The frustration can be seen on people's faces, and heard in their voices.  The just ended joint meeting of governmental and Civil Society representatives at the UN HIV/AIDS meeting was a portrait in the difficult nature of diplomacy.  The governmnetal officials said little, artfully, while representatives of NGOs said time and again, "I will not speak diplomatically" before starting to list the real world circumstances they face everyday — the very problems the world community has assembled to address — and the subject of the increasingly tense negotiations as the hours tick by toward the Friday deadline for a declaration.

Peter Piot, UNAIDS Chief, said last night that he is angry at the prospect of an immoral declaration coming out of these meetings, one that would fail to address the very real state of HIV/AIDS after 25 years of experience, public heatlh research and dedicated work by passionate people worldwide.

At other international meetings when negotiations have stalled at this point, leadership from within the UN community has often been forced to take the floor and remind the delegates to rise above the petty politics and focus on the reality of the issues before them to do the right thing. Thus far, the anger is being expressed in side events, but no one with the moral authority to diplomatically focus the delegates on the real issues appears to be stepping forward in any of the official proceedings.

The just closed session with government and NGOs meeting side-by-side provided a very clear roadmap for what works (proven public health strategies), what does not (inconsistent messaging and overt moralizing that contradicts local and cultural norms), and what is needed (sustained funding commitments).  The government representatives were listening, but did the hear? Can they translate what they heard into action within 48 hours.

One woman from Brazil spoke of "civil society as separate from those who govern us," as opposed to elected officials having the political permission to do the work on behalf of the people.  The power dynamic was clear in her statement. She ended by saying, "we are not being killed by HIV we are being killed by violence and discrimination against women."

Calls for action to improve on the nexus of oppression of gender inequality, homophobia and discrimination against women and margianlized communities was consistent throughout the NGO presentations.  

Jodi Jacobson of the Center for Health Advocacy and Gender Equality stated, "there is a public responsibility. Individually and collectively we have a responsibility to do this work today, because we are here, and around the world another 8000 people will die from AIDS today."

Margaret Chong representing Pacific Asian Council of AIDS Service Organizations said that the promises of governments and the international community have gone unfulfilled.

But the very moving and real testimony of a clinician from Swaziland drove home the underlying frustration with the global governmental response.

She talked of her work in a clinic for HIV/AIDS and TB with 200 children. The clinic is miles from a hospital, many of the roads between the two unpaved. Unemployment is 70-80 percent and there is no clean water, little food and nutrition. The drugs are reaching them, but she is concerned that with the problems of negotiating an agreement here, that the issues of being able to sustain funding for the drugs may be lacking.

"The UN, Worldbank and all governemnts must make sustainable commitments. Without basic infrastructure, jobs, clean water, risky promiscuous behavior is more likely to occur, increasing the problems." Her passionate statement clearly linked the problems in the developing world where poverty and disease walk hand-in-hand.

The people on the ground and in the villages and towns around the world, and the public health professionals who raced for 25 years to get ahead of HIV/AIDS, know what needs to be done. They have now spoken directly to the governmental officials busy negotiating the declaraation.  All that is lacking now is the political will to do what is right.