Momentum Growing for Renewed Commitment to Multi-Pronged Approach to HIV Prevention

Mexico City -- In light of promising evidence of the potential impact of antiretrovirals on HIV prevention, and recent setbacks in other biological interventions, HIV experts at the XVII International AIDS Conference today called for a reinvigorated commitment to prevention research and accelerated implementation of proven prevention strategies.

In 2007, 2.7 million people were newly infected with HIV worldwide, nearly 7,400 each day.

"Today, there are many effective strategies to prevent HIV, and all nations of the world must commit fully to their implementation," 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. "In far too many places, stigma and discrimination continue to fuel counterproductive laws and policies that undermine prevention and treatment scale up. Confronting such policies head on, and demanding that they be changed, is a central component of any HIV prevention strategy."

"We have faced challenges recently in the areas of vaccine and microbicides research, but these difficulties are no excuse to abandon our efforts to find all possible means to prevent new infections," said Dr. Pedro Cahn, International Co-Chair of AIDS 2008 and President of the International AIDS Society and Fundación Huésped in Buenos Aires, Argentina. "They call out to us to increase basic science and vaccine research to reverse the course of the epidemic."

Speakers at the morning plenary session provided insights into current prevention research and programming, while highlighting the harmful effects of oppressive attitudes and policies, which inhibit the implementation of effective prevention programmes.

The Pressing Need to Integrate HIV Treatment and Prevention
Despite important increases in HIV treatment access worldwide, it will be impossible to "treat our way out of the epidemic," according to Dr. Myron Cohen (United States) of the University of North Carolina. Citing the central role clinical and other HIV treatment providers have played in the greatest HIV prevention success to date -- averting mother-to-child transmission with antiretroviral drugs -- Cohen issued a call for treatment providers to become full partners in public health campaigns to prevent HIV. He urged that once and for all, the HIV community marry HIV treatment and prevention.

In his plenary remarks, Cohen examined the opportunities for prevention interventions before and after exposure to HIV, and gave an overview of data and initiatives related to vaccines, topical approaches, and the role of antiretroviral therapies (ART). According to Cohen, animal experiments suggest that ART for prevention before or after exposure hold great promise, and several clinical trials of pre-exposure prophylaxis in humans are underway and/or planned. Reflecting on the need for a multi-pronged approach to prevention, Cohen iterated the urgent need to develop combination primary prevention strategies; reinvigorate research on HIV vaccines, other immune-based strategies, and antiretroviral prevention; and encourage people to learn their HIV status for the own health and the benefit of their sexual partners and communities.

A Call for Accessible Care and Harm Reduction Services for IDUs
Noting that injecting drug users (IDUs) are disproportionately less likely to have access to antiretrovirals, Dr. Adeeba Kamarulzaman (Malaysia) of the University of Malaya argued that the world is failing IDUs. Barriers to care include cost, inadequate health infrastructure, stigma and discrimination, as well as a lack of access to HIV treatments during incarceration or mandatory internment in detoxification and rehabilitation centres. To address these obstacles, Kamarulzaman urged the development of care models located in non-traditional health care settings that integrate HIV services with substance abuse, psychiatric, and primary care services.

Kamarulzaman highlighted the continued lack of access to harm reduction programmes, even in countries where such programmes exist. She cited widespread prejudice and moralistic criticisms as the major obstacle to universal access to harm reduction. She also noted a significant disparity in funding between harm reduction services and drug-related law enforcement, even in nation's with long-standing support for harm reduction. Kamarulzaman contended that the contradictions between the United Nation's public health approach to HIV, and the punitive focus of its drug control policies send a mixed message to member countries, and undermine efforts to provide HIV services to IDUs.

Sex Between Men in the Context of HIV
As part of Tuesday's plenary, Dr. Jorge Saavedra (Mexico), Head of Mexico's National HIV/AIDS Programme (CENSIDA) delivered the Jonathon Mann Memorial Lecture, named in memory of scientist Jonathon Mann, who is credited with building the World Health Organization's AIDS Programme from the ground up. Saavedra provided a multi-dimensional overview the HIV epidemic in men who have sex with men (MSM), specifically highlighting hidden epidemics among MSM in low- and middle- income countries, and factors that increase HIV risk and vulnerability across cultures. He profiled current expenditures for programmes aimed at this population, and provided examples of effective prevention strategies, including community-based interventions.

In light of these challenges and opportunities, Saavedra called for a number of specific policy changes, including greater involvement of MSM in the planning of national AIDS responses, and the inclusion of MSM prevention strategies in the strategic plans of low- and middle-income countries. He also called for the decriminalization of sexual behavior between consenting adults, and greater commitment from donors to both fund MSM programmes, and include measures of responsiveness to MSM needs in programme evaluation.

Tuesday Sessions Examine Key Prevention Topics
Throughout the day, a number of sessions and activities will provide opportunities for analysis and discussion of prevention issues. A full list of all sessions and activities is available through the online Programme-at-a-Glance at www.aids2008.org.

• The Lancet Series on Prevention
  Presentation of six papers on success and failures to date in HIV prevention, with a call to action to push prevention beyond the current levels.
• Symposium: New Frontiers in HIV Prevention Sciences
  Session focusing on what is known about approaches to plan, implement, and evaluate HIV prevention programmes in a range of settings.
• Press Conference: ART as a Prevention Tool
  Experts discuss the potential of antiretroviral therapy as an aid to HIV prevention.
• Male Circumcision: Addressing Implementation Challenges and Demonstrating Impact
  Abstract session analyzing research results from Africa.
• Regional Session: Latin America
  A panel of experts from the region will identify key challenges and identify major regional priorities moving forward.
• Country-level Advocacy Initiatives that Support Children and AIDS
  Report from pre-conference symposium Children and HIV/AIDS: Action Now, Action How.