Opening Session Remarks by Dr. Julio Montaner, President, International AIDS Society and IAS 2009 International Chair
July 20, 2009
Colleagues, friends and distinguished guests; colegas, amigos y distinguidos invitados: I am Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS at St Paul's Hospital and the University of British Columbia in Vancouver, Canada and the President of the International AIDS Society.
It is my privilege today to welcome you to Cape Town as we formally open the proceedings of the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009). Wamkelikeli, Bienvenidos, Welcome!
The selection of Cape Town as the host city for IAS 2009 represents a determined attempt by the IAS Governing Council to focus international attention on the epicenter of the HIV pandemic. In fact, in many ways, IAS 2009 is a follow up to the 13th International AIDS Conference held in Durban in 2000. That meeting is still regarded as a pivotal moment in the history of the pandemic.
Bringing the AIDS 2000 conference to Durban was a tremendously courageous decision, at a time of great uncertainty, and I want to take this opportunity to congratulate my friend and colleague, the esteemed Dr Mark Wainberg, who led that effort in his role as the President of the IAS. Similarly, I would like to acknowledge the tremendous job done by Dira Sengwe, under the leadership of Dr Jerry Coovadia, to make Durban such a monumental success. It has also been an honor to work with Jerry over the past two years to plan this week's conference. Thank you, Jerry.
I also want to take this opportunity to acknowledge the tremendous leadership provided by Craig McClure, the IAS Executive Director who will be moving-on after this Conference. Thank you Craig for your support, hard work and dedication. You have made the IAS exponentially more relevant and effective over the last five years! On behalf of the Governing Council, our staff and our members, many, many thanks!
The Durban conference opened the door to the roll-out of antiretroviral therapy, something that until then many believed was just not possible. Since Durban, we have seen dramatic progress in access to treatment, care and prevention in resource-limited countries. We have gone from virtually no access to well over 3 million people on antiretrovirals in low- and middle-income countries.
Despite such progress, we must not be complacent. Major concerns remain. The world today faces an unprecedented global economic downturn. This represents an immediate threat to the progress we have witnessed over the last decade. Already, we are hearing warnings about the sustainability of the roll-out of antiretroviral therapy. A retrenchment now would be catastrophic for the nearly four million people who are already on treatment in resource-limited countries, not to mention the six to seven million others who have already reached a critical CD4 threshold of 200 cells/mm3, who are still waiting for life saving treatment. This unmet need would be substantially higher if the more appropriate and clinically sound CD4 threshold of 350 cells/mm3 was universally adopted, as the IAS, among others, has recommended.
All of this is taking place against a backdrop of an ever-widening gap between evidence and practice. We know what needs to be done, yet implementation flounders, costing thousands of lives each day. Thousands of fully preventable deaths every day!
The gap between evidence and implementation is particularly apparent between North and South. In the North we have virtually eliminated vertical transmission of HIV infection with the use of HAART. We have unrestricted access to drug combinations, and new, highly-potent, and safer drugs that are easier to adhere to. We also have highly effective second and third line regimens, as well as point of care testing, and routine viral load and resistance testing.
In contrast, in the South people living with HIV are often stuck in a therapeutic corner with a paucity of first line treatment options, typically selected based on cost rather than safety and efficacy considerations. While this was acceptable as a means to jump start the roll-out of antiretroviral therapy, this is no longer the case: short-term savings will come back to haunt us in the form of toxicities and tolerability challenges, which will ultimately compromise adherence and in turn effectiveness.
This past week we celebrated 40 years since the Apollo XI mission first put a man on the moon, a true testament to what mankind can accomplish with focused leadership and determination. I can only wonder why we cannot put the same focused leadership and determination to conquering HIV/AIDS. Ultimately, it is not a matter of whether it can be done, but whether we care enough to make it happen!
Earlier this month, another G8 Summit came and went. HIV/AIDS was indeed the elephant in the room. In 2009 the eight most powerful economies in the world left HIV off their priority agenda. They parted with no progress report on HIV, and they even failed to renew their prior commitment to the goal of Universal Access to HIV prevention, care and treatment by 2010. This is totally unacceptable!
