Can activists gathering in Washington, DC, for the International AIDS Conference get Obama and the world to listen?

Starting this Sunday in Washington, an estimated 20,000 people will convene to “turn the tide” of the AIDS pandemic, at the International AIDS Conference, the largest global gathering devoted to HIV/AIDS. For the first time in twenty-two years, the AIDS conference returns to the United States, thanks in significant part to President Obama’s lifting the HIV travel ban, which had prohibited people living with HIV/AIDS from entering the United States since 1987. Activists are mobilizing in the thousands to ensure that the concerns of people most impacted by HIV/AIDS are not sidelined.

The International AIDS Conference is a bit of a circus, or perhaps multiple rings of competing circuses. High-level policy makers with the power to set the global AIDS agenda, along with drug manufacturers and doctors, join the ranks of community health workers and grassroots activists. On stage and in the hallways, there will be Gateses (Bill and Melinda, whose foundation is a major AIDS funder worldwide), sometimes Clintons and, this year, Bushes (Laura and W.). There are pleasant swarms of consultants and wonks, bright banners and loud marches. Walking through the Global Village, the free satellite conference set up alongside the pricey formal conference, delegates are as likely to find sex educators demonstrating receptive (sometimes called female) condoms as they are to cross paths with United Nations staff. In a sense, all are equal in this space, but just for one week every two years, and even then, not really.

To begin with, far too few people affected by HIV/AIDS will ever make it the conference. Their absence means all the talk of new drugs, new funding and new policy will be disconnected from the experience of those living with HIV/AIDS. Though it’s now possible for people living with HIV/AIDS to legally visit the United States, two of the key communities recognized by UNAIDS as most impacted by HIV/AIDS are still categorically denied entrance to the United States: sex workers and drug users.

In bringing the conference to the United States, said Jonathan Cohen, deputy director of the Open Society Public Health Program, “many, many people saw an opportunity, from a domestic HIV point of view, and from a point of view of maintaining the extensive bipartisan support for HIV funding. But one got the distinct sense that the optimism and sense of opportunity that accompanied the decision to have the conference in Washington vastly overwhelmed any ethical qualms about systemically excluding sex workers and drug users.”

I dreamed of coming to Washington to speak at AIDS 2012,” wrote Irina Teplinskaya, an advocate for the health and human rights of drug users, who is currently living in the Ukraine. “I had a message to deliver to those who have the financial and political means to turn the tide of the epidemic. I wanted to speak up because Eastern Europe and Central Asia (EECA)—the region where I live—is the only region in the world where HIV rates continue to rise while available resources for HIV prevention continue to shrink.”

Teplinskaya will not be able to share her message. Her absence, along with that of countless others working in harm reduction and HIV prevention, isn’t just about the loss of their voices. “To host a major conference on AIDS in a country which turns away those most exposed to the virus,” she concludes, “is to show contempt and disrespect to the millions of people whose lives were lost to AIDS. HIV will claim more lives next year, because this year we won’t be heard and we won’t be helped.”

For sex workers, the ban serves to support “layers of discrimination,” said Cheryl Overs, a member of the technical advisory group on the Global Commission on HIV and the Law. Overs is also the founder of a sex worker organization in Melbourne, Australia, which pioneered harm reduction, rights advocacy and peer education in the early eighties. “These kinds of discrimination have a way of enabling other kinds of discrimination. It reinforces the views of people who think that including the views of sex workers is optional, and that’s actually most HIV programs in the world.”

Overs herself has been turned away from entering the United States, when in 2011 she attempted to come to New York for the first meeting of the Global Commission on which she serves. “It’s an extreme irony – it doesn’t matter how empowered you are or how educated you are. I was a senior research fellow, with a first-world passport and an invitation to an extremely high-level UN meeting. It shows you how far-reaching this stigma and discrimination is.”

The travel ban is rooted in stigma and discrimination, but it also drives dangerous policies that threaten the health and rights of already marginalized communities. “I see the travel ban as the tip of the iceberg of criminalization,” said Jonathan Cohen of Open Society Foundations. In a report linking criminalization and HIV released this week, the Global Commission on HIV and the Law advocates an end to the multiple forms of criminalization that target sex workers and drug users, as well as men who have sex with men. That includes rolling back laws against prostitution, drug use and sodomy and a host of other policies that they identify as fostering inequity that makes people vulnerable to HIV. “Punitive laws, discriminatory and brutal policing and denial of access to justice for people with and at risk of acquiring HIV,” they stated, “are fueling the epidemic.”

This is the tide that is turning: from locating the crisis of AIDS in individual “risk behaviors” to intersecting and systemic forms of inequality. Global networks of men who have sex with men, sex workers, transgender people and people living with HIV further hope to drive this issue at the AIDS conference, in a newly issued set of principles called The Carr Doctrine. They urge that people working to end the pandemic “recognize that HIV is not just a public health issue, but rather a symptom of underlying societal inequities and injustices.”

The Doctrine closes, “HIV is a human rights issue—we all have a right-to-be.” But will those most affected by HIV/AIDS, through violence and ignorance, through a divestment of resources in their communities that predates HIV—will they have the right to be or to be heard in Washington? Or will they be only spoken for?