On governing of Barcelona AIDS conference

[Guest guest]

[This posting is for those of who often wonder how the speakers of the

International AIDS conferences are selected. Moderator]

Digesting the " Marathon Meeting: " Feast or Famine?

by Stern, Ph.D.*

Approximately 90 AIDS experts from all over the globe converged in

Barcelona from March 16-18 in an aptly named " Marathon Meeting " to

plan the program for the upcoming 14th International AIDS Conference

which will take place in July, 2002 in the same city. The Conference

is expected to draw 15,000 scientists, community leaders, physicians

and policy makers from all over the world.

Nominated to be part of the selection committee for Track G,

(Advocacy and Policy) I was invited to the Barcelona meeting, held

in the luxurious Gran Hotel Don , in the Barcelona suburb of

Castell del Fels. I am a Community Organizer working with issues

related to access to treatment for People with HIV/AIDS in Central

America. I found that I was not well prepared for the challenge of

evaluating 1375 abstracts in less than three days to determine which

72 would be selected for " oral presentations " at the Barcelona

conference.

The comments that I present here reflect some of my honest feelings

and observations about what occurred during this very intense

meeting, but these observations are purely subjective and come from

my rather limited perspective as an advocate for treatment access in

Central America, a region of 33 million people, whose problems

related to the epidemic may seem " minimal " compared to other regions

of the world. I think a dialogue is healthy and I would hope that

other Marathon Meeting participants would add their opinions and

react to mine.

Initially the 12 members of our Track were given the top 300

abstracts related to Advocacy and Policy which had been pre-selected

during an internet reviewing process by selected qualified experts.

However, it was soon apparent that the pre-selection process was far

from perfect and that there was in some cases relatively little

difference between the " top 300 " and the more than 1000 abstracts

that did not reach that level. It was possible to have <AB Congrex>,

the conference's technical support team, search the remaining

abstracts by keys words and topics so additional abstracts were

pulled up by the various track reviewing teams.

The on-line rating system must be reviewed for validation criteria.

Some raters constantly rated high, others low. Some raters rated

abstracts considerably lower if the writer's English was deficient.

Of course, since presentations must be in English, there is, sad to

say, a valid reason for using English as a selection criteria. On

line reviewing has advantages, but there are also disadvantages

unless thorough training is provided to reviewers.

In total 10,430 abstracts were submitted for consideration for seven

different tracks, most of them for oral sessions. But only about 70

per track, at total of about 500, will actually be selected for oral

presentation at the Conference. Several hundred more will be

selected as poster sessions. In contrast to previous Conferences, the

vast majority of abstracts will not be selected for presentation at

the Barcelona Conference.

Being part of a process that is " abstract driven " is somewhat

frustrating. Track members were given very little ability (with some

exceptions) to round out a theme with invited speakers but were

asked to stick to abstracts which had been selected. However

symposium presentations (3 per track) do allow for the opportunity to

have more presentations made by invited speakers. Across

track " Bridging Sessions " (13 in total) also allow for invited

speakers. Plenary session planning was not part of the scope of the

Marathon Meeting.

Plenary speakers are chosen by the conference's Organizing Committee.

A major issue which received a lot of attention during the meeting

was the fact that all Conference presentations have to be in English,

in spite of the fact that the Conference is taking place in a Spanish

speaking country. According to the Conference " Invitation Program and

Call for Abstracts, " one of the principal objectives is " to fcilitate

participation from around the world, particularly countries in Latin

America and the Caribbean. " In spite of these eloquent words, it was

a constant struggle during the Marathon Meeting to get any issues

related to Latin America on to the Agenda, and, in my opinion, the

results were quite unsatisfactory.

The language issue must evolve along with other priorities related to

the epidemic. I know many excellent speakers in Latin America, but

they cannot present their work in English and are therefore

eliminated from presenting at the Conference. With AIDS having

evolved into an epidemic in which the importance of overcoming

exclusion has been recognized, language has now, perhaps

unintentionally, become an area in which significant exclusion

occurs. (According to the " Key Messages of the XIV

conference: " Social Exclusion is at the root of HIV- vulnerability... " )

I saw a few dedicated participants from Latin America advocating for =

inclusion of Spanish speakers, but there was no outcry from the

larger population of participants at the Marathon meeting regarding

the issues related to language. Nobody seemed concerned about

participants from French speaking countries in Africa or other areas

of the world where English is not spoken.

The International AIDS Society, (IAS) which financially supports the

Conference only reluctantly agreed to provide simultaneous English to

Spanish translations for sessions in the four Social Sciences

tracks, after pressure from Latin American activists who

participated in the meeting. But speakers must still do their

presentations in English.

