There is a tremendous cone of silence surrounding HIV/AIDS and its sufferers, even in the third decade of the epidemic. Nowhere was this more evident than at the opening session of the Pan Pacific AIDS Conference today in Auckland's Aotea Centre. Before Jane Bruning of Positive Women began her speech, she extended an invitation to anyone in the audience with HIV who wished to support her message to come forward. There was an audible gasp at the numbers who did. Even Bruning herself was surprised. As each new person joined the growing group beside the podium, more came forward, empowered by the stance and visibility of the others. Eventually they numbered about forty, men and women of all ethnicities and ages. It was a powerful moment, and a gesture which NZAF executive director Rachael LeMesurier said “couldn't have been more appropriate”. She congratulated all those who came forward, and also those in the room who did not. “Discrimination is a vicious circle,” said Bruning. “We need more people to come out so we can dispel the stigma surrounding HIV, but it is this stigma that stops people from coming out.” Silence and stigma are also part of a vicious circle. HIV/AIDS is not talked about because it is stigmatised. It is stigmatised because it is not talked about. If it isn't talked about, ignorance prevails and infections continue. This morning's speakers offered up a number of reasons why HIV prevention in the Pacific region has been difficult thus far. JVR Prasada Rao is leading UNAIDS's response in the Pacific to the HIV epidemic, focussing on strengthening support at country level. He expressed a need for the many disparate AIDS support networks across the region to pull together with a unilateral, centralised message. “We can't make general approaches to specific problems,” he said. The epidemic has been exacerbated in the Pacific by small, isolated communities with governments unwilling or unable to engage the HIV issue. Rao noted that there were few countries with direct government involvement with AIDS programmes. In fact, only six countries in the Pacific fund their own programmes. The rest rely on outside help. All suffer from problems with inadequate funding. Behavioural change is obviously required to encourage safe sex practices. However, said Rao, taboos and boundaries imposed by culture are a hindrance. “We need to encourage the churches. Religious leadership is very important.” Encouraging religious leaders rather than berating them for intolerance was a theme also picked up by Dr Jimmie Rodgers of the Solomon Islands, who sits on the board of the Pacific Islands AIDS Foundation. “We can blame the politicians and the churches, but we should also blame ourselves because failure of understanding means we have also failed to convince,” he said. “Our marketing has to improve. We need to speak their language.” But would we want to speak their language? In one of the most well-received speeches, Carlos Perera of Fiji's Sexual Minorities Project gave a moving personal testimonial of life as a gay man in Fiji. Rao and Rodgers had expressed a need for support at the institutional level for those most at risk of catching HIV, yet in Fiji one of the most powerful institutions – the Methodist Church – is the worst offender when it comes to discrimination. Perera recounted two press statements issued by the Church in the last few years. One called for gays to be stoned to death. Another, in the wake of the this year's trial of Australian tourist Thomas McCoskar, who was arrested for having consensual sex with a local Fijiian man in a hotel room, called again for gays to be put to death and destroyed. Dr Rodgers remains optimistic about the future, though, describing the Pan Pacific AIDS conference as “a watershed event, a historical milestone in the fight against HIV/AIDS in the Pacific,” he said. “This is the region where we will stop the trend, and reverse it.” He praised the resources that are already at hand: “We need to recognise the bucket is half-full. We have the commitment, now we just need the delivery.” He described the process of getting governments to recognise HIV/AIDS as “torturous”. The low profile of the disease has not helped in this regard, with other ailments like malaria being given priority with health funding and programmes. Rodgers says there is a perception out there that HIV is “just another disease”, but it needs to be emphasised that HIV is not a disease that can be cured. The associated stigma means that being an HIV sufferer carries a high price. Education, dialogue, and universal access to information and treatments are required. However, identifying the problems is the easy bit. Now solutions must be found. In this respect, said Dr Rodgers, merely having a Pan Pacific AIDS conference is not enough. "The success of this conference will be judged on what it does for people in the Pacific." Chris Banks - 26th October 2005