The largest conference on HIV/AIDS in the region, the Sixth ICAAP succeeded in bringing together high-level political decision makers with members of civil society who work on the pandemic daily. Political commitment from Asia and the Pacific was noticeably absent at the United Nations Special Session on AIDS in June. In Melbourne representatives of 33 countries came together Tuesday for the first large high-level meeting to discuss the impact of HIV/AIDS in the region. While no concrete plan of action emerged from the meeting, the fact that governments acknowledged the magnitude of the pandemic is significant.

"I think this regional meeting has been very effective as a first meeting to expose ministers to views and attitudes of other countries and as a way to confront a lot of difficult and sensitive issues," said Australian Foreign Minister Alexander Downer. "A meeting like this will have a lasting impact because it sets the agenda for the Asia-Pacific region. It means that HIV/AIDS instead of being an issue of the United Nations or one or two countries, becomes a major agenda item for the region."

The morning plenary session, the last of the conference, was packed as delegates waited for ministers to arrive. As the seemingly endless stream of ministers and bureaucrats entered the John Batman auditorium, the delegates greeted them with applause and a few cheers.

Downer, the host of the ministerial session, announced the commitment of 50 million Australian dollars to three major HIV/AIDS initiatives in the area. "We will address HIV related harm associated with injecting drug users in Asia, HIV/AIDS and STD prevention in Indonesia and we will assist Pacific Island countries on implementing national HIV/AIDS strategies," he said.

The Ministerial Statement is not binding, but does express the commitment of the governments represented to step up domestic responses to the epidemic. The statement also proposed to set up an Asia-Pacific Leadership Forum on HIV/AIDS forming a network of political leaders and parliamentarians. Regional collaboration, it said could be achieved through "regular meetings and ongoing communications through the Internet." The statement also said that the forum could led to the creation of a resource center for political leaders.

Some delegates were disappointed that there was no mention of antiretroviral drug therapy and of finding ways to provide cheap drugs to people living with HIV/AIDS in the region.

"This is a very complex issue," said Downer in response to a question about providing cheap drugs in the region. "One of the challenges we have is the TRIPS (Trade Related Intellectual Property Rights) provision of the WTO (World Trade Organization). Work needs to be done on that. Secondly in developing countries using drugs of that kind is very complex. It's not just a question of cutting the price, it's a question of finding an international legal framework where it actually works and putting infrastructure into place. It's a laudable objective and we have to work toward it, but we have to overcome some hurdles first."

Developing countries drew up a statement at the TRIPS Council meeting in June this year asking for a change in the TRIPS provision regarding drugs in the cases of 'national emergency, circumstances of extreme urgency or in cases of public non-commercial use.' The change would allow countries to acquire cheaper AIDS drugs without obtaining a license from the pharmaceutical companies which hold the patents. Under TRIPS and patent laws, pharmaceutical companies effectively hold 20 year monopolies on drugs during which time prices are not regulated in any way and licensing is done by the company itself.

"If a company undertakes research and produces a new, valuable drug then they deserve to have a patent and make a profit," said Mary Moran, Director of the Access to Essential Medicines Campaign of Medecins Sans Frontier.

"But it can't be a patent on life. We have to have some moral imperatives. After the South Africa case we saw prices come down some 90 percent. These companies play hardball when people are dying--it's phenomenal."

Current brand name drug regimes can cost up to 10,000 US dollars annually while generic drugs can cost as little as 300 US dollars. "There's more work to be done on TRIPS to assist developing countries to take what is called 'TRIPS consistent action' to get lowest cost HIV/AIDS treatment," said Downer. "I don't think enough is known about the boundaries of TRIPS and how that can all work and that's why this is going to be very a significant issue. [The Australian] position is that obviously we would like to feel that these drugs could be made available at the lowest possible price, but that would have to be done in a way that is consistent with international law and hopefully an appropriate regime could make that possible."

The United States and Switzerland recently released a second declaration that focuses on the need for health care infrastructure in developing countries and on patent laws. Most pharmaceutical companies that hold patents on HIV/AIDS drugs are based in these two countries. Australia, Canada and Japan have also signed onto this new declaration. According to Moran the declaration is a step back in the campaign for cheap AIDS drugs in developing countries.

"Australia wants a compromise between the US drug company position and what developing countries want," said Moran. "There is going to be conflict between the fact that they offered to draft legislation on behalf of developing countries and that at the same time they're not accepting the developing countries' statement on what they'd like that legislation to achieve."

The TRIPS debate will continue in the coming weeks and will be a major agenda item at the WTO Ministerial meeting in November. In the meantime, Moran said, she will be lobbying to get Australia to reconsider its position and not support the new declaration. While patents should be respected, there has to be some control over pricing and distribution, she said.

Apart from the ongoing debate about access to drugs, the conference ended on a positive note. Delegates exchanged business cards and phone numbers as they left the closing ceremony, promising to follow up on plans made during the conference. The reactions to the conference were mixed.

"This was an amazing opportunity to meet like-minded people and share information about program implementation in our countries," said one delegate.

"I feel very frustrated," said another. "So much money has been spent and what have we gained?"

Some groups, usually marginalized in their societies, gained a lot from this conference. "For drug use issues I think this conference is the best that has happened so far," said Jimmy Dorabjee of the Asian Harm Reduction Network. "There has been an enormous recognition of how injecting drug use is driving the epidemic in this region."

Participants of the conference are taking home renewed energy and hope in their fight against HIV/AIDS. Now with the indication of political commitment hopefully national prevention and treatment programs will be strengthened.

"We know that every effective national program around the world has had strong national political leadership," said Rob Moodie, Co-Chair of ICAAP and Chief Executive Officer of VicHealth. The concrete outcomes of the conference will not, however, be evident until an assessment at the Seventh ICAAP in Kobe, Japan in 2003.