IAC 2004 - Bridging the Gap Between Wish and Reality

The following commentary on the 2004 International AIDS Conference (IAC) was written by a key correspondent from the Health & Development Networks (HDN). It was originally published in HDN's eForum: SEA-AIDS.

From the SEA-AIDS eForum, July 17 2004

"Authority, emotion, tradition and speculation are no substitute for rigorous thinking.

There were two small gaps at the XV International AIDS Conference (IAC). The first was the gap between ideology and reality. We heard a lot about aspirations, vision and goals: How many people we should aim to treat with ARVs. How many should have access to voluntary counselling and testing. How many financial
and human resources are needed. We also heard a lot about local level experiences, pilot projects and practical ways to get around seemingly immovable obstacles. The thing was, we rarely heard about them together, and this created a sense of apprehension or doubt - a bit like leaving home in the morning certain that you have forgotten something, but not being sure what it is until you were well on your way.

This was how we were able to go almost right through the week with
several
blind-spots on our horizon. We talked endlessly about the three million
people who will hopefully be on ARVs by the end of next year - but did
not
address the difficult questions about how those drugs will be rationed
to
exclude the other three million who need ARVs right now. We discussed
the
importance of bringing prevention and treatment closer together, and yet
the
practical nuts and bolts of preventing mother-to-child transmission did
not
get any major focus.

The second gap was equally fundamental and may actually underlie the
first.
It is the gap between advocacy and rigour of scientific thought. The
sciences of HIV/AIDS have suffered from the fact that this is a
relatively
new and fast-moving field. The short time-frame for development of
HIV/AIDS-related thinking has made the tendency to rely on
'observational
generalisations' more likely in this field than many others.

There are two ways to 'do' HIV/AIDS thinking. One is to base general
conclusions on accumulated evidence or observation - the so-called
'inductive' approach. In the HIV/AIDS field, such inductive processes
lead
to statements describing accumulated experimental and observational
evidence. In the broad AIDS discourse, these are separated from - and
sometimes contrasted to - other kinds of statements, such as those
derived
from authority (eg, those made by UN agencies), emotion (eg, testimonies
of
people or communities living with HIV), tradition (eg, faith-based
perspectives) and speculation.

The alternative is to propose an idea or hypothesis and then invite
others
to criticise it, or disprove it through investigation. This requires not
only sound logic and experimental design, but an active willingness to
have
others criticise your work.

The latter is difficult to maintain when you are busy with political
posturing, positioning your organisation or competing with peers for
funding
and other resources. The XV International AIDS Conference has
demonstrated
that in the current environment of rapid change and resource flows

within
the AIDS field, the inductive approach to scientific thought rules, and
constructive criticism is out.

As a consequence, we will have to tolerate disconnects between policy
and
local level realities, learn to live with accepted truths that are
founded
more on repetition rather on data, and accept blindspots because we are
no
longer following data or evidence to its inevitable conclusions.

Toronto 2006 organisers please take heed: some of the urgency
surrounding
the epidemic must be shifted towards regaining critical thinking and
analysis in the HIV/AIDS response."

HDN Key Correspondents Team

Email: correspondents@hdnet.org