Overview of the Sixth International Congress on AIDS in Asia and the Pacific

By the Rapporteur-in-Chief Elizabeth Reid, delivered at the Closing Session, 10 October 2001.

Your Excellencies, First Ladies, colleagues and friends. I wish to pay my respects to the traditional owners of this land, to acknowledge their laws, to recognise their place in Australia's response to the HIV epidemic, and to thank them for the stewardship of Country. I would also like to acknowledge the Key Correspondent/Rapporteur team who have worked so hard during this conference, bringing us daily news and ideas from your sessions and discussions, and all of whom contributed to the earlier thematic reports and to this presentation.

In the Opening Session of this Congress, Dr Peter Piot, Executive Director of UNAIDS, challenged us to find new ways of understanding and acting within the epidemic: "Let us stop the fantasy that drug injectors, or men who have sex with men, or sex workers, or rickshaw drivers, are somehow ring-fenced groups, as if they do not have normal lives where identities, practices and partners merge and flow. So we must abandon the dangerous illusion that close targeting alone is the prevention magic bullet.' Dr Peter Piot. This is a formidable challenge but one of the exciting things about the Sixth International Congress on AIDS in Asia and the Pacific is that it has offered us an alternative. In this presentation I will begin to explore this alternative way of looking at or visualizing the epidemic, and its implications for how we respond.

Early in the Congress, in a session on strategies for HIV prevention in low prevalence settings, and then in later sessions, a new way of conceptualising the epidemic, developed by UNAIDS and WHO, was introduced. We were invited to think of our region in terms of nascent epidemics, of concentrated epidemics and of generalised epidemics, rather than in terms of "risk group" based or core transmitted epidemics. Let us think some more about these new categories. There is an intuitive sense that can be made of these terms. Nascent epidemics are imminent, epidemics in the act of being formed. Concentrated epidemics are localised in certain places or among certain populations and are expanding. And generalised epidemics are diffused or sweeping epidemics. These are spatial images, ways of characterising places or social formations. In any one nation in our region, there may be many nascent epidemics, and some concentrated or generalised epidemics.