Issue:  Vol. 48 / No. 7 / 15 February 2018

Int'l AIDS confab highlights human rights, prevention


Activists take over the stage during the opening ceremonies of the 18th International AIDS Conference in Vienna Sunday, July 18. Photo: Rick Gerharter
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More than 20,000 researchers, public health and policy experts, clinicians, activists, and world leaders gathered in Vienna, Austria, this week for the 18th International AIDS Conference, the world's largest meeting devoted to the epidemic.

Human rights of people living with and at risk for HIV have been a key theme this year, along with the need for more funding to expand prevention and treatment.

Shrinking budgets

We are "nowhere near delivery" on the 2005 commitment by the G8 countries to adequately fund treatment by 2010, said conference co-chair and International AIDS Society President Julio Montaner.

The number of people with HIV receiving antiretroviral therapy (ART) worldwide increased by 25 percent last year, to just over 5 million, but 10 million require treatment, according to the latest epidemiological figures.

While there has been some good news about drops in mother-to-child HIV transmission and decreased incidence among young people in several countries, said Yves Souteyrand of the World Health Organization, an estimated 2.7 million more people are infected each year.

Hundreds of AIDS activists kicked off the conference by marching through the Messe Wien Center and conducted a die-in in the main hall outside the opening plenary Sunday evening. Carrying signs proclaiming "Broken Promises Kill," they accused President Barack Obama, French President Nicolas Sarkozy, and other leaders of reneging on their AIDS funding commitment. Obama came in for criticism for his plan to shift resources away from AIDS toward maternal and child health.

To help shrinking budgets go further, activists also highlighted international trade and intellectual property laws that limit access to cheaper generic drugs.

"People with AIDS in poor countries cannot afford regular [brand name] medications at prices charged by big pharmaceutical companies," Johnny Guaylupo told the Bay Area Reporter . "They need generic drugs to keep them alive."

In contrast with some prior AIDS confabs, meeting organizers, official conference speakers, and protesters often sounded the same note with regard to HIV funding.

World leaders "had absolutely no problem finding money on a moment's notice to bail out their corporate friends, the greedy Wall Street bankers," Montaner said during his opening address, "yet when it comes to global health the purse is always empty."

"The issue is not that HIV is overfunded, but that health is underfunded," concurred Paula Akugizbwe of the AIDS and Rights Alliance for South Africa. "We can afford politicians' luxury vehicles, military expenditures, leaders' pay, and World Cup stadiums, but when it comes to health, we have to beg, borrow, and steal."

Congresswoman Barbara Lee (D-Oakland), who attended the conference, suggested that the U.S. defense budget and tax breaks for the wealthy could be trimmed to pay for HIV/AIDS support.

"In too many countries, too much money pays for too many people to go to too many meetings and get on too many airplanes to do too much technical assistance," said former President Bill Clinton at Monday's plenary. "Every dollar we waste today puts a life at risk."

Vulnerable populations

Keeping with the conference theme "Rights Here, Rights Now," numerous presenters addressed the discrimination and human rights abuses that fuel the spread of HIV among vulnerable groups including men who have sex with men, transgender people, drug users, sex workers, prisoners, immigrants, and women and girls.

Vienna was chosen as the conference venue for its position as a bridge between east and west, spotlighting the burgeoning HIV/AIDS epidemic in Eastern Europe and Central Asia largely driven by injection drug use.

The war on drugs and punitive laws contribute to the HIV transmission and keep people from getting treatment, experts said. The Vienna Declaration – the official conference statement endorsed by more than 11,000 signatories – stresses the importance of science-based drug policy reform.

As highlighted at the all-day "Be Heard" meeting on Saturday preceding the conference, gay and bisexual men continue to bear the brunt of the epidemic in North America and Europe, while men who have sex with men in low-income regions face discrimination, inadequate services, violence, and growing persecution due to harsh laws criminalizing homosexuality.

Criminalization of HIV transmission – both between sexual partners and from mothers to babies – has also been highlighted, with advocates and public health experts worldwide agreeing that such policies hamper rather than help efforts to control the spread of AIDS.

Sex worker activists were highly visible at AIDS 2010. On Tuesday, a group targeted U.S. Global AIDS Coordinator Eric Goosby to demand repeal of the Bush-era "loyalty oath" that requires recipients of PEPFAR funding to affirm that they oppose prostitution.

