Report from the 14th Annual International AIDS Conference

The 14th International AIDS Conference was held this summer in Barcelona, Spain. Over 15,000 delegates from all over the world participated in five days of presentations, workshops, discussions, and debate.

The conference highlighted scientific developments, and also featured clinical advances and challenges, the status of prevention initiatives, and the politics and economics of treatment. Some of the main speakers at the conference included Peter Piot, executive director of UN-AIDS; Gro Harlem Brundtland of the World Health Organization; Nelson Mandela; and former president Bill Clinton. Mr. Clinton facilitated the first "town meeting" of world leaders convened to discuss controlling the pandemic.

Although advances in science and technology were prominently featured in the gathering, the role of complementary and alternative medicine (CAM) enjoyed greater appreciation than in previous conferences. Almost two dozen presentations were given, which dealt with a variety of CAM topics. Massage was offered each day in the lounge provided for people with HIV/AIDS, and acupuncture was available at one of the exhibit booths.

Providers and consumers of acupuncture and herbal medicine will readily appreciate some of the main messages of this conference, specifically:

1. Controlling the AIDS pandemic is a marathon, not a sprint. There are no easy, one-dimensional answers.
2. A false dichotomy has existed between prevention and treatment, causing unnecessary competition for funding. Recognizing that a continuum exists between those who are infected and affected by HIV/AIDS allows creative and effective health care strategies to emerge. For instance, because being infected with one strain of the virus has no effect on whether an individual can be infected with a different strain, an effective health care strategy needs to comprehensively incorporate behavioral and clinical elements.
3. All individuals have a right to treatment.
4. Many countries have an integrative approach to health care and include modalities sometimes called "alternative" as part of their traditional medical care.

Topics addressed in posters and presentations included the following¹:

• The role of nutrition, especially of supplementation, with multi-vitamins, zinc, vitamin C and selenium. Presenters from the U.S. and Kenya addressed these issues with a variety of studies and surveys that estimated prevalence of use (McClelland RS et al.; Baum MK et al, Bartan JM et al, Shor-Posner G et al.).
• Controlling side-effects of HIV-combination therapy was evaluated by investigators in the United Kingdom, Italy, Germany, Belgium, France and Spain (Nasta P et al, Robinson N et al.). √° Public health personnel described the use of traditional medicine in French Guiana and Uganda (Couppie P et al, Aryeija W et al.).
• Use of herbs, including garlic, is widespread in managing various conditions associated with HIV/AIDS.
• Organizations in South Africa, China, Taiwan, Hong Kong and Thailand described their experiences with using herbal treatments (Vo S, Johnson Q et al., Kraisintu K and Eksaengrsi A).

The following studies related to acupuncture and CAM were also presented:

• Preliminary results from an ongoing cross-over clinical trial in Boston, Massachusetts suggest that acupuncture can be effective in treating side-effects related to HIV-combination therapy. In particular, nausea, loss of appetite and excessive gas can be minimized with acupuncture treatment. The results also indicate that adherence to medication protocols improves with treatment. Acupuncture was shown to be safe and no adverse effects were reported (Sommers E and Porter K).
• A survey conducted in the United Kingdom found that individuals who use acupuncture as part of their health care in managing HIV/AIDS report improved adherence to medications (Robinson N et al.).
• A field-based data gathering project which evaluated using acupuncture in the Tenderloin area of San Francisco presented data on programming, utilization, and accessibility (Wilson C, Cohen M).
• An innovative observational study was conducted in Italy evaluating the relationship of using CAM and compliance to medication protocols. Using a case-control methodology, the investigators noted that individuals who integrate CAM therapies into their care have a higher reported level of adherence to their HIV-drug regimens. Compliance can be crucial with combination therapies such as highly active antiretroviral therapy (HAART), because poor adherence can often result in genetic mutation of the HIV-virus and lessened efficacy of treatment (Nasta P, et al.).

Overall, the conference provided a unique forum for exchange of information and resources. It offered opportunities to discuss public health issues from a variety of perspectives, and to interact with providers and policy-makers who have integrated CAM into their countries' health care systems.

It is clear that acupuncture and herbal medicine are making inroads into integrated care world-wide, and that more health care specialists are taking Asian medicine seriously and adapting it for use in their own countries. The next conference, to be held in the summer of 2004, will be in Bangkok, Thailand.

In the face of the HIV pandemic, where approaches consisting of multifactorial components seem to be the most effective for both prevention and treatment, acupuncture and herbal medicine have valuable roles. It is up to the creativity and imagination of clinicians and consumers to demand and ensure access to these types of care, and to evaluate issues of efficacy and cost.

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Note: We will be dedicating a column to international public health efforts involving acupuncture early in 2003. We would like to interview individuals who have worked with programs in other countries, and we encourage you to contact us so that your information and experience can be shared.

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Reference

1. All abstracts cited can be accessed through the Web at www.aids2000.org.