The goal of achieving universal access to treatment remains paramount. The conference was dominated by scientific findings that support the belief that if existing programs were scaled up to meet the needs of the 33 million people living with HIV, the epidemic could be significantly blunted. Of those infected with HIV worldwide, half are women, and in 2008, young people between 15 to 24 years old accounted for 40% of all new HIV infections.
With three new HIV infections for every person gaining access to treatment, access to scientific and medical advancements in treatment is vital. A bold prevention effort will begin this year in which people are given HIV treatment immediately after testing positive rather than waiting until their immune system declines. The five-year study could significantly reduce transmission.
In his plenary speech, former U.S. President Bill Clinton noted, "Too much is spent on studies and reports that sit on shelves. Every dollar we waste today puts a life at risk. It is time ... to spend the money more wisely and to deliver health care in a better and more timely way. South Africa has shown remarkable leadership this year. They're now trying to test tens of millions of South Africans and more than double the numbers on treatment over the next few years."
But treatment alone cannot end the epidemic. New methods of HIV prevention are necessary, especially among women and men who have sex with men (MSM ), who are among the most vulnerable to infection. One of the conference's most encouraging reports came from a vaginal microbicide study, a long sought-after prevention tool for women. The study, CAPRISA 004, reported a nearly 54% success rate in preventing HIV in women who used the microbicide as directed. This finding means there is finally scientific evidence that a vaginal gel could be effective in preventing HIV. This may provide women with a much-needed tool to take control of their own bodies and health. It must be developed further to determine whether it can also provide protection for anal intercourse.
The conference also underlined the immediate need to stop efforts to criminalize sex between consenting adults, as well as to support community-based education and advocacy on the human rights of MSM and transgender people. Sessions stressed the need for anti-discrimination laws in relation to sexual orientation and gender identity. Continued efforts to eliminate prejudice in the general population and discriminatory treatment by health providers and local officials are vital. These behaviors marginalize those most affected by HIV and cause the epidemic to worsen. Anti-gay harassment and abuse magnify health problems and affect mental health, leading to depression, social isolation, and an array of adverse socioeconomic outcomes.
There were encouraging signs of increases in the visibility of issues facing both MSM and women. Although workshops on MSM, especially in Latin America and Africa, have increased from past conferences, it remains an issue that must be addressed by a broader range of institutions. Research on the the links between criminalization of homosexuality and its effect on HIV, and on the global impact of the U.S.-based Christian Right's anti-gay policies, were also discussed.
The issue of HIV and aging gained great recognition at the conference. Three dozen seminars, workshops, and satellites -- the most ever at an international conference -- were focused on the impact HIV has on older adults and those who have lived long-term with the virus. This was a welcome change from previous conferences, which had only lightly addressed this issue. A substantial proportion of people with HIV are over 50, many of whom were among the first to take HIV treatment. They are now facing a host of medical problems, social isolation, stigma, and financial worries different from and greater than their HIV-negative peers.
After co-chairing a satellite session on HIV and aging sponsored by ACRIA and the U.K.'s Terrence Higgins Trust, Dr. Gottfried Hirnschall, Director of HIV/AIDS at the World Health Organization, said, "There have always been older people with HIV, but what is new is the numbers -- that will require new public health thinking compared to the past. Aging with HIV is not just a clinical challenge, it is ... a social challenge, and it's not just confined to one part of the world versus another." There was also a satellite session organized by San Francisco AIDS Foundation, amfAR, and GMHC, featuring Dr. Amy Justice of Yale School of Medicine, an expert in comorbidities and aging.
Ultimately, medical advancement cannot cure gender inequity, pills fail to combat homophobia, and prevention innovations do not redistribute global wealth more equally. Social change that challenges these structures is the only answer. The 2012 International AIDS Conference will be held in the U.S. for the first time, possible only because the HIV travel and immigration ban has finally been lifted -- a reminder that unrelenting advocacy can lead to much-needed reform.