- Email: [email protected]
AIDS 2006 and beyond
Correspondence
AIDS 2006 and beyond The International AIDS Society (IAS) commends Richard Horton (Aug 26, p 716)1 for his provocative analysis of the XVI International AIDS Conference (AIDS 2006), which took place this past August in Toronto, Canada. Critical analysis and debate—two of the hallmarks of the conference—can only strengthen our collective response to this crisis. Yet Horton’s claims that the conference is “disengaged”, and that the opportunity to produce a road map for the future was “squandered”, as outlined in the ten points of his Comment, merit a response from the IAS as lead organiser of these meetings. In 2005, the IAS undertook the first comprehensive review of the conference (the Future Directions project), consulting broadly with our stakeholders in an effort to maximise the reach and impact of the conference. The recommendations from those consultations—among others, to improve the quality of science, to broaden diversity, to facilitate cross-disciplinary links and dialogue, and to strengthen the focus on youth—began to be implemented in the planning for AIDS 2006 and will be implemented more fully in the planning for AIDS 2008. We are also strengthening the conference’s role as an accountability mechanism, a focus reflected in the conference theme, Time to Deliver, that has implications across disciplines and settings. AIDS 2006 highlighted many key policy issues, from HIV diagnostic testing to the growing feminisation of the epidemic, to the need for better coordination between HIV and other disease programmes such as tuberculosis, hepatitis, and malaria. Conference sessions also proposed strategies for addressing the desperate shortfall of health-care workers in the developing world, and drove home the message that scientific evidence should prevail over political expediency in critical areas such as harm reduction for injecting www.thelancet.com Vol 368 October 28, 2006
drug users and outreach to vulnerable populations such as sex workers and men who have sex with men. In my inaugural speech as incoming IAS President, presented at the close of the conference, I was clear about IAS’s agenda, both within and beyond its conferences, for fostering collaboration and accountability: “More than ever, it was confirmed during this week that prevention and care are two faces of the same coin. More than ever, biomedical and behavioural scientists have the challenge and opportunity to work together with people living with HIV and community organizations toward our common goals. Of course, all the knowledge, the innovative research, the new tools, will not be effective without the political leadership that is essential to halting this disease; we must keep pressure on the G8 leaders to follow-up on their commitments to achieve universal access to prevention, care and treatment by 2010.” All stakeholders and all countries need to be held to account for their action, or inaction, on HIV/AIDS. Unlike the UN and some donor mechanisms, the conference has neither the mandate nor a formal mechanism to establish a road map for specific targets or to hold specific countries accountable for action on HIV/AIDS, as suggested by Horton. Nevertheless, it does provide an important forum for drawing attention to the successes and failures of governments, with Russia, South Africa, the USA, and Canada among the many countries whose responses and policies received the scrutiny of the international community in Toronto. In the planning of AIDS 2008, to be held in Mexico City, the IAS aims to provide further opportunities during the conference to review progress in countries and across regions. Horton’s dismissal of Bill and Melinda Gates and Bill Clinton as distracting “celebrities” negates the strong leadership of these individuals and that of their foundations in contributing to the global response. This includes
negotiating significant price discounts for antiretrovirals in the developing world; investing in vaccines, treatments, and new prevention technologies; and lending their influence to increasing awareness of HIV/AIDS globally. The drawing power of these leaders— both for conference delegates and international media—helped to ensure that the conference’s key messages were delivered to a global audience. Substantial effort was made to include an eminent African in the opening session of the conference. Unfortunately, the Liberian President withdrew from delivering a keynote address as a result of the decision by the Canadian Prime Minister not to attend. Nevertheless, in sharp contrast with Horton’s claim that the IAS “inadvertently silenced a great continent”, more Africans spoke in sessions at AIDS 2006 than ever before. While Africa continues to bear the brunt of the epidemic, HIV incidence is rapidly increasing in many other parts of the world. Eastern Europe and central Asia, parts of southeast Asia, and areas of Latin America, the Caribbean, and the Pacific Islands are all experiencing burgeoning epidemics, and the conference must continue to be international in scope. It will also continue to highlight global successes, such as the recent and striking increase in antiretroviral availability in many developing countries, and where we are falling short, such as the persistence of HIV-related stigma and discrimination. Global action on HIV/AIDS in recent years has the potential to revolutionise global public health. It is no longer acceptable for poor countries to be denied access to new treatments and other technologies simply because they cannot afford them. The IAS agrees that each of Horton’s ten questions are essential issues; all of them were the subject of formal and informal presentations, discussion, and debate at the conference. We are pleased that Horton acknowledges the “remarkable and inspiring diversity” of the conference,
e-mail submissions to [email protected]
1489
Correspondence
which has evolved enormously from a small scientific meeting in Atlanta in 1985 to a global platform for advocacy, research, and capacitybuilding. An unprecedented number of delegates came to Toronto in 2006. The IAS is gratified that people continue to vote with their feet. We are committed to improving the conference and strengthening its role beyond a 5-day event to becoming part of an ongoing cycle of education, networking, promotion of best practice, and advocacy in the fight against HIV/AIDS. We declare that we have no conflict of interest.
