SAN FRANCISCO AIDS CONFERENCE, RELATED EVENTS: ISSUES AND UPDATE

The Sixth International Conference on AIDS, the largest scientific meeting on AIDS in 1990, will take place June 20-24 in San Francisco, at the Moscone Convention Center and at the Marriott Hotel one block away. A number of related events -- some officially connected to the International Conference and some not -- are also scheduled in or near that time. And two related international meetings originally planned for San Francisco -- of the International Red Cross and of AIDS-related non-governmental organizations -- have been rescheduled and moved elsewhere, because U. S. travel restrictions make it difficult and potentially dangerous for HIV-positive participants to enter the United States.

This article provides an overview and calendar of the Sixth International Conference, the international boycott by dozens of organizations because of the travel restrictions, and the many related conferences, educational meetings, marches and demonstrations, art events, video coverage plans, and other activities planned to coincide with the Conference. We also address the unmet needs for international communication on AIDS, needs requiring improvements in the annual International Conference in the future, and we propose a computerized system for peer-reviewed publication of scientific and medical findings.

The Travel Ban and the Boycott

The law barring HIV-positive persons from entering the United States was passed by Congress in 1987. In April 1989 the ban gained international attention when Dutch AIDS educator Hans Verhoef was jailed in Minnesota, while attempting to change planes to attend an AIDS conference in San Francisco. (Months before that incident, however, Canadians had been prevented from entering the United States to seek medical treatment for AIDS. At least one earlier incident made front-page, headline news in Canada but was unknown in the United States as it was not reported in any news media here.)

In May 1989 the U. S. Immigration and Naturalization Service (INS) instituted a 30-day waiver to allow HIV-positive persons to enter the United States for certain purposes, including to attend conferences, obtain medical treatment, or visit family members. The waiver process was burdensome, however; a San Francisco law firm published a 62-page guide on how to apply. And there was no protection for confidentiality, as a code known to border agents throughout the world would be stamped in the visitor's passport, leading to risk of discrimination by other countries.

In September 1989 the UK Hemophilia Society wrote to all member organizations of the World Federation of Hemophilia that it could not participate in the August 1990 biannual hemophilia conference in Washington, D. C. because of the entry ban. A separate boycott of the Sixth International Conference on AIDS includes 79 organizations, as of May 4. The list is too long to reproduce here, but just the 'A' section of the alphabetical list gives a sense of the organizations involved: Action AIDS (UK), Action Health 2000 (Britain), AHRTAG (UK), AIDES Solidarite Plus (France), AIDS Action Council of New South Wales, AIDS Interfaith Network, AIDS Linean (Denmark), APARTS Solidarity Plus (France), Australian Federation of AIDS Organizations (AFAO), and Austrian AIDS Help. Other boycotting organizations include the International League of Red Cross and Red Crescent Societies, the British Medical Association, and the European Parliament.

Due mainly to the boycott and to pressure from the organizers of the Six International Conference, the U. S. Government twice made changes in the waiver procedure. First, it allowed the visa to be stamped on a separate piece of paper instead of the passport (only if applicants request that), a system modeled on that used by Israel for travelers who do not want to be barred from entering Arab countries. Later, the White House announced that instead of the 30-day HIV waiver, visitors could request a special 10-day waiver which would not require them to state that they are HIV-positive. These 10-day waivers are available only for the AIDS and hemophilia conferences, and for any future conferences which may be specifically approved as "in the public interest" by the U. S. Department of Health and Human Services. No "record of ineligibility" will be created by use of the 10-day waiver, and the U. S. State Department assured the Sixth International Conference that use of a ten-day visa will not affect later entry into the United States. (Either the 10-day or 30-day visa is required from HIV-positive visitors even if they would not otherwise need any visa.) The National Association of People With AIDS has maintained a list of boycotting organizations, and no group to its knowledge has withdrawn from the boycott because of the new 10-day visa option or other administrative changes.

A bill was introduced in Congress to give the U. S. Centers for Disease Control (CDC) the authority to repeal the travel ban -- an authority it has for all diseases except HIV, which alone was added to the list by Congress -- but the White House refused to support the bill, so it is not expected to pass in time for the Sixth International Conference. Lawyers disagree on whether the White House has the authority to allow the CDC to remove the ban without an act of Congress.

