August 6, 2008
Mexico City -- Researchers, community and political leaders gathered in Mexico City for the XVII International AIDS Conference (AIDS 2008) today received an update on the future prospects of eradicating HIV, and were urged to give greater attention and resources to the needs of affected children, and to reject unproven strategies that ignore the realities of sex workers' lives.
"The persistence of HIV in latent reservoirs presents a major challenge to the ultimate goal of eradicating HIV from the human body," said Dr. Pedro Cahn, International Co-Chair of AIDS 2008 and President of the International AIDS Society and Fundación Huésped in Buenos Aires, Argentina. "While researchers strive to answer this and other key scientific questions, we cannot afford to squander the prevention and treatment knowledge that already exists today."
"Ignoring the needs of children affected by HIV, and continuing to marginalize groups at greatest risk for infection will only lead to more new infections and fewer people on treatment," 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. "We will pay for such foolishness in the future."
Re-evaluating Prospects for Eradicating HIV
Dr. Robert Siliciano (United States) of the Howard Hughes Medical Institute and Johns Hopkins University presented data on HIV persistence in people on highly active antiretroviral therapy (HAART) and the prospects for eradication of HIV. Siliciano demonstrated that HAART can stop viral replication of HIV but cannot eradicate it from the body because of the persistence of HIV in a reservoir in resting CD4 T cells. The reservoir, which researchers have characterized in detail, allows the ongoing production of the virus during HAART.
According to Siliciano, HAART's demonstrated ability to stop replication is one of the three steps needed to cure HIV. The other two are identifying all the stable reservoirs for the virus, and finding ways to subsequently eliminate them. Siliciano discussed the development of cell models for the currently identified reservoir, which would allow for the screening of drug libraries to find drugs that can target it. He also presented evidence of a second major reservoir. Included in Siliciano's presentation are recent data from his team and researchers at the National Cancer Institute and the University of Pittsburgh, which shows that adding a fourth, more potent anti-HIV drug to existing antiviral combinations does not further suppress the number of HIV viral copies in the blood.
No Small Issue: Children and Families
An estimated 2.1 million children younger than 15 years were living with HIV in 2007, 90% of whom are in sub-Saharan Africa. More than 90% were infected through mother-to-child transmission. Pregnant women's access to antiretrovirals to prevent transmission to their children has increased substantially in recent years, from 10% in 2004 to an estimated 33% in 2007. Though children's access to antiretroviral treatment has also increased, from 75,000 in 2005 to 198,000 in 2007 it is substantially lower than the coverage rate for adults.
In her plenary address, Linda Richter argued that, while affected children have been highly visible in photo opportunities and headlines about AIDS, their real needs have been consistently overlooked. An estimated two million children are living with HIV today, and many millions more are directly affected by the epidemic through the illness and death of their parents or caregivers, emotional distress, material deprivation, and lack of access to treatment, support, basic health services and education.
Richter called for the development of family-centered approaches to address the needs of all children affected by HIV and AIDS. She advocated that social protection services that support families and communities in caring for children be central to such efforts. In addition, economic assistance for poor families, particularly through income transfers, is a crucial missing ingredient in a comprehensive response to children affected by HIV in both low- and high-prevalence settings.
Sex Workers: A Part of the Solution
Elena Reynaga (Argentina) of RedTraSex issued a stirring call for the full recognition of sex workers' rights and for the ability of sex worker organizations to develop and implement effective HIV/AIDS programmes rooted in the realities of their lives. According to Reynaga, current efforts to reduce HIV prevalence among sex workers are hampered by inadequate funding and the misdirected investment of what limited funds do exist in programmes that do not meet the population's actual needs.
Reynaga stated that evidence shows HIV prevalence has been lowered in regions such as South America, where sex work is actually recognised as "work" and sex worker organizations receive direct support. In Brazil, for example, programmes based on strategies that incorporate peer outreach, promotion of sex workers' rights and the abolition of laws that repress sex work have been shown to be successful. Critical to reducing HIV infections among sex workers is fighting stigma and discrimination by continued efforts to decriminalize sexual work, end police violence, and sensitize the media. Reynaga concluded that sex workers are dying because of a lack of health services, condoms, HIV treatment, and rights. She rejected programmes that respond to these conditions by seeking to rehabilitate or retrain workers stating that there is no scientific evidence that they are effective in stopping HIV. Instead she called for freedom from repression as the best way to build an effective response to HIV among sex workers.
Wednesday Special Sessions
A full list of all sessions and activities is available through the online Programme-at-a-Glance at www.aids2008.org.