By Professor Salim S. Abdool Karim & Professor Quarraisha Abdool Karim - AIDS Conferences are unique in being a cross between a scientific meeting and a community engagement forum. People from all walks of life attend these meetings and they are a far cry from the usual rigid structure in scientific conferences in order to cater for the range of interests.

By Professor Salim S. Abdool Karim & Professor Quarraisha Abdool Karim

AIDS Conferences are unique in being a cross between a scientific meeting and a community engagement forum. People from all walks of life attend these meetings and they are a far cry from the usual rigid structure in scientific conferences in order to cater for the range of interests.

As a result, there are plays, movies, music concerts, art exhibitions, marches, poster protests, stump talks in the community village and other events in the midst of presentations on, for instance, the conformational structure of gp41 on the outer envelope of the virus.

The International AIDS Conference in Durban in 2000 was all this plus a lot more. It created a unique belief that we could collectively change the world and created a common purpose to do just that by doing whatever it took to bring AIDS treatment to all those who needed it. Critically, scientists and clinicians walked alongside activists, artists, drug company executives, policy makers, front line health care workers, political leaders, clergy, judges and just ordinary people to say altogether that the global inequity in AIDS treatment can no longer be tolerated and that it must change. Each person chipped away at the edifice of inequality and collectively achieved the goal of bringing down the wall of inequity as the prices of the drugs were brought down and international solidarity led to funding becoming available to provide treatment to all those who could not afford it.

Winning the bid to host AIDS 2000 in Durban

Following the establishment of democracy in South Africa in 1994, Quarraisha Abdool Karim was appointed as the Head of the country’s AIDS control programme. At the time, she was also a member of the International AIDS Society’s (IAS) governing council and proposed Durban as a venue for the AIDS Conference in 2000. To create a group to work on the bid, she called a meeting in Pretoria at which Hoosen (Jerry) Coovadia was appointed to lead the conference with Salim Abdool Karim as its Scientific Chair and Gustaaf Wolvaardt as its lead organiser. The team quickly prepared the bid documents and Quarraisha obtained the $1million guarantee from government just in time to lodge the bid.

There was one small snag – Durban did not have a functioning conference centre yet – it was still under construction on the site of the old Durban central prison. There were many naysayers who were concerned that the conference had never been held outside the developed world and that a developing country would not cope with the demands for such a big meeting. There were also those who raised their concerns about the safety of delegates, in response to information doing the rounds about crime in Durban and political turmoil in some parts of South Africa. The most cutting of these criticisms was that the “big name” laboratory scientists would not attend a meeting held in South Africa. Well, none of these criticisms turned out to be warranted, as we now know and, thankfully, several of the senior leaders in the IAS, including Stefano Vella, Mark Wainberg, and IAS Secretary-General, Lars Kallings strongly supported the bid.

Once the bid made it to the final stages, Lars Kallings undertook the site visit. The shortcomings in the bid could no longer be kept out-of-sight; they were now glaring! For example, Quarraisha walked Lars around the Durban International Conference Centre (ICC) building site in hard hats, imploring Lars to use his imagination to ‘see’ that the Conference Centre would be able to cope.

A bigger snag then emerged, Durban did not have the required number of five- and four-star hotel rooms – it took Gustaaf’s stroke of genius to solve this problem with his proposal to have two large luxury liners docked in Durban harbour – just 10 minutes from the Conference Centre – for the week of the conference. For every shortcoming and problem that emerged, yet more imaginative solutions were found. Eventually, we got the good news from Lars that the bid had been successful.

