"Go west, young pug"

We're just about to set out on the Mother of All Roadtrips -- the car is semi-packed, the pug is anxious from all the to-ings and fro-ings. Our intended route today is up the Bruce Penninsula to Tobermory, across to Manitoulin Island on the car ferry, and camping back on the mainland, west of Sudbury. Besides being very pretty, the route will cut out the dreaded clicks of northern cottage country south of Lake Nippissing. We are all very excited about getting on the road; the weather is cooperating, with sun and not too much heat. On y va.

My article in Hour Magazine in Montreal has been published.

For many here, the phrase "three by five" is best seen as the beginning of a success; for others, its failure symbolic of inaction and betrayed promises.

"Three by five" is shorthand for the World Health Organisation's goal of getting antiretroviral drugs to three million of the world's poorest people with HIV by 2005. It fell short -- estimates differ, but many say only one million of the people targetted are recieving care. Many say it is the best example of the hollowness at the centre of the Western world's grudging, incomplete promises to the world's poor

Politics aside, news delivered here yesterday by Dr. Kevin De Cock, director of the WHO's AIDS programme, is not good news for anyone following -- or, more importantly, dependent on -- foreign agencies to access needed AIDS drugs.

The full story is here, nailed down (as usual) by Mr. Lawrence K. Altman, MD.

Maybe those anti-celebrity activists yesterday had a point: I just scoped a Survivor winner -- that curly-headed, earnest, soccer-playing guy from an early season -- wandering around outside the media centre.

Day Four will be shortened as I have a date with a Minnesotan at 14h00. Today, I hope to spend as little time as possible in the media pen or going to sessions, which has gobbled up 90% of my time so far. I want to wander aimlessly around the conference, seeing things and talking to people, getting a sense of what this conference is like above and below the official narratives.

A few short words about covering the conference: As a journalist, it's like trying to sip from a fire hose. You could be 100 journalists and still not adequately cover all the cultural, political, social and scientific stories in this convention centre. (Although, of course, at least one journalist has done away with the ol' notion of talking and learning, content to scribble shallow generalisations from watching the conference coverage on her office television.) And this is not one conference, it seems, but a multitude: Where else can you walk one block and find South African grandmas, top American research scientists, Hollywood celebs and European activists? The diversity of humanity in the Global Village -- the public 'square' attached to the conference -- is the most eloquent testament to the idea that we all have AIDS, whether infected or not.

So a journalist -- okay, so this journalist -- has to guard against frustration. It is very easy to only see the overwhelming number of stories missed, interviews unattempted or ideas abandoned half-baked. You just have to remember to do the best you can with what you have.

I'm leaving the pen -- last night's staircase injury has left my back aching. Time for medicinal applications of heat and alcohol.

I will leave y'all with something i've spent a not insignificant amount of time looking at -- a section of the famous AIDS quilt that hangs over our heads in the media pen. As an angry bunch of South African activists just reminded us -- and, to his apparent gloom, the co-discoverer of HIV-1, Dr. Anthony Fauci -- the men, women and children memorialized in those swatches are why we are here. They should be over our heads, always.

Over our heads

Just back from a demo in support of inSite, Vancouver's supervised injection site, which is in danger of being closed by the federal government. About forty activists blocked Yonge and Bloor, a major intersection in downtown Toronto, for about 10 minutes. I shot a lot of pictures -- they'll be posted, soon.

Update: The pics are at my flickr site here.

Here's one of my favourites:

VANDU man and child, 2

The Canadian Treatment Action Council (CTAC) just finished a press conference on the unequal chance Canadians have to accessing care for AIDS, specifically antiretrovirals (ARV). Some barriers include:

• The patchwork of drug plans, which differ by province and (generally) class: "Some Canadians have private drug insurance, some rely on provincial-territorial government drug plans, and others access federal government plans. Each plan is different: some cover more drugs than others; some will only pay for the cheapest drug in its class; some require co-payments and other payments prior to any coverage; some cover drug costs only for people on social assistance."
• Canadians from specific groups, like new immigrants or members of certain ethnic groups, might face additional barriers to care. "Stigma and discrimination – within the health care system, within Canadian society, and within vulnerable communities – makes it harder for people from ethno-racial communities to access health care."
• Aboriginal Canadians also find it harder to get care. "Aboriginal people in Canada have higher levels of HIV infection relative to other Canadians and face some of the most challenging barriers to health care and medications. The barriers include stigma and discrimination. Recent studies have shown that Aboriginal people with HIV/AIDS die more rapidly because they did not access drugs or health care."

