methods when you’re attempting to engage with western teenagers/youg people. Overwhelmingly, they don’t – and won’t – abstain. It therefore follows that a narrow sexual health funding agenda, predicated primarily on abstinence, is not a sensible way to go. The current US administration is doing exactly that both domestically and inbternationally and is increasingly tying funding support to abstinence-emphasising programs.

For many women in the developing world abstinence and sexual fidelity are matters which men control. Husbands may avail themselves of multi-partnered unprotected sex without discussion. Emphasising abstinence and faithfulness to this group – wherein lies the fastest growing HIV seroprevalence rates – is a bit beside the point.

You have President Museveni of Uganda addressing the World AIDS Conference on the ABC approach and assuring delegates that condoms are only incidental to the extraordinary success of the abstinence/be faithful components of the ABC approach in his country. He’s disbelieved. Uganda is a huge user of condoms and were it not for the fact that Uganda receives significant HIV/AIDS funding from the US, he’d be able to acknowledge the prevention reality fully.

The Center for Disease Control in Atlanta has been forced to censor prevention material that doesn’t incorporate the ABC approach, federal funding is denied to programs that don’t feature abstinence components etc, etc. If you think that this is being driven by a pragmatic approach to public health you’re wrong. It’s being driven by a faith-based agenda that owes nothing to epidemiological considerations.

For instance, Australia has one of the lowest intravenous drug user HIV transmission rates in the developed world and we’ve had federally supported needle and syringe exchange programs in place since the mid 80’s. The US has one of the highest IDU HIV transmission rates in the developed world and has steadfastly refused to consider federally-funded NSP programs through 3 administrations. We don’t make a shibboleth of abstinence-first prevention programs and our seroprevalence rate is way lower that that of the US which does.

The facts are pretty self-evident.

TJW
TJW
2021 years ago

Thanks for the link David, I’ll have a look at it. And, as always, thanks for taking the time to respond Geoff.