For unlike previous international AIDS conferences, this one was infused from the start by deeply divisive political issues that put the spotlight on the differences between have and have-not nations, continents and cultures.
It was the first such meeting ever to take place in Africa, and for this reason alone it accomplished its purpose. For one week, the world's attention was focused on the enormity of human suffering that has and will come down on this troubled continent, where nearly 25 million of the world's 34 million HIV-infected reside.
And like a hero warrior who has at last heard the cries for help, Nelson Mandela himself--perhaps the most admired world figures alive today--belatedly but decisively became engaged in his country and Africa's plight.
His call during his closing ceremony address for an immediate and grand-scale campaign to save the continent was a challenge to his own government, to neighboring African states and to the world.
``This is, as I understand it, a gathering of human beings concerned about turning around one of the greatest threats humankind has faced, and certainly the greatest after the end of the great wars of the previous century,'' the former South African president said.
``AIDS is clearly a disaster, effectively wiping out the development gains of the past decades and sabotaging the future. Something must be done as a matter of the greatest urgency.''
That is a far cry from the lackluster response of the South African government, including Mandela's own administration. The leadership has ignored and trivialized the AIDS threat, even as it grew to the point where 1 in 5 adults is believed to be infected with the virus, for which there are costly treatments, but still no cure.
Mandela ended on a high note a meeting that began with president Thabo Mbeki's reiteration of his own skepticism about the nature of the epidemic, and his insistence that there is nothing about this disease that eradication of poverty would not cure.
The anger many of the 12,000 conference delegates felt toward Mbeki was transformed by the inspiring keynote address by South African Justice Edwin Cameron, a high court judge who is gay, white and HIV-positive. He explained how he was able to ``pay for life itself'' by purchasing antiviral drugs, and he demanded that his poor, black fellow countrymen be afforded the same opportunity.
``My presence here embodies the injustice of AIDS in Africa because, on a continent in which 290 million Africans survive on less than $1 a day, I can afford monthly medication costs of about $400 per month,'' the judge said.
Cameron's address set a high moral tone for the remainder of the week, and assured that the questions of access would dominate discussions. Demonstrators badgered drug company representatives and called on developing nations to sidestep patents and import cheaper, generic forms of the AIDS drugs otherwise so costly they were beyond the reach of their people.
The challenge laid down by treatment access advocates applied to the scientists reporting the latest findings of their own research. ``The development of new drugs does not mean anything without a discussion of how the broader community will get access to them,'' said Mandeep Dahliwal, a Ugandan lawyer who runs an AIDS service organization in Kampala.
Dahliwal was one of dozens of female African women leaders, whose high profile at the conference underscored one of its lessons: that the heterosexual epidemic decimating Africa is disproportionately afflicting women, who are being infected and dying in greater numbers, and at a younger age than their male counterparts.
The presence of powerful female voices assured that the sensitive issues of male violence against women, and the subservient role of women in many African societies, would be openly discussed at the conference.
``We know that the customs and practices associated with male and female roles and sexuality in many societies today are compromising the rights and freedoms of individuals and promoting a cycle of illness and death. This must stop,'' said Geeta Rao Gupta, president of the Washington, D.C.-based International Center for Research on Women, during a plenary address.
``There can be no more powerful reason for change--gender roles that disempower women and give men a false sense of power are killing our youth and women and men in their most productive years. This must change. That is the message that must be communicated--without any caveats, ifs, or buts.''
In the scientific forums, one of the most disappointing moments was the disclosure that a commonly available contraceptive gel used as a microbicide to kill the AIDS virus actually increased HIV infection rates among prostitutes. This was a set-back for women's rights advocates, who are desperately seeking ``women controlled'' methods of HIV protection.
Studies showed that AIDS prevention efforts such as providing HIV tests are both affordable and effective means of getting people to practice safer sex. ``People who know their HIV status change their behavior,'' said Tom Coates, director of the University of California at San Francisco AIDS Research Institute.
Reports on drug research touched on many themes. Studies showed that low-cost treatments with broad-spectrum antibiotics such as Bactrim could be used in African settings to improve the health of HIV-infected men, women and children. Efforts to find new antivirals turned up promising results for ``fusion inhibitors,'' a new class of antiviral drug that targets a different mechanism of the AIDS virus than two other drugs.
There was universal belief that the ultimate solution to the world AIDS crisis is a vaccine. And for the first time, there was enough good news on vaccine research that the topic was placed on the agenda of the international conference.
``At the start of the epidemic, no one knew enough about the virus or immunology to know even what questions to ask,'' said Dr. Margaret Liu, vice president of vaccine research at Emerville-based Chiron, addressing a plenary session.
Today, however, immunization research is highly focused. Numerous approaches are being studied and all are yielding promising candidate vaccines. Liu would not predict that the world would meet President Clinton's goal of an effective AIDS vaccine by 2007, but she said it is clearly within reach. The contrasting worlds of high-power pharmaceutical research and village-level community health care were ever present at the Durban conference. This coastal resort and shipping port embodies the contradictory worlds of South Africa, which is both a wealthy industrial power and an impoverished developing nation.
``You meet in a country to whose citizens freedom and democracy are but very new gifts,'' President Mbeki reminded delegates. ``For us, freedom and democracy are only 6 years old.''
San Francisco General Hospital AIDS clinician Dr. Donald Abrams marveled at the contrasts of Durban itself. ``You look around, and it could be Southern California,'' he said at the modern International Conference Center, surrounded by glass-walled luxury hotels.
Yet only hours before, Abrams had visited Mariannhill Hospital, serving the HIV-infected population of the tin-roofed shantytowns that dot the countryside outside of Durban. Here, the wards are full of the gaunt, skeletal casualties of HIV, just like it used to be in the worst days of the epidemic at San Francisco General.
This young and restless democracy, a study in contrasts, is the place where the culture of the modern industrial state meets the culture of the Third World. It is a tumultuous, fascinating, frustrating and inspiring place. There were many researchers who frankly did not want to come here, either to protest the views of Mbeki or out of concern for personal safety. Yet this week showed that both cultures have common ground, as they do in this very city, and will continue to when all the delegates leave.
Dr. Stefano Vella, president of the International AIDS Society, which put on the $10 million conference and will sponsor another one in Barcelona in 2002, said that those who stayed home made a mistake. ``This was a conference we should have brought our children to,'' he said. ``We need to teach a new generation how to fight AIDS.''
