With so much progress having been achieved in the last couple of decades it would be tempting to let the foot off the gas with HIV prevention and care efforts, so to speak. According to the presentations, seminars and workshops at this year’s International Aids Conference, which has just finished in Melbourne, that’s exactly what we should resist doing. It is especially important to do the opposite by increasing our efforts (and funding), especially considering the ongoing lack of access to effective treatment for millions of people around the world and a worrying growth in discriminatory laws and policies directed at those living with, and affected by HIV.
Within this general theme there were nuanced presentations and speeches which helped give a flavour of current work and (possible) future directions of HIV prevention and care research, programmes and treatment. Some of the key areas are highlighted below and split into key points raised on different days.
Day 1 – Urge to Address Stigma and Discrimination
- There is encouraging data about access to treatment and reductions in new HIV infections globally, however stigma and discrimination remain huge harriers to effective HIV prevention.
- There is recognition that current hot topics are PrEP, TasP and voluntary male circumcision, TB, Hepatitis C co-infection and HIV and hormonal contraception.
- Access is still a huge barrier in the developing world: one third of people living with HIV who need treatment not having access to it.
- The Australian approach to HVI prevention was recognised as admirable due to its inclusion of key affected communities, and capacity building through effective science and research.
- The Melbourne Declaration (see more information here) was referred to which emphasises the importance of a non-discriminatory approach to HIV prevention and a rejection of laws, policies and practices that involve hatred to marginalised communities.
Day 2 – HIV Cure, HIV Co-infection and HIV Laws
- Professor Lewin (of the Burnet Institute) talked about how latest HIV cure attempts are focused on developing treatments which activate, and target, the virus reservoirs before attempting to put the virus into remission.
- Presentations considered how discrimination of affected populations and criminalisation of transmission represent barriers to effective HIV prevention, and hepatitis and TB co-infection.
Day 3 –Decriminalisation, Prevention and Human Rights
- Sir Richard Branson talked of the importance of decriminalising illicit intravenous drug use and replacing costly incarceration with a more effective approach of treatment, education, training and care.
- Other presentations focused on the pros and cons of a biomedical approach to HIV prevention, the negative impact of anti-gay laws on HIV prevention, youth leadership in global HIV response, and gender inequality in HIV prevention and treatment.
Day 4 – Breaking Religious Taboos, The Injustices of HIV and Tackling Stigma and Discrimination
- Former US president Bill Clinton who advocates for the CHAI (Clinton Health Access Initiative) reiterated the importance of the UNAIDS 2020 targets of 90% of people with HIV knowing their status, 90% of people receiving antiretroviral treatment and 90% of people on treatment having an undetectable viral load.
- Presentations focused on improving the outcomes for marginalised populations, including novel approaches to resting e.g. people who use drugs, sex-workers, transgender and indigenous populations, and migrants and refugees.
- A symposium focused on how religious faiths have contributed negatively to HIV prevention, and might play a part of an effective response to HIV going forward.
- Stigma and discrimination in relation to HIV status was again at the forefront of the day’s events and personal stories from those affected by injustice were related in a symposium.
Day 5 – Fast-tracking the Global HIV Response
- Sir Bob Geldof talked about the links between poverty and the HIV epidemic, and called the lack of global governments’ funding of the ‘last mile’ of the HIV epidemic preposterous.
- Presentations were focused on the best approach to accelerating development of an HIV vaccine and development of HIV prevention technologies.
- At a symposium the concerning trends of HIV transmission and co-infection in prisons was highlighted, and reference was made to prevalence rates that run at 50 times higher than the general population.
- The importance of a joined-up approach to the global HIV response where pharmaceutical companies and affected communities work closely together to ensure that treatment is more affordable and accessible.
Day 6 –HIV, Global Health and Human Rights
- Professor Sharon Lewin (conference co-chair) talked of the importance of an individualised approach to HIV focusing on specific areas and key affected populations, and also of the need to increase funding, rather than slackening the pace of prevention and care work.
- John Manwaring, of the Victorian Aids Council emphasised one of the key themes of the conference, stressing the need to recognise and dispel fear and stigmatisation that affect communities living with HIV. This was reiterated by the incoming IAS president Chris Beyrer who criticised the recent raft discriminatory laws and policies which exclude people from treatment and care, and by Professor Olive Shisana who poignantly reminded us that ‘the past three decades of HIV/AIDS has taught us that the disease doesn’t discriminate but that people and governments do’.
The conference raised both the complexity and possibilities of an effective response to HIV. In a small way the GMI Partnership is part of this response here in London through offering innovative HIV prevention through pop-up testing, collaborative working and effective signposting. For more information on the partnership please see here ).
‘On this last mile, on this last hurdle, we cannot allow indifference and incapable governance stop the final victory, which is coming’ – Sir Bob Geldof