The Sixth International Conference has written a five-page letter to all Conference participants registered from outside the United States, to explain the current visa situation and requirements for HIV-positive persons planning to attend. For example, for the 30-day waiver applicants must show evidence that they can pay for emergency medical treatment if needed in the United States (so that there can be no cost to the government), while for the 10-day waiver applicants should be prepared to present proof of their intent to attend the Conference. Application for the 30-day waiver should be made at least 30 days in advance, whereas the 10-day waiver should be applied for two to four weeks before beginning travel. Obviously we cannot safely summarize the letter; persons who need a copy should contact the Sixth International Conference at 415/550-0880. The Conference has also organized a panel of volunteer attorneys to assist anyone seeking to attend who is detained at the border because of HIV status. The toll-free number for this legal referral panel is 1-800-933-0120, 24 hours a day, at the time of the Conference. Callers are advised that many pay phones do not receive incoming calls; they must leave a number at which it will be possible for someone to call them back.

Comment: Entry Restrictions and the Boycott

AIDS TREATMENT NEWS is often asked if we are boycotting the Conference. As press, we must cover the news -- the Conference, and the boycott, too.

We completely respect both positions, to attend or to boycott; people and organizations differ in how they can best serve in the common effort against AIDS. The boycott is not like a strike, intended to shut the Conference down; no one wants to do that. The boycott's main purpose, beyond bringing pressure to change U. S. policy, is to make the statement that the entry restrictions are unacceptable, and here it has succeeded. The worldwide revulsion against a policy based solely on bigotry and not at all on public health, a policy which damages international action against the epidemic for no benefit to anyone, has been critically important in preventing a stampede of retaliatory border restrictions which would have increased discrimination against persons with HIV and greatly impeded international action against the epidemic.

Note that of the two largest ACT UP groups in the world, one is attending the Conference (ACT UP/New York) and one is boycotting (ACT UP/San Francisco). Of the two largest AIDS service organizations in San Francisco, one is attending (San Francisco AIDS Foundation), and one is boycotting (Shanti). The American Red Cross will attend the Conference, although it has strongly opposed the HIV entry restrictions; the International League of Red Cross and Red Crescent Societies is boycotting. In either choice, one has good company. The question is not who is right, but how each can help in the overall effort.

Scientific Program Published: Half of Abstracts Rejected

In a major departure from the earlier conferences in Montreal, Stockholm, and elsewhere, organizers of the San Francisco conference rejected half of the 4,900 abstracts submitted -- about ten times as many as were rejected at Montreal -- "to assure the highest quality presentation at the Conference." The Conference announced the rejection of over 2,000 submitted abstracts in a news release dated April 25. Because the rules allowed each person to be the presenting author of only a single abstract, it is clear that the work of over 2,000 different people was rejected (see "Comment" section, below). The rejected abstracts will not be made public, and most are expected to be permanently lost.

The accepted abstracts were divided into three basic categories: oral presentation, poster presentation, and publication-only. The most valued papers were usually given one of several kinds of oral presentations: a 20-minute slot in one of two concurrent plenary sessions from 8:00 to 10:30AM; a place in a poster- discussion panel during the poster-viewing session from 10:30 to 1:00 PM; or a 15- or 20- minute slot in one of eight concurrent oral sessions from 1:00 to 3:00 PM, or from 3:30 to 5:30 PM.

Each day the two concurrent morning plenary sessions focus on "State of the Art" and "Science to Policy." All the other presentations (oral or poster) are divided into four tracks: Basic Science (track A), Clinical Science and Trials (track B), Epidemiology and Prevention (track C), and Social Science and Policy (track D).

Some of the accepted abstracts not selected for an oral presentation will be shown as posters; hundreds of posters will be displayed each day. Authors are asked to be at their posters at certain times, so that anyone interested can meet them to discuss their work.

All abstracts considered for the Conference had to arrive by January 22, and their authors cannot change them before they are published in the book given to everyone attending; the published abstracts are therefore five months old when participants receive them. But the posters themselves can include whatever their authors want, so they can be changed right up to the day of presentation; information often appears on posters which is not available anywhere else. For the oral sessions, tapes can be purchased from the Conference; but to quickly gather new information from the posters, some people bring cameras, or tape recorders which they dictate into.

Many abstracts were accepted as "publication only," meaning that they only appear in the abstract book, but are not scheduled for oral or poster presentation.

Unfortunately the abstract books themselves will not be available in advance of the Conference. As with the previous international AIDS conferences, a major practical problem will be lack of time to read or scan the abstracts and select which posters to seek out. It is advisable to pick up registration material early, to leave more time to examine abstracts before the meetings start.

Titles of oral sessions, and of categories of posters (but not of the individual poster presentations themselves) are available in an advance program released to the press. We plan to summarize highlights in coming issues. But press cannot examine the accepted abstracts or their titles until the Conference begins -- or the rejected abstracts ever.

What Was Rejected?

