AIDS Lines

Thanks Warren. The commodification of HIV/AIDS helps no one but researchers seeking funding not to end the disease but to promote themselves in the new corporate universities and pharmaceutical companies intent on increasing their already huge profits. Your observations that the "barefooters", who are at the front line of the HIV/AIDS scourge, are ignored and pseudo-scientists given full hearing make apparent the commodification and profiteering of HIV/AIDS.

Thank you very much for the information. No, I was not able to participate in the recent congress held in Toronto.

Feek's article is really insightful. For one i didn't attend the Toronto talk show but the reports i have read suggest that the event was a talk show. there was no solution offered to the access of stop gate measures to those affected by the disease. As a result its still a barier between the infected and unaffected. Eventually the problem will continue to be upon us.There was also need by the developed world to offer practical solutions on affordability as the other world pinned its hopes on the developed states.

Dear Sir, I want to attaind the workshop and present my Countries position on HIV/AIDs.If this will possible please mail back me.

. i wasn't there but was surprised
to wake up and hear on the world service that circumcision was the
answer..or that's how it came across anyway.I think this is scary
packaging; it sounded like 'be circumcised and eliminate all
risk' ...and as you say the cultural issues around this are immense

That is great amount of work you have done trying to capture most important sessions at the conference. How did you managed backforth walking from south to north building and trying to catch such valuable information.

Just my view though, history background was a concern which you can add to paragraph 5 and in the youth pavillion concerned were raised to introduce prevention methodology that does not discriminate were SAVE (Safer Sexual Practise, Access to treatment, Voluntary Counselling and Testing, Empowerment through accurate information) was not really highlighted but I felt myself that it may be a good prevention method. I believe SAVE will reduce ignorance because it personalise the HIV with oneself without trying to direct responsibility to anyone else or categorise.

Keep up the good work and I hope things in Mexico would be different. Media involvement would make huge difference and if some funds would be channelled to the media, it will benefit many other people.

Excellent

I’m glad to see your motivation and share through the net experience,
but I don’t follow the World AIDS congress, I encourage you to continue the research.

Dear Warren, I agree with you. I wasn't at Toronto. I work in Behaviour change communications in Papuaand I avoid large conferences. The medicalisation of AIDS is really a barrier to reducing stigma in resource poor settings. THe community development needs of the workers at the coal face are not considered interesting or sexy. It is really a battle to consistently work at condom promotion for very slight results year after year. Behaviour change takes a really long time and ecuation adn discussion through edutainment so that people are actively engaged adn have some fun - positive messages please not sickness adn negativity -must be continued- we cannot succeed with start stop short sighted approach. Thanks, Sara

I liked the contrast between the well heeled and cracked heeled. And of course I agree strongly with the cracked heel resistance to magic bullets. After all, even bullets need a gun to be shot from and a person to hold the gun, which takes us back again to all the contextual issues well mentioned in the article.

However, even from a medical perspective, why are we not talking about other medical issues which help to explain why HIV is such a serious issue in Africa. There are plenty of researches into the effect of malnutrition, malaria, parasites, genital schistosomiasis etc on the immune system, thereby facilitating transmission and infection. Very simple, barefoot, medical interventions with, for example, adolescent girls, would substantially increase their immunity. Of course that would mean paying attention to the general health of the population, which is probably not so much on the agenda of the well heeled.

Richard Mabala

The article reminded me of how much of the high-profile agenda focussed on scientific "fixes". It also reminded me that the "doers" know how to pick which of the scientific "fixes" make sense in their context. I remember too that Toronto media did cover some of the less prominent participants and some of the locally-effective responses.

Good comments and did capture the flavour of the conference. It also captured the big distinction and seperation between the top down approach captured in the big displays, video screens, personalities and huge meetings compared with the people dealing with the reality which was reflected in the global village. When are we ever going to get the balance right?

thanks a lot for your email and comments on the Toronto conference which I totally agree with. These are the positive and less positive points I would add to yours:

- PLWHA were given a voice: lawyers as well as intravenous drug users, from developping countries and from developped ones were given important opportunities to speak up.

