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“They Come to See Me Before They Go to See God”: Echoes of IAS Rome 2011

It’s the morning after the close of the 6th International AIDS Society (IAS) Conference on HIV Prevention, Treatment and Care, the world’s largest HIV conference.  I am currently on a six month assignment lending my organizational development expertise to IAS as a Pfizer Global Health Fellow.  My main contribution at the conference was to lead a series of focus groups with IAS members to learn about their views on the efficiency and effectiveness in the use of resources applied against HIV.

The title of this blog came from a doctor from India who treats patients who are very ill with HIV. It stunned me.

It was pithy to be sure. It was also well-rehearsed and authentic – a phrase that crystallized years of toil and reflection. He said it simply and with wide-open, caring eyes that set a lump in my throat. In each their own way health care workers from Brazil, Russian Federation, Kenya, Uganda, South Africa, India and several other countries on the frontlines of this disease echoed him. Immersed in a conference setting that heralded far-reaching progress and promise of new scientific progress in the years ahead they simply said: don’t forget the situation on the ground – today.

Great science is needed, but doctors in rural Bihar, India also need educational support to stay up to date with the developments for keeping people alive today.

Creative solutions are needed, but adolescents in rural Brazil must have a place to go where HIV can be discussed and where basic testing can be done.

Good governance is needed but we must also find new ways to counsel intravenous drug users in St. Petersburg and encourage effective behavioral change.

Effective relations among donors, governments and NGOs are needed but, to advance the fight in South Africa, community workers need to be able to read.  And good managers need to be retained,

Health systems need to be strengthened, but communities and local government need to be engaged and empowered as priorities are set, decisions made, and plans are put into action. And this needs to happen in every community where HIV raises its ugly head.

Mine is a message – and I’m just the messenger -- more basic than science. These heroic professionals know that the treatments they have today are not sufficient to win the war against HIV, that investment in innovation, time and science is vital. Yet even when that relief comes none of it will work unless we engage locally in the fundamental needs of each community. And in the meantime each day people die and children are orphaned for lack of basic things, like water and information. And so each day those of us involved in this sacred work must remember to strengthen in every way the voice, power, and resources of those at the front line. In another of the groups a South African doc began his thought by outlining some of the progress that had been made in his district. As he continued his voice slowed as he arrived at the deeper thought within. He looked at us and said “a few years ago we lived in an unremitting nightmare – now we’re just in a very, very bad situation.”

These are my echoes of Rome.

With deep gratitude to the IAS members who contributed to the Rome E2 focus groups that will give the front lines voice in the global debate about resource effectiveness and efficiency.

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