PartnersGF - 2004-07-18

IAC 2004: Bridging the gap between wish and reality
HDN Commentary
HDN Key Correspondents Team
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Authority, emotion, tradition and speculation are no substitute for rigorous thinking

There were two small gaps at the XV International AIDS Conference. The first was the gap between ideology and reality. We heard a lot about aspirations, vision and goals: How many people we should aim to treat with ARVs. How many should have access to voluntary counselling and testing. How many financial and human resources are needed. We also heard a lot about local level experiences, pilot projects and practical ways to get around seemingly immovable obstacles. The thing was, we rarely heard about them together, and this created a sense of apprehension or doubt – a bit like leaving home in the morning certain that you have forgotten something, but not being sure what it is until you were well on your way.

This was how we were able to go almost right through the week with several blind-spots on our horizon. We talked endlessly about the three million people who will hopefully be on ARVs by the end of next year – but did not address the difficult questions about how those drugs will be rationed to exclude the other three million who need ARVs right now. We discussed the importance of bringing prevention and treatment closer together, and yet the practical nuts and bolts of preventing mother-to-child transmission did not get any major focus.

The second gap was equally fundamental and may actually underlie the first. It is the gap between advocacy and rigour of scientific thought. The sciences of HIV/AIDS have suffered from the fact that this is a relatively new and fast-moving field. The short time-frame for development of HIV/AIDS-related thinking has made the tendency to rely on “observational generalisations” more likely in this field than many others.

There are two ways to “do” HIV/AIDS thinking. One is to base general conclusions on accumulated evidence or observation – the so-called “inductive” approach. In the HIV/AIDS field, such inductive processes lead to statements describing accumulated experimental and observational evidence. In the broad AIDS discourse, these are separated from – and sometimes contrasted to – other kinds of statements, such as those derived from authority (eg, those made by UN agencies), emotion (eg, testimonies of people or communities living with HIV), tradition (eg, faith-based perspectives) and speculation.

The alternative is to propose an idea or hypothesis and then invite others to criticise it, or disprove it through investigation. This requires not only sound logic and experimental design, but an active willingness to have others criticise your work.

The latter is difficult to maintain when you are busy with political posturing, positioning your organisation or competing with peers for funding and other resources. The XV International AIDS Conference has demonstrated that in the current environment of rapid change and resource flows within the AIDS field, the inductive approach to scientific thought rules, and constructive criticism is out.

As a consequence, we will have to tolerate disconnects between policy and local level realities, learn to live with accepted truths that are founded more on repetition rather on data, and accept blindspots because we are no longer following data or evidence to its inevitable conclusions.

Toronto 2006 organisers please take heed: some of the urgency surrounding the epidemic must be shifted towards regaining critical thinking and analysis in the HIV/AIDS response.


HDN Key Correspondents Team
Email: correspondents@hdnet.org