The last two years have also seen, arguably, a major change in the dynamics of the debate over HIV.

Since the beginning of the epidemic in the mid 1980s, civil society and AIDS support organisations in developing countries have struggled to make their voice heard internationally. While their North American and European civil society counterparts in the North, principally in the gay movement, formed extremely effective and highly organised caucuses to place the issues of HIV/AIDS on political and public agendas in the 1980s and 1990s, organisations from developing countries found it difficult to find a common voice and a global expression.

In contrast to the highly effective coalition, much of it driven from developing countries, which came into being around the Cairo and Beijing conferences to achieve a sea change in international and national priorities regarding the status of women in society, an analogous international HIV/AIDS civil society coalition has not emerged with the same strength and profile, in part perhaps because there was not a clear issue around which concrete demands for action could be made.



At the end of the late 1990s, that issue potentially emerged in the form of access to treatment for HIV/AIDS. Arguably for the first time, organisations in the South were able to set out their own agenda, their own demands and their own priorities in response to HIV/AIDS. A combination of chronic lack of access to HIV/AIDS treatments, consistent refusal by Northern drug companies and their governments to allow compulsory licensing of combination therapies, the perceived injustices of international framework of intellectual property rights (TRIPS) and the growing scale of the epidemic finally ignited a major international, southern driven political movement to campaign for the rights of people with HIV in developing countries.

The flames of this movement originated principally in South Africa and Brazil in response to the refusal of international pharmaceutical companies to reduce the price of ARVs or allow developing countries to produce them themselves. They were fanned by the political rows surrounding President Thabo Mbeki's unwillingness to acknowledge the reality of the AIDS epidemic in his country, and the lack of commitment to tackling the epidemic by many of Africa's political leaders (most clearly exemplified at the 1999 HIV/AIDS in Africa conference, where not a single African leader attended). The international HIV/AIDS conference in Durban in 2000, the first such international conferences to take place in a developing country and the first where a majority of participants were from developing countries, further energised this movement.

Despite the huge practical, as well as economic, constraints of making antiretroviral therapies available in many developing countries, this movement is beginning to provide civil society in developing countries with the opportunity to make the AIDS issue their own, to carve out their own agendas on the epidemic and to transform a health issue into a political one.

In doing so, millions of people in South Africa, Brazil and elsewhere who have formerly regarded the issue of HIV/AIDS as one of public health and sexual behaviour have been drawn into a debate marking it out as an issue of economic justice and human rights. International lobbying has led to important concessions by international pharmaceutical companies to reduce the prices of ARVs and most recently to major concessions over intellectual property rights at the World Trade Organization.

AIDS has a history of being a highly political and politicised epidemic, capable of energising social movements in a way that is rarely the case with other health issues (although it is far from unique, with the global movement around tobacco providing another example). It is clear that lasting impact on HIV/AIDS is dependent on a major global response, but it is equally clear that that response needs to be implemented within the context of a global agenda on the issue which is shaped and driven from within developing countries. The treatment campaign is helping to crystallise that response.

However many activists remain pessimistic over what can be achieved in providing a markedly increased level of access even with significantly increased funding. The UNGASS document stressed both prevention and treatment as key strategies in tackling the AIDS pandemic, and arguments are likely to intensify over coming months over where and how to prioritise resources.

An alternative analysis of the treatment campaign is that the issue, far from politicising the epidemic, is remedicalising it. A major reason for the establishment of UNAIDS was the acknowledgement of the complexity of the epidemic and the clear need for a multisectoral response to it. With the issue of treatment once again moving centre stage, there is a concern that the focus will move towards an essentially medical solution, with the focus shifting to treating the symptoms of an epidemic, not its underlying causes.



Access to treatment is far from being the only issue which is galvanising social movements in this way. A growing movement to confront HIV/AIDS related stigma is rapidly taking on a new profile and energy, and is emerging from networks of people living with HIV/AIDS, other HIV/AIDS related civil society organisations and is becoming a major priority for international agencies and organisations. UNAIDS has designated the issue as the focus of the next World AIDS Campaign.