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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.

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AIDS 2008 SPEAKERS HIGHLIGHT THE PERSISTENCE OF HIV AS CENTRAL CHALLENGE TO A CURE, THE NEED FOR A FAMILY-CENTERED APPROACH TO AFFECTED CHILDREN AND RESPECT FOR THE RIGHTS OF SEX WORKERS

(Condensed from the official press release of AIDS 2008)

7 August 2008 - Researchers, community and political leaders gathered in Mexico City for the XVII International AIDS Conference (AIDS 2008) today received an update on the future prospects of eradicating HIV, and were urged to give greater attention and resources to the needs of affected children, and to reject unproven strategies that ignore the realities of sex workers’ lives.

“The persistence of HIV in latent reservoirs presents a major challenge to the ultimate goal of eradicating HIV from the human body,” said Dr. Pedro Cahn, International Co-Chair of AIDS 2008. Thus, while researchers seek answers to this and other key scientific questions, it is important that the prevention and treatment knowledge that already exists today not be squandered. Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008 warned against ignoring the needs of children affected by HIV, and continuing to marginalize groups at greatest risk for infection, which will only lead to more new infections and fewer people on treatment. “We will pay for such foolishness in the future,” he said.

Dr. Robert Siliciano (United States) presented data on HIV persistence in people on highly active antiretroviral therapy (HAART) and the prospects for eradication of HIV. Siliciano demonstrated that HAART can stop viral replication of HIV but cannot eradicate it from the body because of the persistence of HIV in a reservoir of CD4 cells even during HAART. According to Siliciano, HAART’s demonstrated ability to stop replication is one of the three steps needed to cure HIV. The other two are identifying all the stable reservoirs for the virus, and finding ways to subsequently eliminate them.

An estimated 2.1 million children younger than 15 years were living with HIV in 2007, 90% of whom are in sub-Saharan Africa. More than 90% were infected through mother-to-child transmission. While access to treatment has increased substantially, it has been substantially lower for children than for adults. In her plenary address, Linda Richter argued that, while affected children have been highly visible in photo opportunities and headlines about AIDS, their real needs have been consistently overlooked. An estimated two million children are living with HIV today, and many millions more are directly affected by the epidemic through the illness and death of their parents or caregivers, emotional distress, material deprivation, and lack of access to treatment, support, basic health services and education. Richter called for the development of family-centered approaches to address the needs of all children affected by HIV/AIDS. She advocated that social protection services that support families and communities; economic assistance for poor families, particularly through income transfers; and, other steps be taken to alleviate the lot of children affected by HIV in both low- and high-prevalence settings.

Elena Reynaga (Argentina) issued a stirring call for the full recognition of sex workers’ (SWs) rights and for the ability of sex worker organizations to develop and implement effective HIV/AIDS programs rooted in the realities of their lives. According to Reynaga, current efforts to reduce HIV prevalence among SWs are hampered by inadequate funding and the misdirected investment of limited funds into programs that do not meet SW’s actual needs. Reynaga cited evidence that HIV prevalence has been lowered in regions such as South America, where sex work is actually recognized as “work” and SW organizations receive direct support. In Brazil, strategies that incorporate peer outreach, promotion of SW rights and the abolition of laws that repress sex work, have helped to control epidemics. Reynaga said that SWs are dying because of a lack of health services and HIV treatment. Fighting stigma and discrimination, and freedom from repression build an effective response to HIV among SWs.

Coming up tomorrow are sessions on the future of the epidemic and new directions in HIV research; building global and national commitments for evidence-based approaches; financing sustainable national health care; and, a family and community approach to prevention and care for sexual minorities.

A full list of all sessions and activities is available through the online Programme-at-a-Glance at www.aids2008.org.

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CALL FOR A MULTI-PRONGED APPROACH TO HIV PREVENTION – ‘MARRYING PREVENTION AND TREATMENT’

(condensed from the official press release of AIDS 2008)

6 August 2008 - In light of promising evidence of the potential impact of antiretrovirals on HIV prevention, and recent setbacks in other biological interventions, HIV experts at the XVII International AIDS Conference today called for a reinvigorated commitment to prevention research and accelerated implementation of proven prevention strategies. In 2007, 2.7 million people were newly infected with HIV worldwide, nearly 7,400 each day.

“Today, there are many effective strategies to prevent HIV, and all nations of the world must commit fully to their implementation,” said Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008. He pointed out that too often stigma and discrimination continue to fuel counterproductive laws and policies that undermine prevention and treatment. Changing these attitudes needs to be a central component of any HIV prevention strategy.

Pointing out that in the recent past there have been some setbacks in the areas of vaccine and microbicides research, Dr. Pedro Cahn, International Co-Chair of AIDS 2008, decried the tendency to abandon all efforts to find other means to prevent new infections. Other speakers provided insights into current prevention research and programming, while highlighting the harmful effects of oppressive attitudes and policies, which inhibit the implementation of effective prevention programs. We need to increase basic science and vaccine research so as to reverse the course of the epidemic.

Despite important increases in HIV treatment access worldwide, it will be impossible to “treat our way out of the epidemic,” according to Dr. Myron Cohen (United States). Citing the central role that clinical and other HIV treatment providers have played in averting mother-to-child transmission with antiretroviral drugs, he mooted a greater partnership between treatment providers and those working in public health campaigns to prevent HIV. Reflecting on the need for a multi-pronged approach to prevention, Cohen iterated the urgent need to develop combination primary prevention strategies; reinvigorate research on HIV vaccines, other immune-based strategies, and antiretroviral prevention; and encourage people to learn their HIV status for the own health and the benefit of their sexual partners and communities. Cohen urged that once and for all, the HIV community marry HIV treatment and prevention.