- GBV remains an important (and emotional) topic in discussion forums but very little data is shown on the eidemiological links between rape and the HIV epidemic.

- The quality of the presentations varied hugely. Again, good quality data was often lacking from important presentations. More epidemiologists from developping countries need to be trained to better analyse and present their vision of the epidemic.

I read your thoughts and for the most part I do agree with your observations and sentiments. The entire conference ran a dual course - one determined by the high level scientific and medical arena - and the other determined by grassroots community initiatives whose needs are urgent, small scale and low key. The Global Village was a reflection of this "apartheid" agenda - there were no representations by the pharmaceutical interests alongside the many community representations - or representations by agencies that would foster communications between these two interest groups.....

The "international" agenda - I fear - will be increasingly driven by the (profit and otherwise) motivations of the scientific community, while the "local" agendas will be left to fight fires. I was involved with a group in Tanzania to bring grandmothers over to the conference - a group of women who remain voiceless and powerless, in their golden years - looking after households of children with extremely limited resources.

enjoyed reading your piece. I found it insightful and for those of us who could not be everywhere - or for those who did not attend the meeting - I think it illustrates the deeper issues that are at play. How power politics plays itself out in these contested spaces and times. I liked the fact that your commentary exposed the duality of engaging in this work.

Enjoyed the article but found the English a bit contorted.

The comments made are very valid and give a goood analysis of the just concluded AIDS Conference. It was also evident that the agenda this time including the speakers towards a so call North dominated with issues specific to developed world.

In response and based on the observation of the role of 'art' in social and cultural development, it is disconcerting that the emphasis at the conference, which I did not attend, has moved more towards the clinical, 'medical technology prevention', approach. When one accepts that it is our cultures that governs our every move, this important aspect is then being overlooked. (Refer ex RSA Deputy President Jacob Zuma comments during his rape trial)

However, the distinction needs to be made between the present generation and future generations. Present generation, of which you and I are part of, can be observed and therefore is much easier to understand. It is in this context that the data you present in your presentation clearly shows that, what are essentially, educational interventions can be very effective in promoting greater awareness. But, in our society, South Africa, (and as we all know smoking is bad for you, speed kills and unprotective sex can lead to HIV, yet many still smoke and many die on our roads and many get infected), education is not the only answer.

It is in this light I agree that the 'medical technology prevention' and treatment is absolutely essential for treating our present generation, this in spite of the shortcomings as you point out below. More than what is being done presently, for this generation, I'm not sure can be improved on except in terms of greater availability of ARV treatments and more educational programs and a much greater willingness by the political leadership, particularly relevant to SA. Your presentation points to a large number of proven educational interventions of which most working in the field are aware of. In this instance one should also look at the Victorian Health Promotion Foundation, recognized as one of the most successful prevention programs internationally, see http://www.vichealth.vic.gov.au/Content.aspx?topicID=239#cs_746 and http://www.vichealth.vic.gov.au/assets/contentFiles/CAPS%20Evaluation%2…
e_full.pdf. But there are many. (Incidently the majority of this educational material refer to does not become part of cultural heritage, if it is preserved it is mostly for academic purposes but useally it gets disposed after use, like a used condom)

Our concern in Art for Humanity focus on future generations, which you allude to, "ARVs be universally available and gels, circumcision and maybe vaccines work and be available in 5 to 10 years, then issues of culture, social norms, behaviors, stigma, poverty, gender and education will present considerable barriers to their application." This statement is correct if we assume that the present status concerning our cultural context will remain the same, with a large section of the population presently being not only illiterate in terms of reading and writing but more importantly 'visually illiterate'. Levels of visual literacy in any society I will contend is directly related to the level of art making in that society, see my interpretation of what constitute art below. Butsocial and cultural developement does take place, in line with the so-called 'developed'
cultures globally, then your projection might be tested.