Then the hard work of organising the conference starts

Gustaaf was tasked with creating the organisational infrastructure (offices, staff, telephones, vehicles etc) and thus the non-profit company Dira Singwe Conferences was born with the members of the South African conference committee as Directors. Right from the start, the team was committed to drumming as a theme – the local animal skin drum felt and sounded African and the team was teeming with ideas on how to use the drum image, drum logo, drum sound and actual collective drumming in the conference. We were initially hesitant as it did not seem appropriate for a scientific meeting but we were totally sold on it after attending a drumming session arranged by Gustaaf at the ICC. We saw a dozen different ways in which the drum could be used in the conference. To give the drum a genuine South African look, it was covered in Ndebele design. Similarly, the word “AIDS” in the conference logo was coloured in the unmistakable Ndebele design and colours – a great looking logo emerged with a distinct African flavour.

Organising the conference was sometimes challenging. There were too many different constituencies to satisfy. Committee meetings were imbued with strong political overtones while discussions on the scientific content rarely featured except when it came to heated debates on who should be invited to speak. A rapidly emerging challenge was the political situation with concern about the 1999 South African elections and concerns that the country may be in turmoil post-Mandela. Fortunately, none of these concerns materialised – the elections were peaceful and the transition to President Mbeki went smoothly and peacefully. Little did we know that South Africa’s real challenge was lurking – AIDS denialism.

Mbeki and AIDS denialism

Mbeki had proved himself to be a powerful orator and intellectual in his “I am an African” speech at the adoption of the Constitution by South Africa’s Parliament. However, shortly after his election as President, a Jekyll-like side emerged – one characterised by an obsession with AIDS denial. Not only did he see AIDS as a racist concept, where blacks were being labelled as sexual predators and promiscuous people, he also felt that he was sufficiently qualified with his post-graduate training in economics to decipher complex biology and medicine to interpret internet-trolled information to come to the conclusion that “a virus cannot cause a syndrome” and by implication that HIV cannot cause AIDS.

It was particularly striking to note how strongly he held these views and how the sycophants in his cabinet, parliament and more broadly in the ANC, defended Mbeki, seeing an attack on Mbeki as an attack on the ANC. Minister of Health, Manto Tshabalala-Msimang, was his defender-in-chief and saw to it that antiretrovirals (ARVs) were not provided by the state. Aided by several provincial MECs, including MEC Sibongile Manana in Mpumalanga and MEC Peggy Nkonyeni in KwaZulu-Natal, she tried her best to prevent the provision of ARVs for rape survivors.

As if organising one of the world’s largest medical conferences was not challenging enough, we now had a new and even bigger problem. The two key leaders of the AIDS conference, Jerry Coovadia and Salim Abdool Karim, were now regularly in the public eye for their strident and forceful attacks on AIDS denialism. Inevitably, those associated with the AIDS 2000 conference came under attack from Tshabala-Msimang, especially when she had read our public comments and statements challenging Mbeki, thereby incurring her wrath against the conference. She threatened both of us repeatedly but undeterred, we stood our ground. However, things came to a head when she learnt about the Durban Declaration a few weeks before the conference. She was furious. Peter Hale and his colleagues had already by then gathered a few hundred signatures and the number was growing rapidly. The Durban Declaration still stands out to this day as a triumph of science over politics – a clear, irrefutable, dispassionate statement of the facts regarding HIV as the cause of AIDS.

The AIDS 2000 Conference

On the day preceding the start of the conference, Durban City Hall was the starting point for the march by thousands calling for affordable AIDS treatment. Almost in sympathy with the marchers, the city hall was bedecked with an enormous red ribbon around its entire exterior walls. Zackie Achmat led the march and it set the stage for things to come.

Durban was buzzing – people had arrived in their thousands to take part in the conference. Logistics, like transport and accommodation, were all being tested to the limit, but held firm. Key to addressing the accommodation shortfall was the way in which the people of Durban opened their homes to conference delegates. Large numbers of conference delegates were staying in homely Bed & Breakfast establishments or in residential homes. Most of the shops in Durban proudly displayed the conference poster heralding the “AIDS drum” in their windows to show their support.