With technology related to translation burgeoning all over the globe

it seems unfortunate that the IAS has not more thoroughly nvestigated

cost effective methods of providing translations to key languages of

all sessions as well as allowing speakers to speak in their own native

tongues.

There is no doubt that there are English speaking people working in

the AIDS field in all developing countries. But my impression from

years of work in Latin America is that, with clear-cut exceptions,

many of these people come from an upper class background, have

comfortable positions in government or NGO's, and may have a vested

interest in not rocking the boat, on a national or international

level. There is a need to reach out to grass roots activists in

developing countries and many of them do not have access to internet,

nor do they speak English.

At one point I spoke personally to a member of the Conference

Organizing Committee about the need to " reach out " in order to assure

participation in Barcelona of populations of People Living with

HIV/AIDS who are from the world's poorest countries, who do not have

treatment access and do not speak English. She asked me if these

people were really prepared to participate in the Conference in a

form where they would learn meaningfully. I suggested to her that

this was the wrong question to ask: it would be better to let these

marginalized and excluded people do some of the teaching about their

experiences and let some of the alleged experts do some of the

listening.

I was told that approximately 9000 individuals have submitted

scholarship applications, many more than for any previous Conference,

but only about 1000 individuals from the international community will

be able to receive support. Once again this is a relatively new

situation for the Conference as the majority of scholarship

applicants will be receiving rejection letters.

Perhaps the most striking aspect of the Marathon Meeting to me was

the lack of reflection in the organizational process (to the very

limited extent that I had access to observing it) of the reality of

AIDS as a plague that is claiming thousands of lives every day,

millions every year. The Conference remains a scientifically based

activity with a focus on excellent scholarly presentations, but, in

my opinion, it does not seem to envision itself as a vehicle for the

dynamic change necessary to improve the situation of People Living

with HIV/AIDS around the world.

On the other hand the " key messages of the Conference " amply

distributed over the Internet emphasize that " HIV/AIDS is a global

emergency with far reaching effects...immediate action is necessary

to prevent further catastrophe...knowledge must be used to translate

commitment into action...this knowledge must now be used to increase

the scale and effectiveness of our response to this epidemic... " The

overall tone and impact of the " key messages " still requires further

translation into concrete actions within Conference structure and

format, and the organizing committee still has several months to work

on this.

Activists from around the world will also be attending the Conference

and need to play a key role, even if Conference organizers have not

provided them with a structure within which to do it. In one

situation (that may appear to be esoteric to some, but was striking

to me as an activist focused on treatment access in Latin America)

that occurred during the Marathon Meeting, an abstract sent in by

members of the Health Gap Coalition, a well known and well respected

treatment activist group from the USA, was selected by a track

member to be included in an oral session. (The abstract criticized

multi-national pharmaceutical companies for creating " self-serving "

discourses) But another, perhaps " higher ranking " member of the

track, vetoed this idea and referred to the abstract as " ranting and

raving. " I suspect that maybe the " ranting and raving " will have to

occur spontaneously, but constructively, during the Conference

itself. (The following day, the " higher ranking " track member

apologized for this situation, but by then, it was too late to

change the decision.)

Perhaps organizers of the Community Forum held prior to the

Conference itself have in mind creating a dynamic event focused on

treatment access activism and creating meaningful dialogue with the

hundreds of decision makers who will be at the Conference. But this

issue remains to be clarified. Most often, the Community Forum brings

together treatment activists as well as People Living with HIV/AIDS,

but does not include meaningful dialogue and debate with those who

control their fate.

Hopefully Community Forum organizers will address this issue, as the

International AIDS Conference occurs only once every two years.

At the risk of irritating some of the other participants in the

meeting, at least a small minority of the various members from

various tracks seemed very interested in nominating renowned experts

(who is some cases are their friends, etc.) for every possible

available slot, and showed little interest in the possibility of

reaching out to see if there is " new talent " available, especially

from countries in the developing world. On the other hand, in all

fairness, some of these same individuals were those who have the

ability to analyze and digest an enormous amount of information in a

very short time, and place it into a structure that is congruent

with what the Conference Organizing Committee is seeking. In the

absence of " affirmative action " guidelines coming from the Organizing

Committee it is hard to find fault with decisions made by track

members who supported the status quo.

In summary I think the Conference Organizing Committee along with the

International AIDS Society need to seek feedback from Marathon

meeting participants as well as the larger community as to how to

guarantee that the annual World AIDS conference continues to evolve

and change in order to meet the challenges of an epidemic that is

also evolving and changing faster than anyone would have imagined.

The Marathon Meeting in itself is not necessarily a vehicle to

insure change unless guidelines are provided by the organizing

committee.

*Director, Agua Buena Human Rights Association

San , Costa Rica: www.aguabuena.org

E-mail: <rastern@...>

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Cross posted from healthgap@...>

Reply-to: healthgap@...

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