AIDS Carnival

created 8/22/2002, posted on 8/26/2002

This is just like a Carnival. With a grand opening ceremony and a celebrity-filled closing ceremony, endless performance, art exhibitions, receptions, film festivals, and of course, a lot of participants. To be exact, there were more than 17,000 of them. And then, as things can get very political in all big events, there were a lot of protests and jeering.

This is the 14th International AIDS Conference in Barcelona.

The biannual International AIDS Conference has always been a colorful event, where individuals working on all aspects of the epidemic and those directly affected by HIV come together to share their latest findings in treatment, epidemiology, and prevention. Activists come to lobby and debate the latest policy issues. Because it is so high-profiled, almost every famous news media send reporters here. I still remember two years ago, I read the news reports from this Conference (which was held in Durban, South Africa) daily on CNN and New York Times websites with great interest. I was about to start a new job in HIV prevention. If I would work hard enough I might be able to be a part of the next conference, I thought. It would be exciting to present my research findings in such a huge and visible event.

And I made it there this time.

After attending five American Public Health Association (APHA) annual conferences in the past 8 years, I thought I would get used to any conference with such Olympic proportion (APHA Conference usually has more than 10,000 participants). Wait until I saw what the AIDS Conference is really like! With historic number of 17,000 attendees this year, the Barcelona meeting easily topped any meeting I have ever attended. Actually, it was so enormously huge, they had to arrange all the plenary sessions (and opening/closing ceremonies) in the Olympic Arena. We had to look at the three projected screens to see the facial expression of the presenters. I could not find some of my coworkers even I knew they were around. How comes there were so many people coming here? Many of them were even from the other sides of the Atlantics (or the other side of Indian Ocean, for people based in Asia and Australia). I don't know, maybe it's just because the location it was held – Barcelona - was more appealing. Or maybe because the AIDS crisis is now worse than ever.

The opening ceremony on Sunday night is as dazzling as a circus act. Els Comediants, a theater troupe did a great performance featuring costumed acrobats twirling from ropes hung from the high ceiling of the cavernous Palau St. Jordi. A giant balloon symbolizing HIV was attacked by a group of dancers dressed like scientists. A candlelight vigil accompanied by the music of a Catalonian cello player while a special guest read a poem dedicated to those who passed away. After the ceremony, a reception was held at the Esplanade outside. With enough tapas and cava (Catalonian Champaign) to feed possibly 20,000 people, the attendees chatted and watch more performances. The Castellers – Catalan "human tower" was shown several times this night.

Unexpectedly, the most memorable moment that night was when I witnessed the Spanish Minister of Health was booed for more than 10 minutes when giving a speech. Because her speech was given in Spanish, I had no idea why she was jeered. In the reception, I was told that many attendees eventually not able to make it here because they couldn’t obtain an entry visa from Spanish embassies. Mostly because these attendees are from poor, developing countries. The Minister of Health actually has nothing to do with Spain’s immigration or visa policy. She got all the blame because she represented Spanish government! As a person who holds a passport from a third-world country (Mmm, it depends how you defined ‘third world’) and require an entry visa to almost everywhere in the world, I could understand that frustration. Those people who had chance to heckle the Minister were at least lucky enough to make it there. I was not sure how many people missed their presentation due to the visa problem.

My presentation was scheduled on Thursday noon, the last day before the closing ceremony. It was quite a work on preparing this abstract. Due to a senior professor (who was not my supervisor) disagreed on the analytical methods I chose, I had to re-organize the whole dataset and analyzed the data with a different model. I even had to work until 9:00 p.m. on both Christmas Eve and New Year’s Eve. Fortunately, this abstract was accepted in April but was only arranged to present in poster format. That means, I did not get to speak in front of 2,000 people but instead, had to put all my work on a small poster board, next to 1,000 other posters. At least I did not need to worry about being hit by stage fright. Or the PowerPoint suddenly breaks down. Yes, those things did happen in my tumultuous career.

Because my research topic was related to a very controversial issue a few years back (Does people with more advanced stage of HIV disease use marijuana more frequently as alternative medication? which might have implication that government should legalize medical marijuana), I thought my poster might be noticed by reporters from CNN or New York Times. And then, I might be talking on TV. Or at least featured on scientific journals like JAMA and Science.

Of course it did not happen. There were just too many things going on. Few people could really find out what was going on in presentations not too related to their own field. Also, news media selectively focused on things more sensational, rather than based on their scientific merits. US HHS secretary got booed in his speech and that made a big headline back in New York. What about needle exchange programs that actually lower incidence of HIV infection? No, they never made it to any mainstream news media.

While all those sessions and posters made my head spin, I did find some sweeter moment brought by this huge meeting. In some way, this conference gave me some nostalgic feeling and brought me back to my student days. Sometimes it felt like a class reunion. I ran into my Indonesian classmate I haven’t seen since 1995. Now she represented Indonesian health ministry to present a epidemiological finding; I ran into a guy who used to married to my classmate back in Harvard; finally I had chance to sit down for a cup of coffee with a friend (We always missed each other when I visited Boston); and I ran into at least two dozen other classmates back from Johns Hopkins and Harvard. Unfortunately, it seemed that every old classmate I ran into had a better career than I do now...

All in all, this was a great conference, even though it did not offer too much good news about HIV/AIDS. We have already known the Highly Active Antiretroviral Treatment (HAART) can effectively reduce opportunist infection and prolong life, but most of the infected people in poor countries still cannot afford any treatment; we know there are a lot of vaccine trials going on but was also told an effective vaccine will not likely be available before 2010; and even with all this effective treatment, there is still no evidence that any medication can completely ‘cure’ HIV. And in the next 10 years, millions of people will continue to die if the effective treatment cannot be offered to those infected...The future looks quite grim.

With all the issues unresolved and attendees still felt overwhelmed, the conference concluded with another Carnival like ceremony. Bill Clinton and Nelson Mandela gave closing remarks for the Conference. The clown came out to reveal the poster and logo for the next Conference. Even Chelsea Clinton made a cameo appearance at the end. The attendees said goodbye to each other and looked forward to next biannual conference, which will be held in Bangkok, Thailand.

Still feeling a little left out that I was not able to give an oral presentation in the Conference (fortunately, my manuscript was finished and submitted for review this month), I don't know if I am so eager to attend another “carnival” like this in 2004. After I conclude this fellowship in September, I am not even sure if I will still conduct research related to AIDS/STD. And who knows what will happen two years down the road. However, AIDS research is really one of the most pressing issues in public health history. Without the treatment breakthrough and prevention programs in the past decade, maybe 5 million more people would have died. Maybe I can really help, even just a little bit (with that little poster). So, maybe, just maybe, "See you in Bangkok."

Next Chapter: Don't Cry for Me Barcelona