Though the official start for the XIX International AIDS Conference – marking the conference's return to the U.S. after a 22-year absence due to the now-repealed HIV travel ban – was Sunday evening, July 22, at the Walter E. Washington Convention Center, there was an unofficial kick-off of sorts Thursday, July 19. That's when Health and Human Services (HHS) Secretary Kathleen Sebelius – perhaps deflecting some of the criticism aimed at President Obama after the White House said he'd be making only a video appearance at the conference – announced that the Obama administration will invest nearly $80 million in grants to increase access to HIV/AIDS care across the United States, a move expected to eliminate AIDS Drug Assistance Program (ADAP) waiting lists.
''The entire administration is dedicated to fulfilling President Obama's goal of an AIDS free generation and today's announcement is one more step in that ongoing effort,'' Sebelius said in a July 19 statement. ''These grants will help make a real difference in the lives of Americans living with HIV/AIDS, especially those in underserved communities.''
The next day, D.C. played host to the July 20 to 21 Gay Men's Health Summit, which, while not an AIDS 2012 event, was likely boosted by the international conference. If nothing else, it allowed for some interaction with the Global Forum on MSM (men who have sex with men) and HIV, held Saturday, July 21.
That same evening, and still ahead of that official start, the Human Rights Campaign made a showing with an AIDS 2012-related panel on HIV and stigma at its downtown headquarters. Along with HRC, that panel was co-sponsored by organizations who'd be making their own showings through the conference: International Association of Physicians in AIDS Care, the Pan American Health Organization and the International Treatment and Preparedness Coalition. Despite some jarring data – particularly with regard to murders of transgender women – Chloe Schwenke closed the panel with some uplifting words about her work with the U.S. Agency for International Development.
''Our approach right now to LGBT health and human rights is that, it's both,'' she told the audience. ''It's not just a health challenge. It's a human rights challenge. We're there. We're there in both of those areas. We're there with strong and unequivocal messages about the importance of human dignity and human rights. That's a language we're not afraid of.''
On Sunday, still ahead of the AIDS 2012 opening session, attendees and locals took to D.C. streets and the grounds of the Washington Monument for the "Keep the Promise" rally and march. The rally, emceed by actress and comic Margaret Cho, featured a number of prominent figures, such as the Rev. Al Sharpton, activist Cornel West, and Haitian-American singer Wyclef Jean. Among the "call to action" points released by Keep the Promise advocates were lower prices for AIDS drugs globally, and "leveraging treatment as prevention in concert with a scale-up of rapid HIV testing and access to care."
At Sunday's official opening session, Elly Katabira, chair of the conference and president of the organization that presents it, the International AIDS Society, helped set the week's tone, saying, ''Our return to the United States after a 22-year absence comes at a time of extraordinary hope, a time when we believe that the end of the AIDS epidemic is possible.''
At a smaller Sunday session, Ugandan LGBT-rights activist Frank Mugisha was among the thousands of conference delegates contributing to the dialogue. On his particular panel, he told of his country's struggle to counter the effects of homophobia, particularly when it comes to HIV detection and treatment. Because of the emphasis placed on the incidence of HIV among MSM, as well as abstinence-only education and the criminalization of homosexuality in Uganda, the HIV epidemic among homosexual men has been exacerbated and driven underground.
On Monday, July 23, Secretary of State Hillary Clinton's AIDS 2012 speech may have given Mugisha hope.
''In low- and middle-income countries, studies suggest that HIV prevalence among men who have sex with male partners could be up to 19-times higher than among the general population,'' Clinton remarked. ''Now over the years, I have seen and experienced how difficult it can be to talk about a disease that is transmitted the way that AIDS is. But if we're going to beat AIDS, we can't afford to avoid sensitive conversations, and we can't fail to reach the people who are at the highest risk.