When one observes these so-called 'developed cultures' it is noteworthy that 'behaviors, stigma, poverty, gender and education', certainly within the context of this discussion, has to a large extend not experience the 'considerable barriers to their application' as you point out. This brings me to what is the difference? After all we are all just human except for our cultural differences and for Art for Humanity it is not incidental that globally art and culture are often used interchangeably and in close association. In this instance we also need to know what is meant by art, in Art for Humanity we tend to look at art as that which we create with the intention to inspire humanity, because one thing we are sure of is that the next generation will be part of humanity, (duh). This as opposed to that which we create purely for ourselves and for now, with no intention or concern for those outside of our immediate community, culture or the future.
This normally would include educational material, cartoons, comics, propaganda, advertising, ritual objects etc. As pointed out above objects we normally will keep for reseach purposes or as curious collectables, but not as part of our national art collections we presersve as tangeble cultural heritage for future generations. It is in this context that I prefer to talk about 'cultures with art' and 'cultures without art' as opposed to socalled 'developed cultures' and developing cultures'.

Knowing our work in this field, see
http://www.afh.org.za/breakthesilence.php you probably allready know my response, but here goes...

I did not attend the International AIDS Congress in Toronto... I WAS a delegate to the International AIDS Congress in Bangkok. Though the timing was different and the audience more relative to location, I believe many of the same currents were operating. I once saw a very stirring film of the previous AIDS Congress of the high profile medical and pharnmaceutical people in their white jacket and fine suits, and outside the AIDS victims crying to be heard.

We are seeing a globalization in human rights, a polarization, and power and money and often governments are so often ruling.

I see the AIDS issue from a gender lens, the Feminization of HIV/AIDS. I am also involved in multiple projects relating to AIDS as the links between Trafficking and AIDS.

I further have privy to a medical program that has proven to address AIDS quite effectively and economically, and has World Bank, and big money support, and was to start soon in a test location in Europe, and there is a big effort by drug corporations to block it. We will see.......I think the key players are in place, and so this will be a supreme test.

This piece is insightful and gives the reader a sense of the 'between the lines' issues that is missing when reading or hearing about what happened at the conference.

Focused and interesting. Well dedicated time to important events that could have skipped off memory.

Please this fit high and be encouraged.
- from Gombe, Nigeria.

Thank you for your email. I followed some of the links and read your
response to the conference and I feel much the same way as you do. I also
attended the conference and felt that there was a major focus on prevention
technologies to the detriment of the more subtle social and cultural issues
that are at the core of the pandemic, particularly in southern African
countries, that must be addressed before behaviour change is a possibility.

My own research is on the role of social network actors in HIV/AIDS
education in rural Malawi. From this research it is clear that cultural
norms and societal values will ultimately impact behaviour more than simply
the availability of VCT or ARVs and condoms. For example, as of now condoms
are widely available but are not being used due to negative views toward
condoms or negative images of people who use condoms due to their
association with promiscuity and unfaithfulness within Malawian society.
Further, due to stigma and discrimination, VCT is not an attractive option
to individuals unless they are quite sure they already have the virus and
want to access ARVs.

Anyways, I could go on and on but I just wanted to say that I am reassured
and encouraged to read your responses and other articles from the DrumBeat
because I feel that the role of communication and education in creating an
environment favourable to behaviour change is often overlooked and
underestimated by political leaders and international institutions. I think
that the experience of Uganda illustrates the importance of interpersonal
communication in behaviour change.

Thank for the update on the Conference

Yes, I totally agree on the naivete of technical fixes. What about the previous ones: VCT and PMTCT?

We are now finding that in fact people who test negative do not practice more protective behaviours afterwards. So VCT is not much help in prevention. We have over 400 VCT sites in Uganda. Those who test are usually people at very low risk (e.g. students) but not those at high risk who really do need to know their status (e.g. widows).

With PMTCT, despite the heroic effort of getting about 250 sites up and running, we are getting only 2% of women who need the medicine through the system (the UNGASS goal is 10%). One of the reasons for this disappointing result is that over 60% of Ugandan women deliver at home unassisted. Another is that we have not done enough to involve men.

