It’s been nearly two weeks since former President William J. Clinton closed the last session of the XIX International AIDS Conference(AIDS 2012) and delegates returned home.
This year’s conference featured commitment and calls for an AIDS-free generation, a growing interest in Option B+, and new research towards a cure. Here are some reflections from what we learned at AIDS 2012, where we truly started “turning the tide together”.
Clinton calls for a blueprint toward an AIDS-free generation
Secretary Hilary Rodham Clinton announced significant funding towards preventing mother-to-child transmission (PMTCT) of HIV, South Africa’s plan for voluntary medical male circumcision, and money for “implementation research,” civil society, and country-led plans. Sec. Clinton also called on Ambassador Eric Goosby to provide a blueprint for achieving an AIDS-free generation during her plenary address. Numerous other stakeholders echoed her commitment. But, if we really want to achieve an AIDS-free generation, the $7 billion funding gap that stands between where we are now, and where we should be, will need to be erased.
Option B+ takes center stage
There is growing consensus that countries should embrace Option B+ to decrease or eliminate vertical HIV transmission. Option B+ — whereby HIV-infected pregnant women are put on antiretroviral treatment for life regardless of their CD4 count — originated in Malawi. In its first year of implementation, the country has seen a 6-fold increase in ART uptake among HIV-infected women. Many plenary speakers and presenters, including UNICEF’s Dr. Chewe Luo, praised the approach and encouraged uptake in other countries.
Elimination of pediatric AIDS by 2015
Along with Option B+, there is a renewed call to action to end pediatric HIV by 2015. MSH welcomes that discussion and the political commitment to achieve it. Great progress has been made toward this ambitious goal in the short history of preventing mother-to-child transmission of HIV: from 2009 to 2011, the number of new HIV infections in children decreased by 24% to 320,000 last year. That is still too many. It is clear that we will not achieve the goal of eliminating pediatric HIV unless we apply some serious innovations and new thinking.
Key vulnerable populations face a growing epidemic
The epidemic is still growing in key vulnerable populations, including: men who have sex with men (MSM), sex workers, and injection drug users (IDUs). Participants discussed lessons learned and programming improvements to help stabilize and turn the tide on the growing HIV epidemic among MSM. For many years HIV care, treatment and prevention programming for sex workers has been less than effective. This year there seemed to be more momentum and reexamination on how we approach prevention in sex worker communities. The IDU population is perhaps still the most marginalized and difficult to reach in many countries. At AIDS 2012, we saw the beginnings of change as countries are starting to think about how to scale up national responses to reach this at-risk population.
Treatment is prevention
Our prevention toolkit is growing. The most promising prevention efforts currently include male medical circumcision and treatment as prevention, pre-exposure prophylaxis, with ongoing hope for further advances in microbicides and vaccines. Male medical circumcision has been shown to dramatically reduce the risk of HIV infection for men by about 60%. The HPTN 052 study that concluded last year definitively proved that initiation of antiretroviral therapy (ART) by HIV-infected individuals substantially protected their HIV-uninfected sexual partners from acquiring HIV infection, with a 96 percent reduction in risk of HIV transmission. New research presented shows that not only is treatment as prevention effective, its very cost-effective as well.
No longer do we have to qualify the term treatment as prevention, we now know that treatment is prevention. Now the hard work begins, how best to bring these innovations to scale…
Tackling HIV & AIDS and chronic non-communicable diseases (NCDs)
Delegates discussed how to use the HIV & AIDS infrastructure to tackle chronic non-communicable diseases in low and middle income countries. One session, “Beyond MDG 6: HIV & NCDs” led by MSH, Pan American Health Organization (PAHO), and partners, focused on how the global health community can fight the dual epidemics by integrating health systems toward universal health coverage (UHC). In other sessions, experts noted the long neglected reality that is now upon us: with the phenomenal success of ART treatment programs, we’re now faced with an aging population of people living with HIV, and dying from tuberculosis (TB) and chronic NCDs.
Searching for a cure
Researchers released new findings at the conference, renewing a focus on finding a cure. Although all agree we’re not there yet, promising findings provide for some measure of optimism: We’re getting people on treatment; we’re getting viral loads down, maybe we can beat this.
“The science has been telling us for some time now that achieving a cure for HIV infection could be a realistic possibility,” said IAS President Françoise Barré-Sinoussi, PhD, Director of the Regulation of Retroviral Infections Unit at the Institute Pasteur in Paris. “The time is right to take the opportunity to try and develop an HIV cure – we might regret never having tried.”
Involving communities and countries for sustainability
Many presenters throughout the week reinvigorated discussions around bringing care, treatment and prevention services to the community via door-to-door testing, care, treatment and support — a not so subtle reminder that successful programs must adapt to suit the communities they serve and not the other way around. Also encouraging was the news that many countries, even those that extremely resource-limited, are contributing increasingly larger proportions of the resources to the HIV & AIDS response.
Other experts eloquently reminded us of the continued intersection of the HIV and TB epidemics, the role that social determinants of health (such as poverty) play in perpetuating the epidemic, and the unmet $7 billion funding gap needed to truly provide universal access for HIV & AIDS drugs. One session captured the unique challenges of improving HIV prevention, care and treatment in fragile states.
Kuala Lumpur & Melbourne: Looking to 2013 & 2014
Optimism filled the convention center during AIDS 2012. To be sure, challenges remain, and we have much to do to close the treatment gap and move sincerely towards elimination of pediatric HIV, but for the first time in memory, the hope that filled the halls was palpable and there was a sense that we can move forward and decrease the terrible hold that HIV has had on people these last 30 years.
As we reflect on what we learned, we also look to the future for HIV & AIDS treatment, prevention, and care. For the next two years, we look forward to being in Asia and hope to see much increased participation from our Asian colleagues. We’ll be meeting in Kuala Lumpur, Malaysia, in 2013 to discuss the scientific progress made by ourselves and our colleagues. The Kaiser Family Foundation and Center for Strategic & International Studies (CSIS) high-level panel said that key issues in Melbourne (AIDS 2014) will likely include country-level and human rights concerns, and more on the search for a cure, as well current results on implementation science and results of the HPTN052 studies.
We’re looking forward to seeing you there, and continuing this vital work together.
What was your favorite moment or lasting impression from AIDS 2012? What do you hope will be different in Kuala Lumpur (2013) or Melbourne (2014)? Tell us your thoughts below.