It’s David’s 45th birthday party, and his friend Carl sits beside me, a glass of wine in hand. We’re waiting to get passed the cream to go with a slice of David’s birthday fruitcake. Imagine a middle-aged bald Welsh guy who, despite living in Mexico City for fifteen years, still pronounces the ‘h’ and sports a brown mustache to complement his shiny white head. I’m here for a week attending the International AIDS Conference. I met David and Carl through some mutual friends. David’s birthday had the luck to fall during the conference. Always the superb host, David invited me to his place in La Condesa, a trendy (albeit sketchy) neighborhood overlaid on an old racetrack.

I’m talking to Carl about Zimbabwe because he used to live there, but our conversation soon turns to the AIDS conference. We chat about why Mexico is hosting it and why the government is trying to rally masses against homophobia via parades and rallies. It’s all about image, he says, the image of Mexico as interpreted by the eyes of the world. This conference is an international stage, and everyone on it is fueled by a self-serving drive to profit off this disease. Why do we care so much about AIDS? Why do we need to have this huge conference? It’s all image and money, he says, red-faced from wine; it’s all about the money. AIDS isn’t any bigger of a problem than any other disease – but it is certainly the most profitable. Why? Because everyone has sex. One’s risk of contracting it has little to do with socioeconomic status and that is why anti-retroviral research and sales are so lucrative. No one wants to die from AIDS – especially not the rich.

When Carl said that, my knee-jerk reaction was that this reductivist way of thinking belittles some of the remarkable efforts to fight AIDS. It ignores a lot of the issues facing the global AIDS fight. However, over, the next few days, I started noticing that few people were talking about environmental health factors, and that there were only a few presentations about co-infections. I started to wonder if this bald Welsh guy really was right. Why is it that when we are trying to achieve “Universal Access Now” – the theme of the conference—it really only meant access to drugs?

Started in 1985, the International AIDS Conference, organized by the International AIDS Society, provides an opportunity for health professionals, policy makers, NGOs, scientists, students, and leather daddies an opportunity to share knowledge and experience in the global fight against AIDS. It is the largest conference held on any one health issue, attracting more than 25,000 delegates from all over the world. This year, it was held in the Banamex Center, which is super big. An adjacent race track held a huge tent – the “Global Village,” which was oddly reminiscent of the Minnesota State Fair.

The speaker at the opening ceremony was a young, AIDS-Afflicted Cambodian girl. Ban Ki-Moon, Secretary General of the United Nations, Dr. Margaret Chan, Director of the World Health Organization, and Bill Clinton also graced the podium. This was the place to be if you’re working in any field related to infectious disease. However, in public health, infectious diseases are often put in a completely different category from environmental health—which deals with air quality, water quality, and nutrition. Sadly, the programs and infrastructure erected to help people living with HIV and AIDS often overlook these factors. We need to shift the discourse of AIDS and its treatment to a more realistic (and perhaps less profitable) approach to bettering the overall environmental health of infected individuals. Many of the co-infections that plague the HIV-infected individuals in the world are precipitated by environmental factors. Of course, this would require a concerted international effort to implement more sustainable environmental policies. Pollution remains one of the greatest causes of respiratory and gastrointestinal co-infections.

The concept of joint solutions to mutual challenges is nothing new in public health. Indeed, it is hard to consider health-related issues without also considering the context in which they occur. However, the discourse of AIDS treatment has traditionally centered on increasing accessibility to anti-retroviral treatment, prevention programs, and putting more funding into biomedical research. Few AIDS-related programs approach the problem from a more holistic standpoint—taking into account ways to improve living conditions of AIDS-ravaged communities. If, for instance, you are running an NGO that works on getting antiretrovirals to people in Somalia, realistically, it is not going to work if they don’t first have water free of Guinea worms. For most of the people affected by the HIV epidemic in the developing world, the biggest challenges for their health remain access to safe water, and malnutrition.

I realize that it would be presumptuous of me to say that no one cares about environmental health issues, and that nothing is being done. There is, of course, a lot of overlap between these two categories of public health, and that lots of people and organizations have been working on specific issues that would fall into the category of environmental health. However, what is lacking is a dialogue between the people who are working on these environmental and sustainability issues and people who work in the area of HIV/AIDS outreach. In the effort to reach out to marginalized populations, many programs have pigeon-holed themselves into only considering specific issues. But policy myopia is ultimately self-defeating. None of these problems exist in a vacuum; they feed into and sustain one another. This is common wisdom: If we leave one apple to rot, the rest of the basket will deteriorate faster. The idea of what “universal access” constitutes traditionally is access to health services, health personnel, reducing stigma around sexual diversity and gender orientation, non-discriminatory work and housing selection processes, as well as treatment.

At this conference, there was a lot of discussion about human rights and how they are also inextricably linked with access. In addition, I think if we were to add to that list access to basic sanitation, clean water and air, and nutrition, our fight against this epidemic would be rendered more effective by an order of magnitude.