As with so many other measures of despair and disease, aboriginal people are over-represented in the group of Canadians who live with HIV/AIDS.

According to numbers distributed here by the Canadian Aboriginal AIDS Network, aboriginal people are 3.3% of the population, but 7.5% of all current infections. That translates to an estimated 3,600 to 5,100 people living with the disease, many in shockingly substandard settings for health care and housing.

From an epidemiological standpoint, the key word in that sentence is 'estimated'. There is no nation-wide measure of aboriginal HIV incidence and two provinces -- BC and Ontario -- do not even collect identifying data with casre reports of HIV infection. Also, according to Randy Jackson of CAAN, some aboriginal leaders do not recognise AIDS as an aboriginal health problem, or place it far down the list of priorities, behind substance misuse, diabetes, and other communicable diseases.

Access to treatment is equally despairing. According to Jackson's scientific findings, aboriginal people wait much longer on average to access life-saving antiretroviral treatments, mainly because it is not on Health Canada's mandatory formulary, and doctors must fill out additional paperwork before an aboriginal person can fill a prescription at a pharmacy. Add to that the sorry state of health care infrastructure in the majority of non-urban or non-southern aboriginal communities.

Jackson also raised the spectre of what he called 'forced migration': Aboriginal people living with HIV/AIDS who move to urban centres in the hope of accessing better care, through a AIDS clinic or infectious disease specialist. That often brings with it depression and adherance deficits, as the person is removed from their social and cultural networks.

I mostly managed to avoid the Bill Clinton adoration, but I must admit to my fanboy moment of this conference: I just chatted with Paul Farmer in the coffee lineup and thanked him for his work and its impact on my work and my decision to go back to school and study epidemiology. He was quite nice, we talked about the food stuff -- "It's crazy, isn't it?" -- and wished me luck in my studies -- "Good luck with epi, it's tough stuff."

Although I was carrying the Nikon I managed to resist the temptation to have a picture taken for posterity. I think it'll stick in my mind for a good while.

Partner in health's Dr. Paul Farmer at AIDS 2006

That's the cost of providing nutritional support -- development-speak for, uh, food -- to people on antiretroviral therapy. Costed out, it would mean $1.1 billion to feed all the 6.4 million HIV-infected people who need it between 2006 and 2008, or just two percent of the $55-billion the UN estimates will be needed to fight the pandemic over that period.
Those numbers come from the World Food Programme, the UN agency in charge of food relief. Robin Jackson, WFP head of delegation to AIDS 2006 has just finished a press conference with Stephen Lewis and Paul Farmer, an MD and PhD (anthropology) at Harvard Medical School who, more importantly, has worked for Partners in health, a legendary health and poverty NGO in Haiti.
But Joseph Jeune stole the show.
Mr. Jeune is a 20-something man from Haiti who is living with HIV/AIDS. Before he accessed antiretroviral therapy and food support through Partner in health's central Haitian clinic, he was at death's door. After, he was the picture of heath. And today, he was the highlight of the press conference.

Joseph Jeune: Before antiretroviral therapy

Joseph Jeune: After antiretroviral therapy

Joseph Jeune: Today at AIDS 2006

Despite the low cost of the intervention -- and its obvious benefits to millions of Joseph Jeunes around the world -- groups like PEPFAR (US President Bush's initiative against the pandemic, the Global Fund and other multilateral bodies do not routinely include food in ARV strategies, Jackson told the crowd, one even calling it a "Rolls Royce" addition to any programme. Dr Farmer noted that food plays a crucial role in ARV therapy, often determining success and adherance, pointing out that many will not continue on the drugs if they are hungry, or most move for food.

Jackson's cost estimate was arrived at by looking at 24 projects of four types in 18 different countries, then feeding the data into UNAIDS estimate of pandemic growth.

Neither Farmer nor Jackson could understand the reluctance of funding bodies to include food supplements, with Lewis underlining the smack-your-head obviousness of the link to an Ontario government report he once read that found "the risk of drownings increase with proximity to large bodies of water."

Asked why he thought these programmes were not supported, despite the medical evidence and cost effectiveness, Farmer told me he thought the bodies were simply being "penny wise and pound foolish."