Contrast that with the 2005 G8 Summit at Gleneagles, which clearly outlined a specific commitment to develop and implement a package of HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010. In four years, the need for bold leadership on AIDS has increased, while the voices of our political leaders have diminished. This is a shame!
Against that backdrop, Prime Minister Stephen Harper of Canada, the convener of the next G8 Summit in 2010, had the courage to openly admit: When top Western politicians make commitments and we don't fulfil them. This undercuts the credibility of our process. And that is a serious problem. He went on to explain that Canada will use its status as host of the next G8 Summit to convince world leaders to end their practice of promising but not delivering help to the world's desperately poor and hungry. I say to Premier Harper and his G8 colleagues: It's time to stop talking. We urge you to deliver the previously committed Universal Access to HIV prevention, care and treatment by 2010!
We must hold the G8 leaders accountable for their failure to deliver on their promises. It is rather incredible that the United States, the country saddled with the worst of the fiscal crisis, remains the ONLY ONE of the G8 that has met its stated fiscal commitments. On that note I am particularly pleased that in a recent yet to be published analysis, my research team was able to document a decrease in HIV incidence among PEPFAR focus countries, when compared with non-focus countries, in Africa. We say to the G8 leaders: let us have more PEPFARs rather than more empty promises, so that we can truly put an end to the pandemic.
Last week, the UK All-Party Parliamentary Group on AIDS released a report indicating that by 2030, an estimated 50 million people living with HIV will need new drugs to stay alive. The report further states that, "Only a third of those who need it are on treatment and this treatment will not work for them forever. The report goes on to say, Political activism is needed once more to ensure that the next generation of drugs is available to the world's poorest." Let's be sure that we work together to motivate our political leadership to fulfill this gap!
MP David Barrow, who Chairs the UK group, said at the release of the report: "We are sitting on a treatment time-bomb. We cannot sleepwalk into a situation where we can only afford to treat a tiny proportion of those infected." The only way to end the HIV/AIDS epidemic is to prevent infection, the report says, and because the drugs suppress the virus, those receiving treatment are much less likely to pass it on.
I am truly delighted that the added preventive value of antiretroviral therapy also known as treatment as prevention is gaining traction. This is entirely consistent with the recommendations of the Vancouver Summit that was held this past February sponsored by the IAS, the Global Fund, the World Bank, and the Public Health Agency of Canada. It is also consistent with a recent mathematical model put forward by WHO-based investigators last January, as well as a policy statement released only a few weeks ago by the French National Agency for AIDS Research, among others.
I firmly believe that the recognition of the added preventive value of HAART represents a key policy break-through as it dramatically enhances the value of HAART. Under this new light, HAART is no longer viewed just as a cost-effective intervention that prolongs the life of a person living with HIV or AIDS. Additionally, HAART is now viewed as an essential tool to curb the growth of the epidemic, and as a result HAART becomes a cost-averting intervention. Even in fiscally challenging times, HAART is therefore a very sound investment!
As the 2010 deadline for universal access approaches, we must continue to strive for that goal, while also recognizing that it will take a redoubling of our efforts to achieve Millennium Development Goal 6, namely, to halt and reverse the HIV pandemic by 2015. Let's be clear, with the appropriate HIV program implementation we can meet this ambitious goal, and in the process strengthen the most heavily affected societies and become a driving force for global health, including other diseases, such as TB and malaria. HIV scale up is a model for health systems strengthening. Let us be perfectly clear, health is a fundamental prerequisite for economic development.
At the same time, we must promote and protect human rights - of women, children and other populations most at risk, including men who have sex with men, people who inject drugs and those who sell sex. There will be no lasting solution without adequate protection of human rights!
Colleagues and friends, as we learn from each other's work this week in Cape Town, let's keep our shared goal in sight and remember to aim high: Our goal is to put an end to the pandemic once and for all through the aggressive implementation of a scientifically-proven combination approach of treatment, prevention, and human rights protection.
With your help, we can and we will achieve this goal.
At this time, please join me in welcoming the IAS 2009 Local Co-Chair and Chairman of Dira Sengwe, my good friend and colleague Dr. Jerry Coovadia.
This article was provided by TheBodyPRO. It is a part of the publication The 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.