Monday, October 30, 2006

Accountability and World AIDS Day 2006

According to Gretta Curtis of Christian Today, the theme for World AIDS Day (December 1) 2006 is accountability:
The theme of accountability, with the slogan 'Stop AIDS: Keep the Promise', was chosen in consultation with civil society campaign groups to stress the critical need to meet current commitments to increase the global response to AIDS and bring universal access to treatment, care and prevention by 2010.

Curtis' article explores the theme in some detail, providing an international context for the concept.

The concept of accountability is a complex one. It is certainly au courant in the US, being used in one way or another in just about every political campaign we see these days. I'd like to see some exploration of the concept in terms of the current HIV epidemic in Texas.

Can we look for accountability from those who:

Yes, I'd like to see some real accountability in our fight against HIV. Wouldn't you?


Gary F. Clark, Ph.D. said...


I agree that the issue of accountability applies to both sides of this issue. However, rather than being divisive and aggressive, perhaps an olive branch would be more effective. Stressing overlaping interests is often much more effective than emphasizing differences. The key goal must be to cure AIDS, but first that will take real understanding.

What would happen if it could be firmly established that AIDS and cancer are actually related pathological states? A molecular linkage has recently been established between ovarian cancer and HIV-1 infection in my laboratory. And women with ovarian cancer often develop the same opportunistic infections as AIDS patients. Our more recent studies suggest that this linkage is applicable not only to ovarian cancer, but to all types of aggressive human cancers. Note that end stage AIDS and cancer patients show many similarities in their physical presentation.

And what would happen if AIDS could also be demonstrated to be be linked to many other persistent pathological states in humans via a common mechanism of action? Go to Wikipedia and type in eu-FEDS at the search, and carefully follow the links.

Please understand that this important research linking ovarian cancer and AIDS is funded by NIH, so your tax dollars are doing something.

In summary, rather than citing differences, maybe AIDS activists can come together with everyone in the world by emphasizing that we are all humans that are negatively impacted by these disease states. And that fighting with each other is not the right answer!

Gary F. Clark, Ph.D.

Carolyn said...

Dr. Clark,

Thank you so much for your comment. I will certainly look for more information about your research; it sounds very exciting.

I felt that your comments about being divisive and aggressive were also important, and I responded at greater length in today's post. Just to reinforce the point that I made there: I heartily agree that the olive branch approach to dialogue is effective. I do, however, feel that it is appropriate to talk about accountability when the dialogue ends up being dual monologues.

I look forward to hearing more about your research.

Gary F. Clark, Ph.D. said...


Thanks for the response. I know that sometimes it is very difficult to deal with Luddites who do cannot readily employ simple logic. And I agree that there are some extremely shrill people who tempt one to respond in kind.

On the other hand, I saw in a recent 60 Minutes interview about how the singer Bono confronted the infamous Senator Jesse Helms over the issue of AIDS. Bono was specifically concerned with addressing AIDS in Africa. Bono nonaggressively asked Helms how he could act the way he did if he truly believed in the teachings of Christ. He pointed out that Christ had lived among the very poorest and most defenseless people of his day, and that he often tried to help them in any way he could. He adeptly compared leperosy as the AIDS of that time, and pointed out how Christ sought out and helped lepers that were shunned by virtually everyone, including their own families. And at that point he was able to get Helms to see that it was our responsibility as a great nation to provide humanitarian aid to help the people suffering from AIDS in Africa. So I personally think that if Bono can turn around people like Helms, maybe a better approach is to emphasize that we are all at our core very afraid. After all, each one of us is just one day away from being handed a death sentence from cancer or some other terrible pathogenic or genetic disease. So I think at some gut level we need to appeal to everyone about our shared humanity, and respond to those less thoughtful people with an olive branch. And then like Bono, perhaps we can engage people on that higher level of their character, and be far more successful in addressing these terrible disease states.

I will tell you that I am not at all into celebrity, but after I saw that 60 Minutes story, I realized that Bono is far more thoughtful that any celebrity I had ever seen before, with the possible exception of Paul Newman. He took exactly the right path in dealing with Helms. And by going down that pathway, Bono accomplished something truly exemplerary, something with infinitely more impact than simply providing us with entertainment.

You may be interested to know that back in 1983, at one of the first grand rounds on AIDS patients at M. D. Anderson Cancer Center, a young resident caring for these victims said that, that with few exceptions, he could not readily tell the difference between patients with AIDS and his advanced cancer patients. So he thought aloud that maybe they could be linked together. I was at that grand rounds and realized immediately that this resident was absolutely correct.

Thank you for your interest in the research. I will be profoundly disappointed if my efforts do not lead to therapeutic application.

Gary F. Clark, Ph.D.

Ron Hudson said...

I am interested to hear the story of Bono and Senator Helms. As a lifelong resident of North Carolina and a gay man, I have often wondered how Bono approached the former Senator from NC to convince him to support AIDS causes in Africa.

It is interesting to note, however, that stigma is still an issue with HIV/AIDS. If I am not mistaken, Sen. Helms has never softened his stance on gay people living with or dying from AIDS. He still carries judgement about us and, for that, I remain leery of his care for others.

At the least, though, Bono was successful in convincing Helms to soften his stance toward some. Sadly for LGBTQ people, Helms would still likely see two groups: "the innocent victims of AIDS" and the rest of us.

Carolyn said...

Thank you, Ron, Dr. Clark, for your comments. The matter of Bono and Helms is an interesting one and an example of something that I talk about when I am doing advocacy training. That is, when talking to policy makers, you have to speak their language. Helms' "language" was not based in science but in a belief system that he appeared to be contradicting every time he spoke about AIDS and people with AIDS. Bono took Helms' belief system to frame his plea to Helms and was successful in getting a positive response. Of course, it didn't hurt that Bono was also a rock star (although I don't think I've ever heard his music).

As Ron is pointing out, nothing has changed in Helms' belief system, and his actions, while less direct these days, still stigmatize people living with AIDS because of who they are.

It should also be noted that "accountability" as a concept does not have to imply punitive action or hostile speech. It may also emcompass the rational review of past promises and present actions, a reasonable discussion of the apparent dissonance between claims of concern for (for example) the health of young people and the continued insistence on using the results of junk science to protect that health. Jesus spoke of faith, but he also spoke of reason.

There's no need to be tacky when confronting those who put up roadblocks to prevention and care. The call for accountability is not a call insults and death threats. It is a call for accounting. "You promised this, but that was what you delivered." "You want to care for the sick, but you deny medicine to these." If it's absolutely necessary, then, yes, go to "I" language. "What I'm hearing is that you want our young people to protect themselves from infection, but what I am seeing is that they are still sexually active but now less likely to use a condom to protect themselves."

We are all accountable for our actions. Just because they hold power is no reason to think that policy makers must somehow be less accountable.