*Pedro Cahn, Craig McClure [email protected] President (PC) and Executive Director (CM), International AIDS Society, PO Box 20, Ch de l’Avanchet 33, Cointrin 1216, Geneva, Switzerland 1
Horton R. A prescription for AIDS 2006–10. Lancet 2006; 368: 716–18.
say that he has superb administrative, managerial, and leadership skills. He has strong political skills and experience (including being a member of parliament in his country). He was a director for a WHO Headquarters department and is currently the Director-General of the national public health institute of Finland (KTL), which has 1000 employees. KTL deals with many aspects of health systems. Having served under Puska at WHO Headquarters, where strengthening health systems was an important part of his work programme, I can confirm, and I am sure my former colleagues will agree, that Puska showed great administrative and managerial skills, ability to achieve results, and to communicate and advocate. In my opinion Pekka Puska has the public-health leadership that WHO now needs. I declare that I have no conflict of interest.
Desmond O’Byrne
WHO Director-General election As a former staff member of WHO of more than 21 years’ service, I am keenly interested in the selection of the next Director-General, the outcome of which is so important for global and national health. As for previous elections, The Lancet is to be congratulated for its contribution to this process. In particular, I refer to the Comment by Richard Horton (Oct 7, p 1213),1 in which he refers to the criteria set by WHO’s Executive Board for the DirectorGeneral and reviews the technical competencies of the 13 candidates. He categorises administrative skills into three groupings: high-level political experience, proven ability to run a complex organisation and to deliver results, and strong communication and advocacy skills. I was most surprised that Pekka Puska was not seen as fully meeting all those requirements. Anybody who knows Puska, his background and achievements, would 1490
[email protected] 16 Domaine de Riondel, 171 Les Eycherolles, 01210 Ornex, France 1
Horton R. The next Director-General of WHO. Lancet 2006; 368: 1213–14.
The food industry and health The Comment by Marion Nestle (Aug 12, p 564),1 fails to live up to The Lancet’s publicly stated mission of offering “critical appraisal of research and reviews”. Instead, it constitutes a highly uncritical review of a report in which there is much to criticise. The Comment makes broad accusations about what food companies are doing to fight obesity, whereas the original report by City University2 clearly states that it constitutes a review of “whether and how these powerful companies are reporting on their impact on diet and health” (my emphasis). City University looked at 25 companies’ websites, annual reports, and accounts. Although it is true that we in the food and drinks industries need
to ensure that we are more actively telling the world what we’re doing, a review of annual reports, accounts, and headquarters websites was a flawed approach to discovering how much we are actually doing, most of which is happening at a local level, country-bycountry. Moreover, whereas the Comment brands all food companies as obstructionist, the original report notes, among other nuances lost on Nestle, that there were several “honourable exceptions” to their overall findings and that food manufacturers “in fact reported most activity” among those companies whose publications were studied. As active members of the European Union Platform for Action on Diet, Physical Activity and Health, Europe’s food and drinks industries have repeatedly shown their commitment to product reformulation; responsible advertising and marketing, taking into account the specific needs of target audiences and in particular children; research; consumer information; public education; and the promotion of physical activity. The scope and scale of the food and drinks industries’ commitments reflects the complicated, multifactorial nature of obesity. At regulators’ requests, we have undertaken to document the efforts that food and drinks companies are making in the fight against obesity. In the meantime, we are acting responsibly in actively contributing to constructive solutions. I declare that I have no conflict of interest.