We also have 50% of adults in Uganda having genital herpes. Yet the focus has shifted away from the important co-factor of STDs.

In Uganda we are relaunching prevention. I hope we will be able to re-situate it within reproductive health and the fundamental centrality of sexuality, building a family and reproduction in peoples' lives.

At Straight Talk Foundation we are trying to return to our roots in comprehensive sexuality education.

In Uganda we are trying to get away from AIDS as business as usual. Let's hope we can.

Philipos Petros(Addis Ababa, Ethiopia, Head HIV/AIDS Management/ECSC)

really very instrumental for those stakes who have difficulty of getting keep touch with the updates, best practices and rich information

I absolutely share your analysis. I have not been there for other competing priorities and moreover due to reasons related to the nature of the conference itself where I believe there is not much space for reflections. Sceintific papers presented could help for programming if there is room to reflect on.
From the media as well as reports from colleagues who attended the meeting I realized that there seems to be a shift of interest and obviously a shift of focus from prevention which has been more comprehensive allowing a wider scope of intervention to technology and quick fix which I do not think is the nature of the pandemic.

This page is as useful as the information that contained herewith. I am greatful for reading such a wonderful compilation of what happened at the event. It was great and I wish we deliver now for life, especially for the African woman facing HIV/AIDS and poverty!

Henry Ekwuruke

This is exactly what I felt and missed from Toronto.
Thank you for this clear formulation,
C. Pervilhac

I agree with the line you're taking but I fear you're fighting an uphill battle. The New Yorker ran a profile on Bill Gates and his foundation a few months ago. It's worth a close read. He believes the problems of the world can be solved through technology. He and Clinton pretty much said this in Toronto.

As I see it, there are several overlapping arenas with communication needing to be pitched in different ways at different levels. You're right about the barefoot group and the need to get their messages to the higher levels but the truth is (as I see it) that in no sphere do the people who know about implementation impact on the decision-makers (this can be seen in the Israeli attacks on Lebanon as easily as the "rebuilding" of Iraq, in every field of commerce and science).

Much as I would be happy to remake the world in some new mould, my practical side suggests that we need to deal with what's here and now and that means a certain amount of gladhanding the big-money folks with the possibility - even the likelihood - that we can defeat HIV. Without this, we get into the Africa argument: Africa is a hopeless cause, let's stop funding everything in Africa til we can think of a clever way to prevent corruption, involve ordinary Africans, etc.

So I think the techno speak is needed in public for the decision-makers. My fear, like yours, is that this speech will turn into reality and will push funding away from those processes that actually work here and now. You call at the end for balance and I think that's exactly what's needed: we need the tech-heads to say their piece but we also need those of us who work mostly with communication to make our case solidly as well. It would be nice to believe that this could be a case of thesis, antithesis and synthesis, but at the least I think we need to be running a parallel argument for communication initiatives.

Keep up the good work on the Drum Beat etc. It's very valuable.

Cheers from Sydney

This piece gives me a view of what went on in Toronto as I did not attend. I think we should start spending more on the root causes than the symptoms of HIV/AIDS.

Warren,

allow me to introduce myself as Guatemala Country Manager of Health Unlimited. My colleague Humberto Rodas passed your letter on, and I hope you don’t mind a couple of observations of my own.

In general terms, I couldn’t agree more with your analysis of the disturbing shift from the “barefoot� to the high-tech as the focus of the struggle against HIV-AIDS. I think there is a tendency for policy-makers to feel the pressure to develop new approaches when those which (as you rightly say) have worked well in places like Uganda have yet to be implemented universally.

In the case of Guatemala, for instance, we have yet to see basic information being universally transmitted in the state educational system - only 7% of schools report conducting life-skills-based HIV Education sessions in the last year.

I for one would have welcomed a more robust challenge in Toronto to US policy on Abstinence emphasis, although here in indigenous communities we do find that ABC actually helps us get to “C�; were we to ignore A and B, we would be perceived as anti-traditional culture, which we very much want to avoid; it’s a matter of emphasis as far as I am concerned, and there is, for me, nothing wrong with ABC, so long as we never stop (or slow down) at A.