Since the Conference will not say what abstracts were rejected, we can only report what we have heard from informal networking. As we go to press we have heard of five papers rejected:

* The hypericin observational study by the Community Research Alliance (also reported in AIDS TREATMENT NEWS February 2, 1990). This study followed 33 volunteers from baseline through four months' use of an herbal extract containing hypericin, one of the most important potential new antivirals, under a protocol providing the same blood tests and other data gathering used in most clinical trials. There was no control group. This research, organized by people with AIDS, reported human efficacy results at least a year ahead of those of any academic, government, or industry study of this treatment.

* A report on the effect of publication delays on AIDS research. The author investigates new treatments for a major AIDS research organization.

* Experience with providing research-nurse support to help physicians conduct AIDS treatment research in their practices. The author, a research nurse, does just that.

* An improved antibody test which shows unexpected fluctuations in antibody levels during the course of HIV disease, with possible clinical implications. This report was initially rejected; the author asked for reconsideration, and the abstract was finally accepted for publication only (no poster or oral presentation).

* Our own abstract on AIDS TREATMENT NEWS and the unmet communication needs in the epidemic.

The Sixth International Conference organized international panels of hundreds of reviewers to rate the 4,900 abstracts submitted. But we have heard from two people involved later in the decision-making process that the work of the reviewers was often disregarded, with final decisions depending on politics and on who was known to those making the decisions.

It is harder to judge abstracts than to judge longer reports, because so little information is available. Reviewers are forced to base decisions on the credibility of the authors, to the disadvantage of authors not known to them.

The rejected abstracts are expected to be lost permanently. The Conference cannot publish them later or give them to anyone else to do so, because it only has permission from the authors to provide them to the Conference delegates. Members of a community task force set up by the Conference can view the rejected abstracts and write to selected authors to request permission to publish their work elsewhere, but there is little chance that this system will prove workable.

Comment: Rejected Abstracts

We question whether anyone knows enough about AIDS today to justify taking half of the work submitted to the major scientific conference of 1990 and making it unavailable to the public. No one can be sure about what will be important later. The above examples of rejected work are not reassuring.

What could still be done would be to allow those attending the Conference to purchase the rejected abstracts -- or at least to place an order there for later delivery. This plan would not exceed the authority of the Conference organizers to make
submitted abstracts available to participants. It would be administratively possible, since the only action needed in the hectic final weeks before the June meeting would be to insert an order blank into the packets of materials to be given out. And there would be no additional expense, as costs would be paid by the purchasers.

But this or any other resolution to the vanishing-abstracts problem will require public pressure, as there is a conflict between the interests of the Conference organization and the interests of the public. The public interest is best served by having the over 2,000 abstracts somehow available. But keeping the rejected papers secret avoids possible criticism of the organization, by obliterating over 2,000 specific cases in which its decision might be questioned.

If the Conference organizers will not make the concealed abstracts available, then efforts will continue to contact as many of their authors as possible and offer to publish their work in a separate volume (suggested title: AIDS Apocrypha). In addition, those rejected abstracts which can be found could help to provide the nucleus of an international AIDS computer conference which could provide instant, peer-reviewed publication of scientific, medical, and other AIDS developments every day of the year, throughout the world. (See "Proposal: Computerized International Publication of AIDS Research Results," below.)

Satellite Meetings and Conferences

The following events are satellite meetings of the Sixth International Conference on AIDS. In almost all cases, however, they were organized independently, and the Sixth International Conference is not a co-sponsor. Organizations boycotting the Sixth International Conference do plan to participate in some of these.

For more information about any of these meetings, call the contact person listed.

* Community Outreach Sessions of the Sixth International Conference on AIDS, June 20-23. Contact Mr. Mike Shriver, 18th Street Services, San Francisco, 415/861-4898. (For more information, see "Community Outreach Sessions," below.)

* AIDS and Ethics: The First International Conference, June 24- 27. Contact Conference Coordinator, Bioethics Consultation Group, Berkeley, CA, 415/486-0626.

* 2nd Annual AMA HIV Conference: Counseling, Testing, and Early Care, June 18-19, 1990. Contact Dr. John Henning, Office of HIV/AIDS, American Medical Association, 312/645-4566.

* Community-Based Clinical Trial Network (CBCTN) Meeting, June 19. Contact Mr. Ron Goldberg, American Foundation for AIDS Research, 212/719-0033.

* Collaborative Clinical Studies on AIDS and HIV Infection, June 19. Contact Dr. John Mills, San Francisco General Hospital, 415/821-8666.