Jean Martin [email protected] President, Confederation of the Food and Drink Industries of the EU, Avenue des Arts 43, 1040 Brussels, Belgium 1
2
Nestle M. Food industry and health: mostly promises, little action. Lancet 2006; 368: 564–65. Lang T, Rayner G, Kaelin E. The food industry, diet, physical activity and health: a review of reported commitments and practice of 25 of the world’s largest food companies. London: City University, 2006. http://www.city.ac.uk/ press/The%20Food%20Industry%20Diet%20P hysical%20Activity%20and%20Health.pdf (accessed Oct 4, 2006).
www.thelancet.com Vol 368 October 28, 2006
AIDS 2006 and beyond The International AIDS Society (IAS) commends Richard Horton (Aug 26, p 716)1 for his provocative analysis of the XVI International AIDS Conference (AIDS 2006), which took place this past August in Toronto, Canada. Critical analysis and debate—two of the hallmarks of the conference—can only strengthen our collective response to this crisis. Yet Horton’s claims that the conference is “disengaged”, and that the opportunity to produce a road map for the future was “squandered”, as outlined in the ten points of his Comment, merit a response from the IAS as lead organiser of these meetings. In 2005, the IAS undertook the first comprehensive review of the conference (the Future Directions project), consulting broadly with our stakeholders in an effort to maximise the reach and impact of the conference. The recommendations from those consultations—among others, to improve the quality of science, to broaden diversity, to facilitate cross-disciplinary links and dialogue, and to strengthen the focus on youth—began to be implemented in the planning for AIDS 2006 and will be implemented more fully in the planning for AIDS 2008. We are also strengthening the conference’s role as an accountability mechanism, a focus reflected in the conference theme, Time to Deliver, that has implications across disciplines and settings. AIDS 2006 highlighted many key policy issues, from HIV diagnostic testing to the growing feminisation of the epidemic, to the need for better coordination between HIV and other disease programmes such as tuberculosis, hepatitis, and malaria. Conference sessions also proposed strategies for addressing the desperate shortfall of health-care workers in the developing world, and drove home the message that scientific evidence should prevail over political expediency in critical areas such as harm reduction for injecting www.thelancet.com Vol 368 October 28, 2006
drug users and outreach to vulnerable populations such as sex workers and men who have sex with men. In my inaugural speech as incoming IAS President, presented at the close of the conference, I was clear about IAS’s agenda, both within and beyond its conferences, for fostering collaboration and accountability: “More than ever, it was confirmed during this week that prevention and care are two faces of the same coin. More than ever, biomedical and behavioural scientists have the challenge and opportunity to work together with people living with HIV and community organizations toward our common goals. Of course, all the knowledge, the innovative research, the new tools, will not be effective without the political leadership that is essential to halting this disease; we must keep pressure on the G8 leaders to follow-up on their commitments to achieve universal access to prevention, care and treatment by 2010.” All stakeholders and all countries need to be held to account for their action, or inaction, on HIV/AIDS. Unlike the UN and some donor mechanisms, the conference has neither the mandate nor a formal mechanism to establish a road map for specific targets or to hold specific countries accountable for action on HIV/AIDS, as suggested by Horton. Nevertheless, it does provide an important forum for drawing attention to the successes and failures of governments, with Russia, South Africa, the USA, and Canada among the many countries whose responses and policies received the scrutiny of the international community in Toronto. In the planning of AIDS 2008, to be held in Mexico City, the IAS aims to provide further opportunities during the conference to review progress in countries and across regions. Horton’s dismissal of Bill and Melinda Gates and Bill Clinton as distracting “celebrities” negates the strong leadership of these individuals and that of their foundations in contributing to the global response. This includes
negotiating significant price discounts for antiretrovirals in the developing world; investing in vaccines, treatments, and new prevention technologies; and lending their influence to increasing awareness of HIV/AIDS globally. The drawing power of these leaders— both for conference delegates and international media—helped to ensure that the conference’s key messages were delivered to a global audience. Substantial effort was made to include an eminent African in the opening session of the conference. Unfortunately, the Liberian President withdrew from delivering a keynote address as a result of the decision by the Canadian Prime Minister not to attend. Nevertheless, in sharp contrast with Horton’s claim that the IAS “inadvertently silenced a great continent”, more Africans spoke in sessions at AIDS 2006 than ever before. While Africa continues to bear the brunt of the epidemic, HIV incidence is rapidly increasing in many other parts of the world. Eastern Europe and central Asia, parts of southeast Asia, and areas of Latin America, the Caribbean, and the Pacific Islands are all experiencing burgeoning epidemics, and the conference must continue to be international in scope. It will also continue to highlight global successes, such as the recent and striking increase in antiretroviral availability in many developing countries, and where we are falling short, such as the persistence of HIV-related stigma and discrimination. Global action on HIV/AIDS in recent years has the potential to revolutionise global public health. It is no longer acceptable for poor countries to be denied access to new treatments and other technologies simply because they cannot afford them. The IAS agrees that each of Horton’s ten questions are essential issues; all of them were the subject of formal and informal presentations, discussion, and debate at the conference. We are pleased that Horton acknowledges the “remarkable and inspiring diversity” of the conference,
e-mail submissions to [email protected]
1489
Correspondence
which has evolved enormously from a small scientific meeting in Atlanta in 1985 to a global platform for advocacy, research, and capacitybuilding. An unprecedented number of delegates came to Toronto in 2006. The IAS is gratified that people continue to vote with their feet. We are committed to improving the conference and strengthening its role beyond a 5-day event to becoming part of an ongoing cycle of education, networking, promotion of best practice, and advocacy in the fight against HIV/AIDS. We declare that we have no conflict of interest.