I would also say, though, that we should be careful not to turn our backs on circumcision; in contrast to most quick-fix medical or scientific solutions, such as gel, this is something potentially viable in many developing countries. Of course I agree that it is not a panacea, and that cultural issues are of major importance, but I do think that it could be something to encourage, if current studies continue to show the results they have done so far.

If you have any comments, please get in touch at ssljuventudkiche@hotmail.com, and see our web page for a snapshot of our project at: www.saludsinlimitedgt.org

All the best, and congratulations on your work, Thomas Hart

Lots of interesting and useful thoughts as usual Warren, but at the same time I think it's more helpful to see the 'well-heeled' and the 'shoeless' as on a continuum, not on two sides of a fence. It might well take 5 years for a microbicide to be produced, but it could take 50 years for men to change their horrendously harmful behaviour in so many parts of the world (and many other ultra long-term social issues to be addressed too). I don't see any problem with running both streams at the same time. If the big money donors want to spend their funding on ARVs and medical research we shouldn't tell them they are wrong, but perhaps encourage them to ALSO spend on other activities including communications.

All the best
David Wood
BBC World Service Trust

While I was not at the Conference in Toronto, I followed it quite closely.
I was dismayed by the lack of political commitment from the Canadian
Goverment but amazed by the diversity of the conference. Flipping through
the proceedings of the conference, I fall asleep looking at the scientific
studies ...mostly focusing on treatment. The scales have been tipped where
prevention is falling behind and the reality of it seems to get blurred.
The AIDS pandemic has unfortunately become a business where people lose
sight of what is pragmatic. You can invent something but to ensure that it
will be socially and culturally accepted is another story. Take for example
condoms, simple, easy and effective. Despite high knowledge of use, its
application is still limited. Trying to understand the complexities behind
behaviour change is a mammoth task but its contextual and culturally
specific. In Namibia, the home environment where young children grow up is
culprit to the spread of the disease where violence, abuse and alcoholism
prevail....this behaviour becomes acceptable and normal for young children
and the disease perpetuates. I would probably say that Alcohol is the
biggest issue in this country where people engage in risky behaviours under
the influence and its frightening to say that children as young as 10 start
to indulge in this. Every second shop in the north is a bottle store and
commercially brewed alcohol is cheaper than soda and even bottled water.
People have problems and alcohol numbs the pain. Having worked in
several African countries the situation is contextual and different.
Working in a rural village in Kenya by the Lake Shore, HIV is spread
through transactional sex for fish. Any boy or man who could catch fish was
guarenteed sex...the women would give sex so that they can sell the fish.
Coupled with issues of polygamy, a high traffic/trading area, lack of
circumcission, wife sharing, widow inheritance all contirbute to a
staggering 35% rate in this specific community. I am not denying that
research is important and critical but the approach needs to be balanced
and more grounded to the reality. Will a new intervention be possible for
those who need it most. We tend to just develop the intervention and hope
this will work. The politics of AIDS is completely another story but the
barefooters stay with the people and those most affected and come up with
innovative microsolutions to prolong life on a day to day basis. There is
hope in the people of this great continent and even in light of the
adversity, you see the smiling faces. I was heavily involved with the
Picture Change project (well publicized at the Conference) and I remember
the photograph of two women with a blackboard in the background scribed
"Never Give Up!". We need to continue to do what we do best with the
communities and people on the ground but we also need to push a little more
on the prevention side. I have been inspired by the hope and it will help
me to continue to make a difference because every little bit counts.

The information in the article is interesting especially for those of us who were un able to attend the conferene. How is the issue of dry sex being dealt with? The Sub-Sahara Africa levels are high because 90% of them practice dry sex and we all know that blood to blood transmission is 99.9%

Thank you very much for your email. I happy to share
this information. Down here in tanzania HIV/AIDS
transmit every minute and most of the effected sex are
female. But in rural areas still need education on
pevenstion and transmission including how to
handle/care an AIDS patient.

