Scale up of HIV Prevention, Treatment, Care and Support
Requires Renewed Leadership and Resources
Mexico City -- The XVII International AIDS 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 programmes, and called for sustained action to eliminate the barriers to universal access.
"Despite the progress we have made, we are not on course to meet universal access targets, and in fact, appear to be slipping away from our existing commitments," said Dr. Pedro Cahn, International Co-Chair of AIDS 2008 and President of the International AIDS Society and Fundación Huésped in Buenos Aires, Argentina. "It appears that we are poised to accept defeat when victory is still within our grasp. Our failure to meet those commitments will have an impact on millions of lives. This cannot be allowed to happen. It is time for 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 Head of the Molecular Virology Unit at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Coordinator of the Clinical Care Committee of CONASIDA, Mexico's National AIDS Council. "The fact that, last year, 2.7 million people were newly infected with HIV, a disease that is entirely preventable, is unacceptable."
AdvertisementExamining the State of the Epidemic
On Monday, the conference's opening plenary featured presentations by leading global experts on their perspectives on recent advancements and challenges, followed by a panel discussion on the state of the epidemic.
Understanding the Spread of HIV and The Possibilities of Combined Prevention Interventions
Dr. Geoffrey Garnett (United Kingdom) of Imperial College London noted that knowledge of current trends in HIV incidence and associated patterns of risk is greatly limited by commonly used epidemiological methods. New methods of analysing HIV prevalence and risks of infection, however, are improving understanding in these areas. As an example, Garnett provided an analysis that models the impact of various behavior changes on a population's HIV prevalence over time in order to compare it with the actual prevalence data during that period. This comparison allows researchers to look back and determine past significant declines in incidence and risk. Turning to analyses of risk behavior, Garnett illustrated the importance of including social and structural determinants of HIV risk, along with behavioral and biological risk factors.
Garnett also examined how HIV spreads within a population and demonstrated the ability of a single effective intervention, such as male circumcision or consistent condom use, to reduce HIV prevalence rates and facilitate the greater impact of other interventions. According to Garnett, the powerful synergy of such combinations could dramatically alter the future spread of HIV.
Building on Progress To Date
Dr. Jaime Sepulveda (Mexico), founder of Mexico's National AIDS Council, who is now with the Bill & Melinda Gates Foundation, noted that attention to and resources for AIDS are at all-time highs, including substantially increased funding for the Global Fund and the U.S. President's Emergency Plan for Emergency AIDS Relief. According to Sepulveda, reaching the goal of 3 million people in low- and middle-income countries on treatment at the end of 2007 was a critical step forward, 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. Highlighting the fact that more people became infected with HIV last year than began treatment, 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. In conclusion, he reiterated that political leadership from all countries and accountability at all levels are essential for stopping the epidemic.
Leadership Key to Success
Citing the results in both treatment and prevention scale up in countries with sustained leadership, such as Rwanda and Tanzania, Alex Coutinho (Uganda) of the Infectious Disease Institute of Makerere University made a passionate call for greater leadership as a path toward meeting the challenges ahead. In looking at progress to date, Coutinho highlighted increased access to HIV testing and counseling, to prevention of mother-to-child transmission services, and to paediatric care and treatment, as well as the effectiveness of male circumcision as a prevention intervention. In contrast, he noted that most countries will not achieve universal access by 2010 and that the majority of people living with HIV (PLHIV) are still unaware of their HIV status. In his call to action, Coutinho urged greater investment in prevention, and financial resources flexible enough to support health systems, and systems that reach into rural and other hard-to-reach areas, and fully embrace PLHIV as partners. He also urged outreach to and support of marginalized and at-risk communities, as well as the greater involvement of PLHIV as a catalyst for change.
Full Recognition and Inclusion of Youth Essential
Elisabet Fadul (Dominican Republic) of the Dominican Network for Youth Rights/Global Youth Partners outlined a broad and urgent youth HIV/AIDS agenda, calling for comprehensive rights- and evidence-based plans to provide access for young people. Highlighting the 40 percent of new infections worldwide among young people between the ages of 15-24, Fadul noted that HIV prevention and treatment programmes are failing to effectively reach young people, with the most vulnerable and marginalized being stigmatized, criminalized or forgotten by many of these programmes. To reverse this course, she called for actions and policies that engage youth, especially young people living with HIV/AIDS, as respected partners in developing and implementing programmes that forthrightly address their needs and diversity.
Monday Sessions Highlight Efforts to Measure Success, Confront Challenges
Throughout the day a number of sessions and activities will look closely at the progress toward universal access and related barriers. A full list of all sessions and activities is available through the online Programme-at-a-Glance at www.aids2008.org.
- HIV/AIDS and Health System Reform: Achieving Universal Coverage
Keynote by President William J. Clinton, with introductory remarks by Dr. Julio Frenk, of the Carso Institute and the Bill & Melinda Gates Foundation.
- Where Are We in Achieving UNGASS Targets?
Featuring representatives of five nations, the session will examine how far the United Nations and member states still need to go to honour their UNGASS commitments.
- Learning by Doing: Scaling up HIV Operations Research in Resource Limited Settings
An examination of HIV operations research in resource-limited settings and the importance of building research capacity as a critical element of health systems strengthening.
- Regional Sessions: Sub-Saharan Africa and Asia-Pacific
A panel of experts from each region will identify key challenges and identify major regional priorities moving forward.
- Symposium: Reaching Millions: Youth, AIDS and the Digital Age
Harnessing the energy and activism of youth through online social networking and civic engagement, ICTs and mobile technology platforms.
- Positive Synergies between Health Systems and Global Health Initiatives
This satellite will discuss how to maximize the synergies between HIV programmes and other initiatives to strengthen overall health systems.
- From Commitment to Action: Implementing Effective Responses on Gender and AIDS
Satellite session on gender equality and empowering women through national AIDS responses.