AlertNet Deputy Editor Tim Large is at the world’s biggest AIDS conference, which takes place in Bangkok July 11-16. Here are his notes from the opening day.

Sunday, July 11, 2004

For Nung, a 24-year-old sex worker in Bangkok’s Patpong red light district, the 15th International AIDS Conference on the outskirts of the capital might as well be in another hemisphere.

Never mind the enormous banners all over the city announcing the biggest AIDS powwow in history, an event that brings together more than 17,000 scientists, politicians, aid workers and activists for a week of talks about a disease that affects some 40 million globally.

And never mind that schools will be closed all week to keep traffic to a minimum, that demonstrators have taken to the streets demanding better treatment and preventions, that 5,000 police have been enlisted to keep the peace.

Nung, perched on a stool at one of the dozens of Patpong "go go" pole-dancing bars frequented by foreign business men and tourists, said she has never heard of the conference, let alone its catch phrase, “Access for All”.

“I’m not very worried about AIDS,” she said on the eve of the conference. “Before I go with a customer, I look him up and down. I only go with rich men from Europe because they couldn’t come to Thailand on business if they had AIDS."

Although she doesn't pole dance herself, Nung charges men upwards of 2,000 baht ($50) for sex. Customers must also pay the bar a "fine" for the right to take her to their hotels.

And why does she think rich businessmen from Europe are likely to be AIDS-free?

"They have to have tests before they come in to make sure they’re clean.”

***

European businessmen don’t have to have AIDS test before entering Thailand. But myths like these may be yet another factor explaining why Thailand now faces a resurgence of an epidemic it had done so well in stemming.

Thailand figured out a long time ago its notorious sex industry was largely to blame for an alarming rise in annual infection rates in the 1980s. Rates peaked in 1991 at 143,000 and fell to just 19,000 in 2003, thanks to a campaign of discouraging men from going to brothels and a “100 percent condom programme”.

It worked for a while, but then complacency set in. Only 20 percent of young people are now using condoms consistently and men who get infected in brothels are still passing the disease onto their wives.

Meanwhile, HIV prevalence among injecting drug users, the target of a bloody government crackdown last year, has risen to as much as 50 percent from 30 percent in 1994.

Thailand’s “war on drugs”, in which more than 2,000 people died, has made matters worse by driving those who are most at risk of AIDS underground.

***

Drug users were out in force on opening day, marching with hundreds of other activists in a sea of orange shirts past the hulking conference venue, chanting slogans and waving signs such as “Thai Government Drug Policy = Drop Dead” and “No more drug war”.

Some staged a lie-in, playing dead on the street to commemorate the hundreds of drug users they believe were shot in the government’s crackdown. The government says the killings were the work of criminals in the drug trade.

“Thailand’s drug war has killed 3,000 people in the last year through extrajudicial executions of drug users,” said Paisan Suwannong, director of the Thai Treatment Action Group.

“Instead of taking lives, we want our government to focus on saving them using harm reduction tequniques like clean-needle exchanges.”

Thai Prime Minister Thaksin Shinawatra received catcalls and boos as he picked up the theme in a speech at the conference's opening ceremony.

“In the past, drug use was treated like a crime, which warranted severe punishment,” he said. “At present, our mindsets have changed, and we now see drug users as patients who require our support and treatment.

"We are now implementing a ‘Harm Reduction Programme’ to reduce the risk of HIV infection among injecting drug users as well as to provide appropriate care for injecting drug users with HIV.”

About 20 protesters held up posters in the auditorium saying: "No more lies" and "Methadone now", a reference to a heroin subsitute that remains illegal in Thailand.

***

The Sunday-evening opening ceremony was a lavish affair, studded with luminaries including U.N. Secretary-General Kofi Annan, Internationional AIDS Society President Joep Longe and Jennifer Hawkins, Miss Universe 2004.

Annan hit all the right notes, praising Thailand for its past successes in reining in AIDS and warning that Asia was at a critical turning point in fighting the scourge. He called for strong leadership at every level, including the top.

“We need leaders everywhere to demonstrate that speaking up about AIDS is a point of pride, not a source of shame. There must be no more sticking heads in the sand, no more embarrassment, no more hiding behind the veil of apathy. ”

Hawkins, for her part, was tall and radiant but she struggled to find relevance.

“Standing among so many prominent activists, government leaders and healthcare practitioners, a part of me feels like I may be too young to have anything substantive to say about HIV/AIDS,” Miss Universe said, adding that she was as old as the virus itself: 20 years.

She was right about the substantive part.

***

Everything about this conference is larger than life, from the soccer-playing elephants in the car park to the man doing the rounds dressed as a giant condom. But then AIDS is a crisis that requires a Goliath response.

The numbers speak for themselves.

A record 17,000 delegates from 160 countries are registered to take part. Almost 2,000 journalists are covering the news. Eighty-thousand square metres (860,000 square feet) of conference space are devoted to everything from plenary sessions to NGO and drug-maker exhibitions to spontaneous poetry readings.

It doesn’t stop there. Four-hundred thousand free condoms will be handed out during the week. There are 200 satellite sessions, 280 hours of workshops and a festival of 22 films. If you add up all the hours of official talking, you’d have a programme running 27 days, speech-to-speech.

But how useful is it really?

Apart from satisfaction of being a part of the buzz of the travelling circus that accompanies this biennial event, what do delegates hope to achieve by being here? Can so much talking amount to anything more than a whole lot of babble?

And what about the price tag? How many life-prolonging antiretroviral drugs could you buy for the collective cost of having delegates fly in from all corners of the world, not to mention printing all those press releases?

“I hate to think,” said Delphine Valette, policy officer with British NGO the National AIDS Trust.

But she said the conference was a useful chance to connect with her peers around the world. “For me, it’s about networking, sharing experiences. It’s a give and take thing.”

Others said the value lay in keeping AIDS in the media spotlight, if only for a week. There’s also the chance to get up close and personal with your enemies, whether you’re an NGO eager to give the drug firms a grilling or a person living with AIDS hoping to lobby policymakers.

“It is quite big, and it’s challenging to see where to go, what to cover, where to have our two cents put in,” said Oxfam’s Mona Laczo. “But it’s positive because we can go up and talk to the big companies.”