Autumn Davidson at the International AIDS Conference in Mexico City
The Seventeenth International AIDS Conference took place in early
August at Mexico City's Centro Banamex, a gigantic conference center
and horse racing track located some 10 miles outside Mexico City's city
center. The horses were cleared out for the event to make room for
27,000 people from around the world gathered to discuss the current
state of HIV/AIDS. Although the Conference's food was terrible, the
event did seem to offer something AIDS-related for everyone. A myriad
of perspectives and interest groups were represented at the conference,
and participants were presented with a plethora of events to partake
of, ranging from speeches by President Clinton and UN Secretary General
Ban Ki-Moon, to transvestite sex worker fashion shows and rowdy
protests against drug company profiteering.
In the center of the horse racing track stood the Global Village, a massive hall devoted to networking and coalition building among organizations (less mainstream than those gathered in the main booth area) working in the general area of HIV advocacy. Walking through the many aisles in the Global village, a participant could familiarize herself with work being done by organizations from every geographic region happy to share their causes. I personally had enlightening discussions with Kyrgyzstani LGBT advocates, lawyers form various countries challenging human rights abuses resulting from stigma against HIV, and Chinese youth living with HIV who created destigmatizing media projects. I was also able to catch the tail end of a fashion show modeling novel clothing designs created by Brazilian sex workers. The conference was peppered with participants proudly sporting "HIV Positive" t-shirts and clothing openly promoting safe sex.
On the other side of the Banamex, thousands of speakers throughout the week presented research on topics ranging from emerging ARV technology, to updates on the HIV vaccine trials, to HIV epidemic surveillance, to socio-political issues around male circumcision campaigns, to worldwide experiences of stigma and discrimination against people living with HIV/AIDS, to the criminalization of intentional transmission. Most of these sessions provided me with a useful framework from which to understand many of the current issues in the global fight against HIV; and some functioned as forums to debate controversial issues in the field. The Coalition for Genital Integrity, for example, had a strong showing at the session on male circumcision, which made for a lively and emotionally charged dialogue.
I was saddened by the ubiquitous reminders of the gravity of this tragic epidemic, yet at the same time, inspired by the successes that may be accomplished when dedicated individuals work together towards a common end. My favorite part of the conference was the daily poster sessions, where hundreds of individuals from diverse countries and backgrounds congregated to present their research to a receptive audience.
I was honored to have the opportunity to present the research I conducted during the year I spent as a Fogarty-Ellison scholar in St. Petersburg, Russia in 2006-2007. Under the Soviet Union, the spread of sexually transmitted infections (STI) was held in check by highly effective, albeit draconian methods of STI control, with strictly enforced policies of mandatory partner notification programs and forced medical treatment of STIs. HIV only first appeared after the fall of the Soviet Union in 1991, but Russia's epidemic now ranks among the fastest growing in the world. Unlike in most other countries, HIV in Russia is found primarily among injection drug users, and has until recently been concentrated among young males. However, sexual transmission is now becoming an increasingly important mode of infection, and recent data from St. Petersburg show alarmingly rapid rises in HIV case detection among pregnant women in antenatal clinics. Given the daunting speed of this epidemic, and the unique historical and social context in which it emerges, questions regarding the most appropriate prevention policies for Russia abound.
With these unique characteristics in mind, I developed a research project intended to better characterize the population of individuals who are now receiving HIV care, to understand the degree of communication about HIV serostatus among patients and their sexual partners, and to describe patients' attitudes toward the potential implementation of a practitioner-driven partner notification policy. Until recently, epidemiological research on HIV in Russia has been conducted in research facilities not directly affiliated with the treatment centers; for this reason, little data exists on the population who is currently seeking HIV treatment. My research was based out of the City AIDS Center, the only outpatient AIDS treatment facility in the country's northern capital. At this clinic, I conducted a survey-driven, cross-sectional analysis of 204 HIV-infected patients.
The results of my study showed that a majority (52%) of patients seeking treatment were female. Females were more likely than males to report a sexual route of transmission, and were twice as likely as males to have revealed their positive serostatus to their sexual partner. My data also showed consistent condom use to be infrequent among this population, with women more likely than men to report always using a condom during intercourse. Finally a majority of males and females responded favorably when asked if physicians should inform sex partners of HIV infected people of their risk of HIV exposure. The results of my study support the hypothesis that the HIV epidemic in Russia is becoming feminized, and that much work needs to be done to encourage open communication about disease status among sexual partners.
I was surprised as well as heartened to find that right next to me at the poster session, was a young woman from Nigeria who was presenting data from Lagos that were very similar to mine. It was a good reminder to me that all around the world, people like myself are doing their best to contribute to the vast body of knowledge and solutions to this deadly epidemic.