I am trying my level best to get some funds for
education and awareness.

I was not able to attend the conference in Toronto another journalist at my newspaper got the sponsorship. However i was able to follow the news unfortunately the local journalists here who attended from the two daily newspapers one which is work for chose not to highlight significant issues like those which i think you do in the thoughts you put down, which is really sad.

I guess one of the reasons they failed to send us stories that would have been significant to our situation in as far as the HIV/AIDS pandemic goes is that there are currently factors that are invisibly creating friction. How do you cover such a high level conference on HIV/AIDS when you are from a country that is currently at crossroads in as far as the approach to the problem is concerned. Our greatest challnege is the fact that we as Journalists in Uganda realise it is a fight between the ABC policy that for year proved fruitful in Ugand and yet suddenly we have the abstinence only approach which in a way is much more desired to be promoted by governmnet because of the whole donor aid factor.

That brings me to the point i would very much like to talk about in your thoughts. THE BIG AGENCIES. I think this poses a big threat to the whole fight aganst the pandemic. We all know that these agencies are after making money at teh expsense of havign people suffer and die as a result. And many people benefit even if indirectly, i have a feelign we shall over the years see a situation where more and more leaders in the developing world are moving away from certain issue of fighting HIV/AIDS as the ABC and trying insetad to try and promote the technology and the vaccine talk which we may not see in so many years. And even at one time their technologies will pay off, how long will it take for the grassroot Ugandan (Just an example could be Kenyan, Zambian) be able to acces this technology when even access to ARVs is still a miracle to some. And then like you said there is the issue of cultural difference and stigma. Even after living with the disease for over 20 years, these still exist.

I think that the old ways of trying to overcome the pandemic such as the ABC which was used in my country should not be discarded at the expense of technology that may not make it until after 5-10 years like you said.

balanced, insightful report. Thank you

THE ARTTICLE IS GOOD BECAUSE IT IS SHORT; THE ANALOGY OF DIFFERENT
DIRECTIONS IS SO APOSITE & IT POINTS TOWARDS A CHANGE FOR 2008. MY VIEW
IS THAT THE TWO DIRECTIONS WILL PROBABLY ALWAYS BE THERE AND I AM HAPY
ABOUT THAT BECAUSE ALTHOUGH IT MAY BE FRUSTRATING IT ALSO SHOWS THAT
PEOPLE ARE THINKING ABOUT THE PROBLEM. CAN COMMUNOICATION ALONE SOLVE
THE PROBLEMS? No. CAN TECHNOLOGY ALONE SOLVE THE PROBLEMS? No. CAN WE
LEARN TO WORK TOGETHER WITH OUR DIFFERENT BIASES? Hopefully. If we
don't then we are actually being selfish.

Although I followed the conference on the Internet, I do think that your comments echoed very real and authentic. Having worked mainly in the area of prevention since the early 1990s and also with a communications background, I have been increasingly aware of what is now known as the medicalisation of the response to the epidemic.
- from Kingston, Jamaica.

The article by Warren on The World AIDS Congress in Toronto realistically deals with the challenges as they appear in the third world where up to now, not even 25% of AIDS patients have access to ARV's. For me, the focus on the conference just perpetuates the thinking that some of have - that the disease is there to help enrich the pharmaceutical industry and not to honestly help the sick. Marvin Hanke, Executive Director, Story Workshop, Private Bag 266, Blantyre, Malawi. swet@malawi.net

I appreciate the sharing of the information on issues of HIV/AIDS. The value of the congress can not be over emphasised. Presently we are trying to see how we can utilise the info they gathered to improve our work in our local setting.

you're absolutely right. but as long as the medical "epistemic community" controls the definition of AIDS (or other diseases for that matter), magic bullets will always be appealing. all social issues that you mention (and we care about) will remain "interesting" rather than central to understanding the problems. the "barefoot" are important in the hiv/aids community (perhaps more than in other disease affecting the South), but aren't powerful enough to define the problem and its solutions. so, vaccines, gels, sundry technologies and quick fixes will get more attention. frustrating but that's why we are here...

