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There is no easy fix for one of AIDS' biggest factors: poverty Add to ...

We would all like a pill. Or a gel. An injection, even a minor surgical procedure such as circumcision would be fine. We would like one great thing that will stop AIDS.

You could see it this week, in the packed meeting rooms at the International AIDS Conference: so many painfully hopeful upturned faces, wanting to hear that it will get better, soon. You could see it in the rapturous welcome given to Bill and Melinda Gates, who are now the single biggest drivers of AIDS research.

It's an entirely human instinct: so many people at this conference have lost family, friends, colleagues, and have worked for so long to fight this disease with so little tangible progress. They are desperately overdue for that big piece of good news.

The Gates duo made a stirring speech at the opening ceremony of the conference in which they hit all the right notes: they talked about the need for cheaper drugs, for more condoms and for women to have control over their sexual choices. The Gates Foundation is clever about where to put its AIDS money: it funds vaccine research that brings together scientists across the globe to collaborate on trials, and work on delivery systems for microbicides, though the potential products are still in early trials, to ensure that when there is one, poor women will get it quickly.

But for two smart people, the Gateses missed a key point: Science can't fix this.

There's no use inventing a microbicide if a woman is terrified to use it, lest her husband find out. Those same women can't make their husbands use condoms now. If they do insist, they'll be thrown out of the house; they and their children will be left with nothing. A virus-killing gel doesn't fix that dynamic.

On the second day of the conference, a delegate from Sudan asked Mr. Gates about food. What, he asked, is the point of putting people on anti-retroviral medications if they have nothing to eat? Mr. Gates replied with a pledge to fund research into better agricultural technologies, saying he wished to make up for the fact that Africa missed the Green Revolution.

That reply prompted some eye rolling from Maria Tokwani, who works for an AIDS project run by the aid agency CARE in Zimbabwe. Sure, drought-resistant or higher-yield crops would be nice, she said, but the people with whom she works don't lack food because they missed the Green Revolution. They lack food because they are 12-year-old orphans raising siblings, or exhausted grannies nursing the sick.

And perhaps Mr. Gates, as the world's richest person, gets a little tense in conversations about resource distribution. But what leaves people with AIDS without food is poverty. And fixing that will require a serious conversation about things such as the systems of global trade that keep people poor.

At a minimum, it means practical steps such as helping African governments to abolish school fees, so that girls get educations and jobs, and have a realistic chance of negotiating safer sex. It means helping countries like Malawi and Zambia to pay their nurses real wages so they don't flee to the hospitals of Halifax and Vancouver.

Certainly there was grim news this week: A vaccine is at least a decade away; agencies providing care and treatment in the developing world are critically short of cash, and that hasn't changed. But there were also announcements that were heartening.

There is solid evidence that circumcision protects men against infection with HIV, there is progress on more effective, less-toxic anti-retroviral drugs. There was also a collective sense of bolstering, as the people who work on the front line of this disease -- in laboratories in British Columbia and brothels in Sao Paulo, prisons in Siberia and villages in Kenya -- all got to see just how many others are fighting the same battle.

Still, more than 50,000 people died of HIV-AIDS while the conference went on. It's so tempting to give in to the seductive words of the Bills, Gates and Clinton, when they say the solution is coming.

But it won't come as long as the search is confined to laboratories and clinical trial sites. Activists from the developing world struggled to point that out this week.

AIDS went from a localized phenomenon in central Africa 50 years ago to a small outbreak in the United States 25 years ago to a catastrophic pandemic now because the virus preys on our intimate behaviour, on the things we don't like to talk about, and on inequalities.

The most passionate articulation of this truth came this week from Gregg Gonsalves, an HIV-positive American now working in South Africa. AIDS has spread and indeed is still racing through communities of gay men, sex workers, drug users, prisoners and migrants. And, of course, the poor, he said.

"We talk about the stuff that's easy to talk about -- who doesn't want a microbicide? Who doesn't want to prevent AIDS infections? But when it moves beyond technology and charity," he added, "then it gets sticky."

 

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