Return to the Bay Area
It was in San Francisco that a mysterious disease, later identified as AIDS, first emerged onto the public radar as a major issue in the early 1980s. When the city hosted the 6th International AIDS Conference (AIDS 1990), AIDS was well on its way to becoming the main cause of death of Americans aged 25 to 44, with San Francisco seen as an epicentre. By 1995, the city had the highest percentage of people infected with HIV in the US, and by far, most were gay or bisexual men.
AIDS 2020 returns to a very different San Francisco. It was one of the very first cities to embrace the UN 90-90-90 targets: to get 90% of HIV-positive people tested, 90% of those onto treatment, and 90% of those to having a fully suppressed virus. It went further, launching Getting to Zero, a citywide collaboration of stakeholders from all sectors to work together to end HIV transmission. The campaign involves widespread testing and immediate treatment with additional health and social support services.
In recent years, the profiles of the HIV epidemics in San Francisco and Oakland have become similar. Historically, the two cities had different HIV epidemics and different resources with which to address them. The experiences of these cities parallel those of other settings in the global North and South, and afford an opportunity to examine all the ways in which different contexts affect HIV epidemic trajectories and responses.
San Francisco still has one of the largest HIV-positive populations in the US: about 16,000 people live with HIV in the city. However, infection rates have plummeted. In 2016, there were 223 new HIV cases, a massive decrease over previous years. Of all people diagnosed with HIV in San Francisco, 73% are virally suppressed, which means that they have better health outcomes and do not transmit HIV to others.
Although Oakland is fewer than 7 kilometres from San Francisco, different social and economic conditions in several East and West Oakland neighbourhoods have contributed to notable racial/ethnic inequities in the HIV burden.
In 2014, there were 3,275 people living with HIV in Oakland. African Americans accounted for more than half of all new diagnoses and Latinos about 20%. The rate of new HIV diagnosis among African Americans from 2012 to 2014 was three times higher than that for whites. Oakland signed on to the Fast-Track Cities Initiative in 2015 and has seen declines in HIV diagnoses, particularly among African American women and men as the city works to strengthen policies and programmes in order to reach the 90-90-90 targets.
AIDS 1990 witnessed one of the most extraordinary moments in the history of AIDS activism: hundreds of activists joined together to demand an end to discriminatory immigration policies and major new investments in HIV research. The return of the International AIDS Conference to the US for AIDS 2020 will serve as a powerful reminder not only of the extraordinary return on US investments in global AIDS programmes, but also that AIDS is not over.
Selecting the host city
The search process
To find the best host for each International AIDS Conference, the International AIDS Society (IAS) conducts an extensive, open-bid process that begins 18 months before a decision is made. For the 23rd International AIDS Conference (AIDS 2020), we engaged more than 20 cities across the world, starting in 2016.
Our process involves an extensive evaluation that determines each city’s ability to house the meeting and its delegates, commitment to supporting scientific research and implementation, and inclusion of civil society and communities living with HIV in their local response. Each city is required to represent a cross-section of policymakers, scientific researchers and civil society as part of the bid.
It is always our preference to represent different geographies in hosting the International AIDS Conference. For many years, we were fortunate to identify willing government and community partners in resource-limited settings that allowed us to host the meeting while maintaining our commitment to access for people around the globe. For AIDS 2020, only cities in the global North completed a bid application. Even after direct engagement from IAS staff and site visits to potential hosts in the global South, we did not receive any applications.
This is understandable. Being selected as a host city for the International AIDS Conference is not a reward; it is a recognition that there is something particularly unique and challenging about the epidemic in that setting. It is a commitment by conference organizers and local partners to shine a light on strengths and weaknesses in the response. For a variety of reasons, including political climate, not every country is willing to make this commitment.
Many previous conference sites were chosen to directly challenge political and social norms. AIDS 2020 is no exception.
The leadership demonstrated by the State of California in bidding for AIDS 2020 is unparalleled. We received 33 letters of support from local AIDS organizations, local key population networks, leading activists and political leaders, including Senator Dianne Feinstein, Democratic Leader Nancy Pelosi, Congresswoman Barbara Lee, the Governor of California, and the leaders of the State Legislature’s Lesbian, Gay, Bisexual and Transgender Caucus. Each of these leaders committed themselves to supporting the mission of the conference.
Additionally, San Francisco has agreed to waive the cost of the conference venue to ensure affordable access to the meeting for delegates from around the world. Local partners are also helping to secure low-cost accommodation by partnering with universities, hotels and hostels.
In December 2017, the IAS’s Governing Council selected San Francisco and Oakland as the joint hosts of AIDS 2020 because we are concerned about the retreat from executive leadership on AIDS in the US. The US Government plays a vitally important role in addressing the epidemic both globally and domestically, and yet, year after year, we see attempts to dismantle and de-fund these programmes. In its bid, the State of California and the cities of San Francisco and Oakland have jointly shown their willingness to resist these changes in partnership with conference organizers.
Travel restrictions to the US remain a significant concern for us. AIDS 2012 in Washington DC is an important model for preparing for AIDS 2020. Early engagement from policy experts and advocates helped address a large number of access issues for delegates travelling internationally. That work led to the largest International AIDS Conference in history – with over 23,000 registered delegates – and lifting of the 22-year travel ban that prevented people living with HIV from entering the country.
We commit to organizing a US-based working group similar to that formed in advance of AIDS 2012. This group will be supported to proactively address access concerns and make recommendations to the conference organizers that support the mission and vision of AIDS 2020. Together we will develop solutions that ensure maximum participation and advocate for policy change at federal level.
This is not a time to shy away from engaging on AIDS in the US. We believe holding AIDS 2020 in the Bay Area, a global capital of AIDS activism, will send a powerful message to all those threatening to undo the progress of the past three decades and provide support to those living with HIV and fighting to protect global AIDS funding.
Having the conference in the US in 2020 will provide a powerful reminder not only of the extraordinary return on US investments in global AIDS programmes, but also an opportunity to work together to demand an end to discriminatory immigration policies and call for new investments in HIV research.