NAPWA at IAC 2012
August 12, 2012
Wednesday was the day of women -- and the day of facing the real complexities of making our new HIV control tools work.
The morning Plenary focused on "Turning the Tide on Transmission." How close are we to realizing the promise of a generation in which no one's HIV progresses to AIDS and new HIV infections are rare?
Distinguished virologist Barton Haynes, director of the Duke Human Vaccine Institute and Center for HIV/AIDS Vaccine Immunology (CHAVI)discussed prospects for an effective vaccine. The good news: we understand more than ever before about HIV's vulnerabilities, especially the location and structure of sugar and protein shell structures that do not usually mutate, and the shape of possible antibodies that would bind and destroy them. The bad news: the antibodies tend to fall into classes that the immune system itself deletes in order to prevent self-damage. The good news: as the deletion mechanisms become better understood, we should be able to find candidate antibodies that are broadly effective against most strains of HIV and that the immune system will tolerate. The vaccine field is energized, but effective vaccines are still years away.
Do we have other tools to protect women and girls, who now make up half the epidemic worldwide despite the concentration of MSM, and to protect their children?
Chewe Luo, HIV/AIDS Advisor for UNICEF, called for wider "test-and-treat" among women, especially pregnant women, and innovative strategies to have the most effect in heavily impacted populations in sub-Saharan Africa and other HIV conctration zones. Mother-to-child transmission can be eliminated, she said, but health care delivery systems will have to make it possible for HIV+ pregant women to stay in treatment through and long after delivery. In the long run, this means that preserving the health of the mother is just as important as preventing transmission to the child.
Linda Scruggs, a Baltimore and D.C. area activist whom we at NAPWA have the honor to call a friend, spoke about the importance of sexual power relationships and gender-based violence in making women vulnerable to HIV. Not only do women need unhindered access to testing, care, and treatment, but they need equality and respect in relationships and an equal place at the HIV policy table. Geeta Rao Gupta, Deputy Executive Director of UNICEF, echoed Scruggs, saying high rates of infection among women, especially adolescents, reflect pervasive and stubborn cultural norms in many countries that disenfranchise women and then blame them for the resulting higher rates of infection.
An afternoon Regional Session examined progress in scaling up prevention and research actities in Washington, D.C., where the epidemic is heavily black and -- as in many poor countries -- disproportionately female. The CDC's Carl Dieffenbach talked about the the CDC's 2007 decision to reboot its partnership with the District of Columbia, and the complext network of relationships that the CDC and NIH, the District, a consortium of universities, teaching hospitals, and communty-based health care facilities. The research is as important as the treatment: before 2007, the District did not have surveillance infrastructure to understand where and how the epidemic is concentrated. With better surveillance, interventions can be designed and targeted more effectively -- in some case, reaching out to previous unidentified key populations, in others, deciding which biomedical intervention might be most effective with that population. Dr. Mohammad Akhter of the District's Department of Health spoke about the intracacy of the network of relationships, the effort of all parties to coordinate the research and treatment consortium's work, and the absolute necessity of welcoming community activists to the polciy table. No matter how uncomfortable they can be, Akhter said, they are experts, just as much as the MDs, MPHs, and PhDs form the universities and health care providers. There are four pillers to the District's response to the epidemic, he said: robust research into the what, when, where, and how of transmission, prevention and treatment; treatment of the whole HIV+ person, not just for his of her HIV; the best scientific, clinical, and administrative staff; and continuing pressure from activists to for effective action.
An evening session on the role of stigma in spreading HIV brought us back to women -- and to the importance of details. Public and institutional stigma interact with race, gender, and other (e.g., disability) discrimination to produce internalized stigma that in turn produces poor utilization of treatment and poor health outcomes. The mechanisms are recognizable across many cultures, but the details are different in every case -- and so, necessarily, are effective responses. The panelists reported from several studies that education about HIV and its non-viral causes is important for reducing stigma, but simply ensuring the people know they know people with HIV is even more effective. We were reminded of Elton John's call, the day before, for everyone living with HIV to "come out" about it.
This article was provided by National Association of People With AIDS.
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