Dr. Adeeba Kamarulzaman (Malaysia) highlighted the sorry plight of injecting drug users (IDUs) who are disproportionately less likely to have access to antiretrovirals. They are often faced with stigma and discrimination, inadequate health infrastructure, as well as a lack of access to HIV treatments during incarceration or internment in detoxification centres. To address these obstacles, Kamarulzaman urged the development of care models located in non-traditional health care settings that integrate HIV services with substance abuse, psychiatric, and primary care services. She also pointed out the lack of access to harm reduction strategies such as needle exchange programs (NEP) which have proven value in arresting the epidemic. Widespread prejudice and moralistic criticisms are a major obstacle. This is also reflected in the implicit contradictions between the United Nation’s public health approach to HIV, and the punitive focus of its drug control policies which tend to undermine efforts to provide HIV services to IDUs.

As part of Tuesday’s plenary, Dr. Jorge Saavedra (Mexico) delivered the Jonathan Mann Memorial Lecture, named in memory of scientist Jonathan Mann, who is credited with building the WHO’s AIDS Programme from the ground up. Saavedra provided a multi-dimensional overview of the HIV epidemic in men who have sex with men (MSM), specifically highlighting hidden epidemics among MSM in low- and middle- income countries, and factors that increase HIV risk and vulnerability across cultures. He profiled current budget outlays for MSM prevention programs, and provided examples of effective prevention strategies, including community-based interventions. Saavedra called for some specific policy changes including greater involvement of MSM in the planning of national AIDS responses, and the inclusion of MSM prevention strategies in the strategic plans of low- and middle-income countries. There is a great need for donors to both fund MSM programs, and include measures of responsiveness to MSM needs in programme evaluation.

For additional information, including programme information, abstracts, rapporteur and scientific summaries, transcripts and presentations from key conference sessions, please visit http://www.aids2008.org/

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(From the official press release of AIDS 2008)

5 August 2008 - The International AIDS Conference is convened every other year by the International AIDS Society (IAS), the world’s leading independent association of HIV professionals with more than 10,000 members from 172 countries. International institutional partners for AIDS 2008 include: Joint United Nations Programme on HIV/AIDS (UNAIDS), and its co-sponsors, the World Health Organization (WHO) and World Food Programme (WFP); International Council of AIDS Service Organizations (ICASO); Global Network of People Living with HIV/AIDS (GNP+) / International Community of Women Living with HIV/AIDS (ICW); World YWCA; and the Asian Harm Reduction Network (AHRN). This year’ conference is hosted by Mexico City and runs from 3rd to 8th August.

The Conference (AIDS 2008) began with an assessment of the state of the global epidemic as a panel of researchers, public health and civil society leaders examined recent progress toward the scale up of treatment and prevention programs, and called for sustained action to eliminate the barriers to universal access. Progress has doubtless been made in getting universal access but the targets are still a long way off. It is necessary for all nations to live up to their commitments.

“With only two years to go until the 2010 deadline for universal access set by world leaders, we must redouble our commitment to scaling up all proven HIV prevention strategies,” said Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008 and Coordinator of the Clinical Care Committee of Mexico’s National AIDS Council.

On Monday, the conference’s opening plenary featured presentations by leading global experts on epidemiological aspects of the epidemic, recent advancements and challenges.

Dr. Geoffrey Garnett (United Kingdom) noted the need for new methods of analyzing HIV prevalence and risks of infection which can help targeted prevention strategies. Regarding the analyses of risk behavior, he illustrated the importance of including social and structural determinants of HIV risk, along with behavioral and biological risk factors. According to Garnett, the powerful synergy of awareness and single effective interventions such as male circumcision could dramatically reduce HIV prevalence rates and facilitate the greater impact of other interventions altering the future spread of HIV.

In another intervention, Dr. Jaime Sepulveda (Mexico) noted that attention to and resources for AIDS are at all-time highs, but the world has only scratched the surface of possibilities in responding to the epidemic. Greater resources, more effectively spent and targeted where they can have the greatest effect, would have a dramatic impact on the epidemic’s course. Sepulveda called for radically increased investments in prevention research, evaluation, and delivery of services, as well as accelerated research on promising prevention methods, including a vaccine.

Sepulveda’s views were reiterated by Alex Coutinho (Uganda), who called for greater political leadership from all countries and accountability at all levels as essential for stopping the epidemic. Citing the results in both treatment and prevention scale up in countries with sustained leadership, such as Rwanda and Tanzania, he made a passionate call for dynamic leadership as a path toward meeting the challenges ahead. He also urged outreach to and support of marginalized and at-risk communities, as well as the greater involvement of people living with HIV/AIDS (PLHIV) as a catalyst for change.

Elisabet Fadul (Dominican Republic) outlined a broad and urgent youth HIV/AIDS agenda, with comprehensive rights-based and evidence-based plans to provide access for young people. Highlighting the data that young people (15-24 years of age) account for 40% of new infections worldwide, she noted that HIV prevention and treatment programs are failing to effectively reach young people. The most vulnerable and marginalized are stigmatized, criminalized or forgotten by many of these programs. To reverse this course, she called for actions and policies that engage youth, especially young PLHIV, as respected partners in developing and implementing programs that address their needs and diversity.