*Pedro Cahn, Craig McClure [email protected] President (PC) and Executive Director (CM), International AIDS Society, PO Box 20, Ch de l’Avanchet 33, Cointrin 1216, Geneva, Switzerland 1
Horton R. A prescription for AIDS 2006–10. Lancet 2006; 368: 716–18.
say that he has superb administrative, managerial, and leadership skills. He has strong political skills and experience (including being a member of parliament in his country). He was a director for a WHO Headquarters department and is currently the Director-General of the national public health institute of Finland (KTL), which has 1000 employees. KTL deals with many aspects of health systems. Having served under Puska at WHO Headquarters, where strengthening health systems was an important part of his work programme, I can confirm, and I am sure my former colleagues will agree, that Puska showed great administrative and managerial skills, ability to achieve results, and to communicate and advocate. In my opinion Pekka Puska has the public-health leadership that WHO now needs. I declare that I have no conflict of interest.
Desmond O’Byrne
WHO Director-General election As a former staff member of WHO of more than 21 years’ service, I am keenly interested in the selection of the next Director-General, the outcome of which is so important for global and national health. As for previous elections, The Lancet is to be congratulated for its contribution to this process. In particular, I refer to the Comment by Richard Horton (Oct 7, p 1213),1 in which he refers to the criteria set by WHO’s Executive Board for the DirectorGeneral and reviews the technical competencies of the 13 candidates. He categorises administrative skills into three groupings: high-level political experience, proven ability to run a complex organisation and to deliver results, and strong communication and advocacy skills. I was most surprised that Pekka Puska was not seen as fully meeting all those requirements. Anybody who knows Puska, his background and achievements, would 1490
[email protected] 16 Domaine de Riondel, 171 Les Eycherolles, 01210 Ornex, France 1
Horton R. The next Director-General of WHO. Lancet 2006; 368: 1213–14.
The food industry and health The Comment by Marion Nestle (Aug 12, p 564),1 fails to live up to The Lancet’s publicly stated mission of offering “critical appraisal of research and reviews”. Instead, it constitutes a highly uncritical review of a report in which there is much to criticise. The Comment makes broad accusations about what food companies are doing to fight obesity, whereas the original report by City University2 clearly states that it constitutes a review of “whether and how these powerful companies are reporting on their impact on diet and health” (my emphasis). City University looked at 25 companies’ websites, annual reports, and accounts. Although it is true that we in the food and drinks industries need
to ensure that we are more actively telling the world what we’re doing, a review of annual reports, accounts, and headquarters websites was a flawed approach to discovering how much we are actually doing, most of which is happening at a local level, country-bycountry. Moreover, whereas the Comment brands all food companies as obstructionist, the original report notes, among other nuances lost on Nestle, that there were several “honourable exceptions” to their overall findings and that food manufacturers “in fact reported most activity” among those companies whose publications were studied. As active members of the European Union Platform for Action on Diet, Physical Activity and Health, Europe’s food and drinks industries have repeatedly shown their commitment to product reformulation; responsible advertising and marketing, taking into account the specific needs of target audiences and in particular children; research; consumer information; public education; and the promotion of physical activity. The scope and scale of the food and drinks industries’ commitments reflects the complicated, multifactorial nature of obesity. At regulators’ requests, we have undertaken to document the efforts that food and drinks companies are making in the fight against obesity. In the meantime, we are acting responsibly in actively contributing to constructive solutions. I declare that I have no conflict of interest.
Jean Martin [email protected] President, Confederation of the Food and Drink Industries of the EU, Avenue des Arts 43, 1040 Brussels, Belgium 1
2
Nestle M. Food industry and health: mostly promises, little action. Lancet 2006; 368: 564–65. Lang T, Rayner G, Kaelin E. The food industry, diet, physical activity and health: a review of reported commitments and practice of 25 of the world’s largest food companies. London: City University, 2006. http://www.city.ac.uk/ press/The%20Food%20Industry%20Diet%20P hysical%20Activity%20and%20Health.pdf (accessed Oct 4, 2006).
www.thelancet.com Vol 368 October 28, 2006