The opening session of the conference was held in the Kingsmead cricket stadium next to the ICC, as a way to enable the people of Durban to attend at least one part of the conference. Conference delegates were carefully shepherded to the chairs on the playing field while the general public took over the stadium’s raked seating in their thousands.

The funding for the theatrical opening session came from a generous philanthropy and what a spectacle it turned out to be. Flying acrobats and a choir with over 1 000 singers – almost every church choir in Durban was roped in – all in regal costumes pouring forth amazing renditions.

We were worried about this grand opening, but everything was going along well – until Mbeki spoke.

He rambled on quoting an out-of-date WHO report that said that AIDS was not a major health problem and proceeded to lecture the thousands of AIDS patients, activists, health care providers and researchers that AIDS should not be our country’s and the world’s priority. A hush descended with palpable disappointment in Mbeki, turning rapidly into anger. The audience was bristling with disbelief as Mbeki ended. But, Nkosi Johnson, who spoke next, stole the show – his tiny frame conveyed in a booming voice what the world was like for a child of Africa living with HIV. Almost as if he was speaking to the President one-on-one, he explained why everyone should stand up and be counted in the fight against HIV.

Unmoved by this child’s trembling words, Mbeki simply got up and walked out midway during Nkosi Johnson’s speech. The irony of a little child conveying home truths to the President was not lost on the crowd. Their disappointment in Mbeki was now bitter.

The stage was set for global AIDS treatment access

The conference itself became a melting pot for new opportunities and for unlikely interactions – drug company representatives were speaking at community forums in the Community Village about their commitment to affordable treatment; healthcare providers explaining the pain of watching their AIDS patients die helpless in their efforts to fulfil their oaths to ease suffering and community voices everywhere. Speaker after speaker talked about the pain, the suffering, the stigma and the orphans. At the same time, speakers described new options for financing treatment access, using Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreements to overcome intellectual property obstacles, generic drug options and human rights obligations to provide treatment.

The stage was set to create a unique cauldron for the set of ideas for making AIDS treatment possible to percolate. By the time the audience streamed into the ICC for the closing session, it was clear that a new era in AIDS was dawning. With 17 ovations, the packed-to-capacity crowd in the ICC acknowledged and lauded Nelson Mandela for his poignant words of support for their cause, their pain and their attempts to remain alive. His rallying cry for action in ending AIDS injustice and for a world where everyone would be able to live with dignity reverberated in the plenary hall as thousands stood up in a rousing standing ovation.

The AIDS 2016 Conference

The stirring moments of the AIDS 2000 conference are not just distant memories. The conference’s legacy continues in every poor person who is able to get affordable AIDS care today. As the conference winds its way back to Durban on a sojourn that saw stopovers in Barcelona, Montreal and Washington amongst others, it is a good time to contemplate the future of the AIDS Conferences and, specifically, what it should aim to achieve in 2016.

The vibrancy of 2000 is no more. It has been replaced with calm and rational options for the future of the HIV epidemic made possible by a combination of scientific discovery, innovative funding mechanisms and deep commitments from policy makers, activists, researchers, health care providers and many others to make AIDS treatment available.

2016 is an opportunity to take a cold and hard look at what it is really going to take to bring about the “end of AIDS as a public health threat” – the UNAIDS 2030 vision. There is no easy road to this goal but if there is an opportunity to build momentum in 2016 towards this goal, then Durban is the place to do it.

The conference will be the perfect stage to generate new ideas on how to reach this noble goal – it will be an opportunity to create, once again, a common purpose focused on achieving this important goal. It is no easy goal. Some say that it is not even remotely achievable. What better venue to debate these issues than the birthplace of the movement that brought hope, dignity and life to so many?   

Professor Salim S. Abdool Karim is the Director of the Centre for the AIDS Programme of Research in South Africa and Professor of Clinical Epidemiology at the Mailman School of Public Health at Columbia University

Professor Quarraisha Abdool Karim is Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa, Professor of Clinical Epidemiology at the Mailman School of Public Health, Columbia University