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In June, 2006, UN member states at the General Assembly High Level Meeting on AIDS ambitiously committed themselves to provide "universal access to comprehensive prevention programmes, treatment, care, and support by 2010". The XVI International AIDS Conference, held last week in Toronto, provided the first opportunity to draft a strategy to meet that goal.
What werethe highlightsof this meeting? Fresh science brought attention to a new class of antiviral agent, the integrase inbibitors. An extremely drug-resistant (XDR) strain of tuberculosis (TB) was described. A visible shift took place in the terms of engagement with HIV-from treatment to prevention.1 Male circumcision, preexposure prophylaxis with antiretrovirals, microbicides, and vaccines were all discussed vigorously. Women were centre stage. Routine testing for HIV provoked furious debate, with proponents arguing that it was one of the few practicable ways to expand treatment. Opponents said it would undermine essential liberties. In sum, there was much to reflect on: narrowly defined, a success.
But the opportunity to produce a roadmap to reach the 2010 target of universal access was squandered. Rarely has there been a meeting that felt so disengaged from a global predicament of such historic proportions. The agenda in Toronto was unfocused, giving prime air time to celebrities, such as Bill Gates and Bill Clinton, while largely ignoring Africa. Africa bears the greatest burden of AIDS today-24-5 million of 38-6 million people with HIV. Yet no African representative spoke at the opening of this meeting. Instead, non-Africans were nominated to speak on behalf of Africa. This surprising marginalisation sent an incredibly negative signal to the conference's 30 000 attendees. It suggested that Africa lacked leadership on HIV-AIDS and that its peoples paid the disease far too little attention. A leadership vacuum does exist in one country-South Africa. But in its anger over South Africa's shameful handling of the AIDS epidemic, the International AIDS Society inadvertently silenced the voice of a great continent.
Away from the star-studded plenaries, Africans and many others from countries most affected by AIDS had a troubling message. Global action to defeat this pandemic has stalled. A veneer of achievement-1-6 million people taking antiretroviral drugs, together with the existence of powerful financing mechanisms, such as the Global Fund, the President's Emergency Plan for AIDS Relief (PEPFAR), and...