J. Stephen Morrison
Senior Vice President & Director, Global Health Policy Center at CSIS
There were innumerable – indeed too many! – important developments at the International AIDS Conference that concluded here in Washington on July 27. I had four major impressions from the IAC which I wish to share.
First, I was struck by the strong, unequivocal reaffirmation of the United States’ commitment over the long haul, at home and abroad, to address HIV/AIDS: scientifically, politically, financially, and programmatically. This came through resoundingly in Secretary Clinton’s powerful speech, and was reinforced in statements by HHS Secretary Kathleen Sebelius, Global AIDS Coordinator Eric Goosby, NIAID Director Anthony Fauci, CDC Director Thomas Frieden, Director of the Office of National AIDS Policy Grant Colfax, and other senior U.S. officials.
Widespread disappointment that President Obama did not address the opening plenary on Sunday, July 22, did trigger a debate over the merits of that decision and whether his absence signaled a weakening of U.S. resolve. In my view, whether wise or not, the decision by the President was a calculated judgment, based on competing demands in the heat of the electoral season, and perceived risks and benefits, and ultimately did not significantly detract either from the overall message the administration sought to convey or its impact. Secretary Clinton and other senior officials successfully carried the day in the public domain. For his part, President Obama delivered a powerful and effective statement of commitment at the White House reception for 200 HIV/AIDS leaders, which he hosted on Thursday, July 26.
Second, I was struck by the unity of efforts across key American constituencies on vivid display at the IAC. Bipartisan Congressional leaders, American faith leaders, and senior figures from the Bush administration each had a prominent place in the IAC program and used it to make clear that they stood in support of continued U.S. leadership on HIV/AIDS. The expanded space for their participation was thanks to the strategic leadership of IAC Co-chair Diane Havlir and Elly Katabira and IAS President-elect Chris Beyrer. Their efforts made it possible to hear from Kay Warren, co-founder of Saddleback Church, former First Lady Laura Bush, Representatives Barbara Lee (D-CA) and Nancy Pelosi (D-CA), Senators John Kerry (D-MA), Lindsey Graham (R-SC), Mike Enzi (R-WY), Marco Rubio (R-FLA), Chris Coons (D-DE), former Senate Majority Leader Bill Frist, and former Bush administration official Mark Dybul. This was a major achievement.
Third, the quest for an “AIDS Free Generation” has emerged as the central organizing concept, at a moment of complex transitions, and has triggered a conspicuous debate between two camps, the optimists and the realists. We are both in an era of austerity, in which financial resources have flattened and diminished, and in an era of programmatic and scientific excitement, where it is possible to build upon the platforms that provide treatment to 8 million, and the advances in ‘Treatment as Prevention,’ circumcision, reductions in mother-to-child transmission, and other promising technological and scientific advances.
The optimists include a formidable assembly: Secretary Clinton, former President Bill Clinton, UNAIDS head Michel Sidibé, new World Bank director Jim Kim, former Bush official Mark Dybul, and Anthony Fauci of the NIH, among others. In varying ways, each uses the ‘AIDS Free Generation’ to make a renewed call to action; to offset the complacency, fatigue and fear that have intensified in recent years; to appeal to enduring moral obligations; and to lay out a moon-shot vision that builds systematically on scientific and programmatic achievements.
The realists also include a formidable assembly: Bill Gates, Richard Horton, managing editor of The Lancet, Laurie Garrett of the Council on Foreign Relations, Larry Altman of the New York Times, Peter Piot, head of the London School of Hygiene and Tropical Medicine, among others. For each, an AIDS Free Generation evokes a call for caution: to define goals, targets and strategies much more concretely than has been the case up to this point; to address the complexities and unknowns of ending an epidemic; to guard against runaway hubris and a marketing campaign that could backfire; to focus on what tools and what finances will truly be available and when; and to keep an eye on what are the immediate actionable priorities: expanding treatment steadily, and pressing ahead patiently and steadily in developing the essential new tools that are not yet available.
This debate will continue to evolve, rapidly I expect. In my view, there is ample opportunity for a sensible middle ground, and it will be very important to steer clear of doctrinaire positions, either realist or optimist.
Fourth, I was struck at the IAC by the maturation of the HIV/AIDS community, which itself encompasses a great diversity of interests: scientists, persons living with HIV, advocates and activists, governmental officials, leaders of international organizations, non-governmental and governmental agencies responsible for implementing programs. There remain very divisive issues, not the least of which is effective access to, and respect for the rights of commercial sex workers, persons who inject drugs, and men who have sex with men. At AIDS 2012, open and civil debate over these and other difficult issues was indeed possible. Earlier fears that the return of the International AIDS Conference to U.S. soil after 22 years would be marked by rancor, division and disruption were simply not realized. This too was a major achievement.