''Unfortunately, today very few countries monitor the quality of services delivered to these high-risk key populations. Fewer still rigorously assess whether the services provided actually prevent transmission or do anything to ensure that HIV-positive people in these groups get the care and treatment they need. Even worse, some take actions that, rather than discouraging risky behavior, actually drives more people into the shadows, where the epidemic is that much harder to fight.''
Clinton continued, offering points on how the United States is working to counter those situations, to ''Turn the Tide'' – the conference theme – in the fight against HIV/AIDS. She announced three new efforts to reach key populations: $15 million for research to identify specific interventions that are the most effective for at-risk populations; $20 million to support country-led plans to expand HIV services; and $2 million to help civil society groups that do outreach in those communities.
Among the smaller panels that same Monday, one focused on young American gay men of color. Looking at those who provide health services to this ''YMSM'' population, Dr. Ron Stall, professor and chair of the Department of Behavioral and Community Health at the University of Pittsburgh, said those providers must adopt a more holistic approach to treating young gay men of color, rather than focusing on HIV and STDs alone.
''Scientists are just obsessed with the area between the knee and the navel when it comes to gay men,'' Stall said, citing a study showing that the more psychological/emotional health problems a person has, the more likely it is he will engage in high-risk sex, leading to greater HIV prevalence.
Monday also saw some debate over the newly approved pre-exposure prophylaxis (PrEP) treatment, Truvada, at another panel. Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS, argued in favor of "treatment as prevention" through antiretrovirals, while Kenneth Mayer, medical research director and co-chair of Boston's Fenway Institute, countered that more research needs to be done before the medical community endorses pre-exposure prophylaxis. Audience members – on both sides of the issue – also spoke passionately.
''We need to do this without any further delay,'' Montaner insisted. Mayer, however, spoke of unknown effects of such therapies in healthy individuals with normal CD4, or T-cell, counts. He mentioned the possibility of resistance to the medications over time among people with normal CD4 counts as a possible side effect, particularly in cases where adherence is lax.
Mayer and Sean Strub, founder and advisory editor of Poz magazine, also warned that while linking people with care is an admirable goal, public health officials may use antiretrovirals as a crutch of sorts, recommending it for all people regardless of the nature of their serostatus, instead of basing their recommendations on science. Strub, as well as some audience members, also raised questions about the ethical issues that accompany scientific advances such as antiretrovirals.
Tuesday saw another march through D.C. streets, the We Can End AIDS Mobilization for Economic Justice and Human Rights. Inside the convention center, meanwhile, one panel focused on challenges faced specifically by the transgender community in fighting HIV/AIDS.
JoAnne Keatley, director of the University of California, San Francisco (UCSF) Center of Excellence for Transgender Health, covered several of the factors contributing to transgender people's higher risk of acquiring HIV. For example, she said, transgender people face relatively greater degrees of discrimination in employment, housing and health care, as well as marginalization, or, in some countries, criminalization of people who do not conform to gender norms.
Marcela Romero, a Colombian-born transgender activist, said that governments are complicit in the challenges faced by transgender communities. Marginalization and a lack of resources to address health and well-being contribute to a higher incidence of HIV and sexually transmitted infections, and lower life expectancy among transgender people.
"A person without an identity ceases to exist," Romero said of governments who ignore transgender citizens.
Tuesday evening, Whitman-Walker Health marked a sad anniversary: 29 years since D.C.'s first community meeting about HIV/AIDS, April 4, 1983, held at the Lisner Auditorium at George Washington University. These nearly three decades later, the fight has certainly evolved.
The audience members at ''Return to Lisner'' heard from Jeanne White-Ginder, the mother of the late Ryan White, a teenage hemophiliac and AIDS activist in the early days of the epidemic for whom the nation's largest federally funded program to treat people with HIV/AIDS is named.
''I think there's miracles happening all the time,'' she said.
As the conference continues through Friday, July 27, conference attendees will continue to share their data and dialogue, in the ongoing hunt for those miracles – as well as straightforward scientific and social advances – to turn the tide toward a future without AIDS.
Will O'Bryan contributed to this report.