The Positive Side

Winter 2008 

Reflections on a Global Epidemic

An interview with International AIDS Society executive director, and Canadian, Craig McClure.

By Ann Silversides

WHILE WE ALL HAVE our personal relationship with the virus,  HIV affects people around the globe, and the biennial International AIDS Conference (IAC) is a chance for the world to gather and reflect on the bigger issues. After the hubbub of the most recent IAC in Mexico City settled, journalist and author Ann Silversides chatted with Craig McClure, executive director of the International AIDS Society (IAS), the conference organizer. McClure, a proud Canadian who once worked at CATIE, shared his views on where we are and where we’re going.

Ann Silversides: You’ve been to eight other International AIDS conferences. How did AIDS2008 compare?

Craig McClure: For me, there were a couple of differences. One was the emphasis on human rights and concentrated epidemics. It has never been emphasized so clearly that in order to scale up treatment and prevention services we have to make some progress on HIV-specific stigma and discrimination as well as other forms of discrimination against communities at risk of HIV infection. Homosexuality is illegal in, I think, more than 80 countries, as one example, and it is difficult for a community to access services if its identity is criminalized or ignored.

Another difference was the clear recognition of the need to strengthen overall health systems in developing countries. We’ve hit a wall in terms of expanding HIV services in these countries until health services are strengthened. We need to pay close attention to the links between systems broadly and to the integration of HIV services with other services — primary care, maternal health, tuberculosis testing and treatment, and sexual and reproductive health.

What was most memorable for you about the conference?

Meeting with the youth coalitions in the Global Village and seeing so much energy among young people. I don’t think many of us realized 20 years ago or more when we got involved that this was going to be a multigenerational fight. But I am now moving through middle age and it is that much more evident to me that it is going to be the next generation of advocates and researchers and healthcare workers that carries the torch. It is their ideas and creativity that will take us into the next phase of the epidemic. I was impressed by their forthrightness, assertiveness and demand to be at the table. That strikes me as very powerful indeed.

What did you hear or learn about the epidemic that made a big impression on you?

That the idea of eradication [that is, curing HIV] is back on the table. It was a presentation by Bob Siliciano at a basic science plenary session. It is the first time that eradication has been on the table publicly since 1998.

Also, the new guidelines from IAS-USA that recommend going back to earlier treatment — to start at 350 CD4s, and in the small print the guidelines talk about starting even earlier on an individualized basis, such as if someone has an HIV-negative partner or an underlying propensity for heart disease.

The reason for this shift is the confirmation that HIV disease is really a chronic inflammatory disease, and that even before the immune system starts to be damaged, right from the beginning of infection the virus is causing inflammation that is putting pressure on the heart, kidney and lungs. So, with gentler, more forgiving drugs now, the argument to start treatment earlier is even stronger, to prevent damage to the body even before the immune system starts to weaken.

What did you learn or realize that might change the way you do your work?

From where I sit, the conference is still grounded in HIV/AIDS but is moving more and more toward a conference about global health and human rights. This is an issue for the IAS board to think about — how far do we want this to go?

The more we respond to AIDS, the more we all realize that dealing with this disease is really about dealing with human rights, including the right to health, and the lack of protection of human rights among the most marginalized people in communities around the world. HIV has always exposed the ugly underbelly of our societies.

To read the perspectives of four other Canadian delegates who attended AIDS2008, check out A uniquely Canadian look at AIDS2008 (2008 Sept 17).

Ann Silversides is the author of AIDS Activist: Michael Lynch and the Politics of Community (Between the Lines, 2003), a history of the early days of AIDS activism in Toronto and Canada. She recently moved to a log house in the Ottawa Valley and spends her spare time (and money) at country auctions.

Photographs: Jacob Peters