Finally, Everjoice Win of ActionAid International, speaking at Tuesday's plenary, decried violence against women and girls, emph

Approximately 30 protesters gathered in front of House Speaker Nancy Pelosi's (D) office in San Francisco Tuesday to advocate for increased funding for the AIDS Drug Assistance Program. Timed to coincide with the International AIDS Conference in Vienna, the demonstration by the AIDS Healthcare Foundation included protesters wearing skeleton masks and carrying a coffin filled with 428 letters signed by individuals across the country calling for improved action by Pelosi. The letters were delivered to Pelosi's office. Photo: Lydia Gonzales
asizing that gender equality must be a cornerstone of efforts to fight AIDS.

"Culture, religion, and tradition should not be used as excuses for violation of women's human rights," she stated. "Culture is defined by those in power to reinforce or maintain their status."

Prevention, treatment, and cure

HIV prevention was highlighted this year, with a focus on biomedical prevention strategies.

The big news coming out of the conference was data from the CAPRISA microbicide trial of nearly 900 women in South Africa, showing that a vaginal gel containing the antiretroviral drug tenofovir – an ingredient in the popular Atripla, Truvada, and Viread pills – reduced HIV transmission to women by 39 percent, or from 9.1 to 5.6 infections per 100 people.

"We now have evidence that a vaginal gel can help prevent HIV," said Global Campaign for Microbicides director Yasmin Halima. "This is good news for women, good news for the field, and a good day for science."

While the study received extensive media coverage and won applause for demonstrating for the first time that a microbicide has the ability to reduce infection in humans, the gel is still in early development and it is not expected to be widely available for at least a few years until larger studies have been completed. It has not yet been tested as a potential rectal microbicide for use during anal sex.

With no new HIV drugs nearing the end of the development pipeline, news on the treatment front has focused on use of antiretroviral therapy for prevention and how this influences the ongoing debate about when to start treatment.

HIV-positive people on effective ART typically have very low or undetectable viral load, which dramatically reduces the likelihood of transmission of the virus. A new study by conference co-chair Montaner and colleagues, published this week in the Lancet, adds to the evidence that treatment – by lowering "community viral load" – can significantly decrease HIV incidence. Their study in British Columbia, where the epidemic is largely driven by needle-sharing, found that widespread early ART cut new infections by about half.

A growing body of data also suggest that starting treatment earlier can help minimize damage related to inflammation triggered by HIV infection, which starts to happen long before a person's CD4 T-cell count falls into the danger zone.

Current U.S. treatment guidelines call for starting ART when the CD4 count falls to 500, and the International AIDS Society-USA released new guidelines at the conference confirming this threshold. But this approach remains controversial. San Francisco General Hospital recently instituted a new policy to offer ART to everyone diagnosed with HIV, but others oppose earlier treatment due to concerns about side effects, drug resistance, and not having enough resources to go around.

Advances in treatment that have kept HIV people alive longer, coupled with recognition that providing lifelong ART to everyone who needs it worldwide is unsustainable, has led to renewed discussion about the prospects of a cure for HIV.

Eradication of HIV may be more scientifically feasible than ever, researchers suggested at the pre-conference "Toward a Cure" meeting sponsored by the International AIDS Society.

Keynoting at Sunday's AIDS 2010 opening plenary, Sharon Lewin from Monash University in Melbourne emphasized the cost of providing standard-of-care treatment according to current guidelines.

Treating 40 percent of HIV-positive people in low- and middle-income countries (the current level of coverage) would cost $25 billion by 2030, she noted. Expanding coverage to 80 percent would increase the cost to $35 billion – equal to half the U.S. foreign aid budget by 2016.

"I don't think we should accept that HIV is a chronic illness requiring lifelong treatment," she said. "In the absence of an effective vaccine, we must seriously pursue the possibility of a cure."

Researchers described a variety of potential approaches, from ART intensification, to driving latent HIV out of its hiding place in resting cells, to altering resting cells using gene therapy to be resistant to HIV infection.

"The international conference in Vienna will not be the conference where we announce a cure for AIDS," Lewin concluded. But just as the 2006 International AIDS Conference marked the start of the ART era, she expressed hope that Vienna "will mark the beginning of a future where we seriously prioritize finding a cure."

The Stop AIDS Project will hold a forum on emerging HIV research Wednesday, August 11 at 6:30 p.m. at the Bank of America Community Space, 18th and Castro streets.

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