AIDS 2008 - XVII INTERNATIONAL AIDS CONFERENCE (MEXICO) - 4

HIV EXPERTS UNDERSCORE THE NEED TO LINK AIDS RESPONSE WITH HEALTH SYSTEMS IN POOR COUNTRIES, TO WORK AT OPTIMAL TREATMENT STRATEGIES, AND TO WORK FOR GREATER INVOLVEMENT OF PEOPLE LIVING WITH HIV

(Condensed from the official press release of AIDS 2008)

8 August 2008 - Speakers at AIDS 2008 underscored the importance of simultaneously scaling up AIDS programs and strengthening health systems in poor countries, emphasizing that the two goals should be viewed as allies, not adversaries. They also stressed the importance of expanding the role of people living with HIV in the planning and provision of health care as a part of the solution.

“HIV and global health advocates have enough common enemies, chief among them political complacency and inadequate human and financial resources,” said Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008. “In the struggle to recognize health care as a human right, we are natural partners.”

“If the urgency of AIDS and the sheer magnitude of human loss we are now experiencing is not enough to compel us to provide even the most basic level of health care to those living in low-income countries, then we, as a global community, are morally bankrupt,” said Dr. Pedro Cahn, International Co-Chair of AIDS 2008. “If, in the context of AIDS, we walk away from this challenge, we may never get another chance.”

According to Anton Pozniak (United Kingdom), when it comes to antiretroviral therapy (ART) the questions of “when to start?” and “what to start with?" remain central to people living with HIV and their clinicians. The move to start treatment earlier is gaining momentum in light of evidence that those untreated patients with high CD4 counts fall prey to many other non-AIDS related illnesses such as cardiovascular disease. He stated that clinical trials are needed to weigh the costs and benefits of starting ART earlier. Debates regarding which therapies to use in initiating treatment also continue in those countries where there is an abundance of choice. Cost considerations and toxicity of antiretrovirals need to be carefully concerned especially in resource-poor countries. Pozniak concluded that in situations where there is a choice of therapies, treatment of HIV has become focused on minimizing toxicities and maximizing convenience, and that this choice should be offered to all people living with HIV.

Morolake Odetoyinbo (Nigeria) opined that the greater involvement of people living with HIV (PLHIV) can be a key component of efforts to strengthen fragile health systems in low- and middle-income countries. Many of these weak health care systems have been further taxed by the HIV epidemic, with a depleted health workforce due to illness and death, thus magnifying the impact of existing malnutrition. Highlighting the existing involvement of PLHIV as counselors, peer educators, and spokespersons, Odetoyinbo explained how PLHIV can do even more to help strengthen health systems if their involvement is rooted in their existing capacities and skills, and not used to simply fill quotas. They should have multi-dimensional roles as advocates, watchdogs and managers, and should also be active participants in decision-making bodies responsible for the planning, implementation, monitoring and evaluation of programs.

With 3 million people in low- and middle-income countries now receiving antiretroviral therapy, Gregg Gonsalves (United States) called this feat one of, the most ambitious public health undertakings of our lifetimes. This milestone was reached despite powerful critics, and in the face of many operational and political barriers to sustained and expanded access to AIDS treatment. He called on those who have attacked AIDS funding and programming to recognize the innovations and momentum the AIDS response has brought to the entire field of global health. In fact, thanks to this enterprise "health for all" — the provision of comprehensive primary care to all who need it — which was central to the Declaration issued by WHO member states 30 years ago, is being gradually realized. Gonsalves urged a new covenant between communities, governments, United Nations agencies, academics, health care workers and scientists to build on what has been achieved in AIDS to make health, not a privilege for a few, but a fundamental human right for all.