How far is the scientist with the cure of hiv/aids, is ther hope that they
can find cure, we are dying her in Namibia.

Your thoughts in "The AIDS Lines" reflected exactly what I have been feeling but have been unable to properly express. Before reading your piece, I had just emailed my friend about the 'two levels' of the HIV/AIDS response. I was thinking about how seductive it was for a young person like myself to be engaging in discussions with "the well-heeled", as you put it. Sure it was nice to network with UN officials; but I felt shame as well, because I knew it wouldn't be constructive for me to align myself with a group so far removed from the realities faced on the ground. This detachment is the reason that people speak of the frustrations of rhetoric. Exploring the Global Village and meeting people who worked on the ground left me feeling so much more inspired and utterly awed by the resilience and determination of humankind.
Not to say that multinational organizations - both research and
administrative - don't contribute or don't play a role. But, like you, I
fear what will happen if the world's attention and resources become fixed on their grand agenda. The world is in dire need of understanding the social, political and cultural context in which the world's strategies to fight HIV/AIDS are inevitably placed. Pushing this essential piece of the puzzle to the fringe of the HIV/AIDS response will only keep us from moving forward with the technological and scientific advances that we glean.

This is a very useful contribution.

The issues raised by the "barefooter" are more relevant to my work. I am looking into the issue of increased condom use, stigmatization, socio-cultural norms and improved communication between couple. I believe more attention should be given to this area if we are to see significant change in the rate if infection in Africa and the Careabean. the avaialablity of ARV universally is also crucial.

Dinah

This article reminds of the AIDS India 2003 conference in Chennai. It was heavily in favour of medical technology and had grossly neglected the "barefoot". It is disappointing to see that trend still continuing. In this context, it becomes far more important that a better balanced strategic and funding line is developed to address the problem more effectively. A recent research study has emphasised the adverse impact HIV/AIDS will have on Indian economy if it's growth is not checked. HIV/AIDS is also threatening the food security scenario in many developing countries.The good old saying that prevention is better than cure still holds true and all efforts should be made to stop the growth of HIV/AIDS infections and offer quality health services by the time a a vaccine or a lasting solution is developed.

Manish Kumar
OneWorld South Asia,
India
manishat@rediffmail.com

Thanks for a courageous piece. I am member of a barefoot team in the hot sands of Congo.
Medical technology approaches have tried to absorb AIDS resources since the beginning. Let us hope the world community wakes up to the realities especially in the developing world
Bon courage
Cecile de sweemer MD; DrPH

The article really filled me in about Toronto conference activities since i did not attend it.

i still feel that the conference organisers still forget to include people with disabilities in their strategies and with that they continue to be overlooked and the chances of forgetting them in AIDS crisis stemming efforts are high .
This group are facing serioues challenges especially women with disabilities in Africa.

it is has emerged from speakers that our current strategies are not working and we have to face the truth: testing alone is not a solution to win aids war . advocates\ still claim that good news is still hard to find, but until when and why?

providing tretament is essential but it seems to me it is a bottomless pit as long as the diseases continue to spread so fast, people with disabilities have been largely overlooked , their rights to confidentiality,consent and provisions of ARVS with respect to adherence especially to them are nowhere in the Aids conference and these challenges needs serious minds . as we alreday witnessed only effective prevention can stop the spread of AIDS yet it is precisily that current poplicies are failing most seriously due to leaving marginalised groups behind.long chain of action is required to include all people , infeted and affeted regardless of their disability to stop the spread of AIDs , why sould the wold still reamin silent about disability and HIV/AIDS?how do we talk to marginalised groups to break the stigmna attached to HIV/AIDs and disability.

we still remain a long way in finshing this line in order to reach equality, acceptance and AIDS toleraable world.this things are alive and people should face the truth to encourage mixed environment and much need to be done on disabling effects of HIV/AIDS on people with disabilities to achive our millenium debelopment goals.