* AIDS/HIV Nursing: Learning from the Past...Envisioning the Future, June 19. Contact Ms. Angie Lewis, RN, MS, University of California San Francisco School of Nursing, 415/476-4455.

* AIDS '90: The Social Work Response -- The Second International Conference on Social Work and AIDS, June 16-19. Contact Dr. Vincent Lynch, Boston College Graduate School of Social Work, 617/552-4095.

* Gay Men of Color AIDS Institute, June 25. This one-day workshop of panel discussions is designed for AIDS/HIV treatment or prevention service providers to gay and bisexual men of color. Contact Reggie Williams, National Task Force on AIDS Prevention, 415/255-8378.

* First International Invitational Conference on AIDS and Homeless Youth: An Agenda for the Future (invitation only), June 25. Professionals attending the Sixth International Conference who work with street youth outside of North America should forward a letter of interest and resume to: Ms. G. Cajetan Luna, Conference Chairman, Mount Zion Hospital and Medical Center, 1600 Divisadero St., San Francisco, CA 94120, USA, phone 415/885-7533.

* International AIDS Society General Meeting, June 23. Contact Dr. Friedrich Deinhardt, Max V Pettenkofer Institute, Munich, phone 89 5160 5200-5202; fax, 89 5380584.

* Neurological and Neuropsychological Complications of HIV Infection, June 16-19. Contact Dr. Joseph Berger, University of Miami Medical School, 305/547-6732.

* Oral AIDS Research: Clinical and Laboratory Skill (invitation only), June 18-19. Contact Ms. Carol Neuman, School of Dentistry, University of California San Francisco, 415/476-2169.

* Current Therapies and Future Strategies in the Management of HIV-Related CMV Infections, June 19 (sponsored by Syntex Laboratories, Inc.) . Contact Ms. Edna Faulk, Pro Health Communications, San Francisco, 415/788-2464.

* The Challenge of Combination Antiviral Therapy, June 20 (sponsored by Roche Laboratories). Contact Ms. Deborah Rachlin, Triclinica Communications, New York, 212/698-4084.

* Fluconazole: Management of Fungal Infections in People with HIV Disease, June 22 (sponsored by Roerig, a division of Pfizer Pharmaceuticals). Contact Ms. Ellen Kash, World Health Communications, New York, 212/679-6200.

* Display of the AIDS Memorial Quilt, June 21-24. Contact the NAMES Project, San Francisco, 415/863-5511.

* A Celebration of Life Worship Service and Networking Fellowship Reception, June 21. Contact Mr. Bob Elkins, 415/861-5690.

* Gospel Artists Against AIDS, June 23-24. Contact Rev. Yvette Flunder, An Ark of Love, Oakland, California, 415/482-1288.

* Exhibit on AIDS at the Exploratorium, June-August 1990. Contact Deborah D. Raphael, AIDS Project Coordinator. For Exploratorium information, call 415/561-0360.

* Searching Online for AIDS Information, June 20, 1990. Contact Ms. Ginny DuPont, U. S. National Library of Medicine, 301/496- 6193.

* Interactive Global Teleconference -- San Francisco, June 1990. Contact Mr. Johan Almquist, Interactive Events Ltd., Sweden, fax: 46-171-70545.

Community Outreach Sessions:

Speakers Include Montagnier, Fauci, Mann, Osborne

These evening and Saturday meetings, free and open to all, are sponsored by the Sixth International Conference on AIDS. Speakers will give five to ten minute presentations, then be questioned by a panel of experts and by the audience. Sessions will be held at the Herbst Theater, 401 Van Ness Avenue. The sessions and scheduled speakers are:

* "The Global Impact of AIDS," Wednesday (June 20), 7-10 PM. Speakers include Jonathan Mann, Rafael Pagan, Ishmael Bangura, Amy Pascual, and Ferenc Sebastien.

* "Barriers to Outreach," Thursday 7-10 PM. Speakers include June Osborne, Mary Goulart, Virginia Schubert, Moher Downing, Beatriz Pestana, and Reggie Williams.

* "Treatment, Research, and Clinical Trials," Friday 7-10 PM. Speakers include Anthony Fauci, Luc Montagnier, Ellen Cooper, and Mindy Fullilove.

* "The Political Stuff of HIV Disease," Saturday 2-5 PM. Speakers include Paul Boneberg, Jean McGuire, Martin Delaney, William Roper, and Larry Kramer.

For more information about this program, call Mike Shriver, 18th Street Services, San Francisco, 415/861-4898.

