The US government came under scathing attack from senior members of the medical establishment yesterday for blocking scientists from attending the International AIDS conference which opened in Bangkok.
The biennial conference, with 17,000 delegates, is more political rally than scientific meeting and bears huge significance for those involved in the fight against HIV/AIDS.
The US government has sent only a fraction of its usual contingent of scientists, pleading cost 50 instead of the 236 who attended the last event in Barcelona in 2002.
The Department of Health and Human Services, headed by the health secretary, Tommy Thompson, was yesterday accused of actively preventing certain US scientists and doctors who had a contribution to make from travelling to Bangkok.
Many suspect that behind the action lies a rift between the US and AIDS activists who oppose America's approach to the global pandemic.
Joep Lange, president of the Sweden-based International AIDS Society, which organises the conference, said it had been forced to retract papers that had been accepted for conference sessions after the US scientist authors had been refused permission to come. Many meetings, some to train developing world researchers, have had to be cancelled.
"I really think it is shameful that they restricted the US government participation, particularly when you think they are putting so much money into the fight and people in the field who have to do the job are directly prevented from coming here," said Dr Lange.
Earlier, the editor of the Journal of the American Medical Association (Jama) had also unexpectedly spoken out. Catherine DeAngelis said that Marc Bulterys, the co-author of a Jama paper who worked for the government's Atlanta-based Centres for Disease Control (CDC), had not been allowed to accept an invitation to fly to Bangkok to talk about it.
"It stymies the ability of scientists to discuss and learn from each other," said Dr DeAngelis. "It is wrong."
She pointed out that the trip would have been paid for by the American Medical Association, not the US government. "It is an incredible example of political pettiness. It is anti-intellectual and it is interfering with scientists and the scientific process and means American government-employed scientists are not allowed to be here to share their knowledge," she said.
Behind the fracas lies the gulf between the US policies on tackling HIV/AIDS in the developing world and those of AIDS activists who tend to dominate the big international event. Two years ago, Mr Thompson tried to give a speech at the conference in Barcelona but was rendered inaudible by noisy protests. This year the organisers have asked activists to be more civil and allow those with whom they disagree to be heard.
Although the US has put more money into the fight against HIV/AIDS than the rest of the world put together, including $15bn (#8.5bn) pledged by President Bush in January last year, activists are unhappy with the way the money is to be spent. Most of it will go to American-instigated programmes in 15 selected countries which stress the so-called ABC philosophy abstinence, be faithful and condoms "where appropriate".
Peter Piot, executive director of UNAIDS, said last week that abstinence, particularly for women in southern Africa, was often not an option.
Randall Tobias, the former head of the pharmaceutical firm Eli Lilly, who runs the president's plan for AIDS relief, heads the US team in Bangkok. Yesterday he said he had "a very large delegation" with him.
The CDC had offered another scientist instead of Dr Bulterys, he said. "It is true that the person who was the author was not part of the delegation but we offered another scientist and they declined," he said.
The significance of the conference was emphasised at the opening ceremony by Joep Lange, president of the International AIDS Society. The Bangkok event is the first in the AIDS-hit developing world since the conference in Durban, South Africa, in 2000.
"Durban was a watershed event that catalysed many developments," he said. Prices of AIDS drugs came down, fundraising was stepped up and there are now plans to put millions on treatment.
"Like Durban, Bangkok could be a watershed event," he said. "The conference is strategically located in Asia, the most populous continent in the world and home to a quarter of all new HIV infections. Asia still has the opportunity to prevent the epidemic from getting completely out of hand."
Kofi Annan, UN secretary general, called for leadership from all parts of governments, all the way to the top, which has not been seen in all Asian countries, just as African leaders took years to recognise the crisis and speak out against stigma. "AIDS is far more than a health crisis. It is a threat to development itself," he said.
Leadership was one of three priorities he defined. He also called for infrastructure to be scaled up in AIDS-hit countries to allow more people to be treated and he called for a better deal for women who are unable to defend themselves against unsafe sex because of poverty, abuse, violence and coercion by older men. "What is needed is the education of girls," he said.