Zero new infections, Zero AIDS-related deaths, and Zero discrimination.  On December 1st, World AIDS Day, while these goals were being explicitly discussed in various fora around the world,  I was in a hospital in Addis Ababa working with colleagues from Ethiopia and Tanzania to develop plans to improve healthcare quality.  We mentioned World AIDS Day, but we spent most of the time talking about concrete changes we could make for trauma patients in local hospitals, for clients in local health centers who need HIV testing, for patients who need pain relief.  For me, working for tangible change against the backdrop of big inspiring ideas, was the perfect way to mark the day.

A few days later I found myself engaged in a different way.    I headed down Bole Road in Addis Ababa toward the 16th Annual Conference on AIDS and STIs in Africa (ICASA 2011), part of a throng of 1o,000 people who all, in one way or another, were part of the fight against AIDS.  Today we were coming together to share 1000 scientific papers and 175 workshops, and to imagine how to create an AIDS free generation.  We would be celebrating the successes of the last 10 years, including the facts that 32 countries have stabilized the epidemic,  22 countries have reduced new infections by >25%, and countries like Botswana are leading the way with universal access to care and virtual elimination of mother to child transmission of AIDS.  Kenya is leading in important ways also, with the establishment of tribunals to assure rights and address stigma and discrimination.

We followed the sound of drums emanating from the main hall of the Millennium Conference Center, where many political and public health leaders were on the agenda.  In the final hours before the event it was rumored that former President  George Bush would be making an appearance…

… and he did.  Acknowledged for his courage as a first responder to the call for care for people with AIDS,  and praised for the establishment of PEPFAR,  a program which (in spite of its imperfections) has dramatically changed the landscape for people with AIDS,  George Bush was greeted with a standing ovation by the predominantly African crowd.

Did I stand up myself you may be wondering?  Well, first I should disclose the I am a life-long Democrat.  I consider myself open-minded and I care most about integrity and competence. I would vote Republican if the right candidate came along..but my bi-partisan credentials are weak.  I have never actually pushed the button….

I should also say that I am kind of  persnickety about standing ovations.   I think they should be rare, and I save them for near perfect performance.  The abstinence only campaign was definitely a wrong note that I could not overlook….

When Bush took the podium, and nearly everyone stood up, those who did not kept their hands in their laps, looking incredulous, uncomfortable, or just plain still.  There was a lone shout of “what about Iraq.”  I myself stayed seated.  As I listened to Bush from the audience I was a bit surprised by what I heard.  “In order to advance as a society we must focus on the needs of women.”   “We can’t retreat from the need in the world.”  “Isolationism is always a mistake.”  “Even when economic times are difficult we have to stand against human suffering and make saving lives a priority.”  A cynical voice in my head asked if Bush would be willing to go on tour in the US with these messages. But the mood in the room told me that this was bigger than partisan politics. Bush was saying the right things, and he was not triumphal.  He gave credit to both parties for what the US began in 2003 and continues to do under the Obama administration.  He went on to describe the new pink ribbon/red ribbon campaign, a global effort to use the capacities developed in the fight against AIDS to address cervical cancer, which can be detected easily, and if caught early, can often be treated in a clinical setting with a very simply procedure.  It is interesting to me (though really not surprising!)  that all the ex-presidents, in one way another, have discovered that global health is the thing that really matters.

I felt  privileged to be part of this assembly, moved by what those in the room had accomplished, by what PEPFAR (and other efforts!) had meant for people living with AIDS, and even by Bush himself.  At the end of his remarks people rose again.  Yes, I remained seated, but I clapped my hands until the end, until they tingled a bit, and I meant it.

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