Alternative Conference on Natural Therapies Seeks Abstracts Rejected by Sixth International

Just two blocks from the Sixth International Conference on AIDS, and on the same days (June 20-24), will be a natural-therapies meeting with no official relationship to the International Conference. The Second Annual Advanced Immune Discoveries Symposium (AIDS 90), organized by Laurence Badgley, M. D. and sponsored by the Foundation for Research of Natural Therapies (FRONT), will be held at Le Meridien Hotel, 50 Third Street, San Francisco.

Papers rejected by the Sixth International Conference can still be considered for AIDS 90. The International Conference has not released information about the over two thousand abstracts it rejected, but we suspect that work on "natural" therapies (i.e., other than high-tech approaches which interest the major commercial organizations which support academic research) were likely to have been rejected.

For more information about the natural-therapies conference, call the Foundation for Research of Natural Therapies, Foster City, CA, 415/349-0718 (fax 415/349-1257).

Meetings Moved Due to U. S. Travel Restrictions

Two meetings which had been planned for San Francisco have been rescheduled due to U. S. restrictions on HIV-positive delegates:

* The Second International Conference of AIDS-Related Community and Non-Governmental Organizations has been tentatively rescheduled to September 24-27, in Paris. For information about this meeting, call Chris Castle, National Minority AIDS Council, 202/544-1076.

* A San Francisco meeting of the League of Red Cross and Red Crescent Societies has been cancelled. In addition, a workshop by the American Red Cross to train Hispanic AIDS educators will not be held in San Francisco and may be held later in Mexico.

ACT UP Events

Each ACT UP (AIDS Coalition to Unleash Power) is an autonomous organization. In addition, a national organization ACT NOW (AIDS Coalition to Network, Organize, and Win) helps to coordinate the local ACT UP groups.

The ACT NOW calendar of events is still being put together. Workshops and/or demonstrations are being planned for every day, from June 17 to June 24. Other projects include publishing a handbook for the week, organizing a media center near the Conference site, social and entertainment events, encouraging artists to come to San Francisco with a focus on "instant art" of posters, murals, etc., setting up computer and other links with the newly-formed ACT UP/Amsterdam at the Paradisio Cultural Center, and marching as an ACT UP contingent in the Lesbian and Gay Freedom Day Parade.

It is not possible to publish a definitive schedule now, because plans are changing too rapidly. For more information about ACT UP events, contact ACT NOW, phone 415/861-7505 (fax 415/863-4740).

Lesbian and Gay Freedom Day Parade

The annual Lesbian and Gay Freedom Day Parade and Celebration takes place on Sunday, June 24, the day the AIDS Conference closes. Over two hundred thousand people are expected. The parade leaves at 11:00 AM from Market and Speer Streets (less than a mile from the Conference site), and travels up Market to the Civic Center, for a rally from noon to 6 PM. There will be four stages for speakers and entertainment, plus a disco tent, and 300 vendor booths.

For more information, call the Parade Committee at 415/864- 3733.

Other Arts Events

Many arts events related to AIDS are occurring in San Francisco at the time of the Conference. Shows and/or lectures are being sponsored by or will occur at San Francisco Camerawork, San Francisco Art Institute, Ansel Adams Center, Eye Gallery, and Magic Theater. AIDS films will be included in the San Francisco International Lesbian and Gay Film Festival, from June 15 to June 24. Two major shows -- Witness: Against Our Vanishing, and AIDS Timeline -- will not display on the Conference site because of the boycott; other locations are being sought.

Many other arts activities are also being organized. If you know of any event which should be listed in the calendar of cultural events related to AIDS, send a notice to Ken Maley, Media Consultants, Box 330171, San Francisco, CA 94133.

Television Broadcast Plans

The Sixth International Conference will broadcast a one-hour program each evening (repeated at 8 PM, 9 PM, 10 PM, and 11 PM), reviewing presentations made during the day, providing expert analysis, and including updates on Conference activities. The program will be shown in most Conference hotels, and will also be made available worldwide by satellite.

In a separate effort, the Chicago-based Physicians Association for AIDS Care (PAAC) will broadcast a total of 25 hours of programming from the Conference on June 21, 22, and 23. Besides over four hours of programming each day on Conference news, interviews, and speeches, there will be 12 hours on current treatment options for AIDS-related diseases, and on social, financial, and ethical issues raised by the epidemic.

The PAAC telecast will be available to any institution with satellite reception capabilities, including cable stations and persons with home satellite dishes. For more information, write to: PAAC, 101 W. Grand Ave., Suite 200, Chicago, IL 60610.

Let Us Know

The above lists are not complete. If you hear about other events related to the Conference, please contact us at AIDS TREATMENT NEWS, P. O. Box 411256, San Francisco, CA 94141, 415/861- 2432.