Feature Stories of the 16th International AIDS Conference

Men’s Liberation Would Help Women, Conference Told. August 18, 2006

What Do Women Want? HIV Protection. August 18, 2006

AIDS Conference Turns to Political Front. August 17, 2006

Researchers Have Proof of What Works for Young People. August 16, 2006

Health Care Workers Lacking for AIDS Scale-Up. August 16, 2006

Taking the Experts for a Ride. August 16, 2006

Is ABC Enough? August 16, 2006

Poverty Causes AIDS and Vice-Versa, Conference Told. August 16, 2006

The Two Bills – Clinton and Gates – Answer “Why AIDS?” August 15, 2006

Women March for Women at AIDS Conference. August 14, 2006

Marginalized Groups Speak Out at AIDS Conference. August 14, 2006

Health Care Workers Lacking for AIDS Scale-Up. August 14, 2006

US Policy Spreading AIDS, Not Stopping It, Conference Told. August 13, 2006

AIDS Conference Opens With Focus on Women. August 13, 2006

XVI International AIDS Conference. August 9, 2006

Top Findings of the 16th International AIDS Conference
 
The conference had five “tracks” for its more than 400 sessions over six days, including hard science, social science and policy research. A rapporteur summarized each one.

1. Biology and pathogenesis of HIV: Rafick-Pierre Sekaly of Canada:

• Overreaction of the human immune system to HIV exposure is what drives the way the infection progresses.
• A good vaccine candidate could target both the infection and the very early signals of reaction to it.
• The “fitness” of the virus – how it changes to survive and flourish in the body – is a promising avenue of study.
• The virus not only changes the cells it targets but alters all the “bystander cells” as well. “The whole system is being altered,” he said.

2. Clinical research, treatment and care: James McIntyre of South Africa

• “Treatment success is blind to race and continent…but treatment delayed is treatment denied.”
• Nutritional supplements are widely needed but rarely funded.
• Treatment is going to 1.65 million people but 70 percent of the need is still unmet, and children must specifically be included.
• Concerns about sticking with drug regimens are misplaced: the rate at which patients take their medicines as ordered exceeds 75 percent in Africa, compared with 55 percent in the United States.
• Nearly 60 percent of those receiving treatment are women, slightly higher than their infection rate, but drugs to prevent mother-to-child transmission are still failing to reach 90 percent of HIV-positive mothers .
• The need for another 4 million health care workers is urgent: “Open your purses, we need more nurses.”

3. Epidemiology, prevention and prevention research: Quarraisha Abdool Karim of South Africa

• “HIV continues to spread relentlessly throughout the world,” with epidemics emerging in Eastern Europe and Asia.
• The fight is “not a sprint nor a marathon, but a relay that will need this generation and the next to make a difference.”
• “There is absolutely no room for complacency. In Uganda, once a “leading light,” new infections are up among older men and risky behaviors have increased.
• The conference put to rest the false dichotomy between prevention and treatment. Both are essential in curbing the pandemic.
• Taking treatment programs to larger size will help prevention too, but funds fall far short of needs.
• The pandemic is “not a single epidemic but a mosaic of multiple differing epidemics” that requires different prevention tools and approaches.
• “History will judge us not by our scientific advances but by what we do with our scientific advances.” -- Anthony Fauci, head of the infectious diseases department at the U.S. National Institutes of Health.

4. Social, behavioral and economic science: Michael Tan of the Philippines

• “Where is the sex?” Sexual behavior must become a topic of open and frank discussion, especially among political leaders.
• Marginalized groups have hidden epidemics: sex workers, people in prisons, indigenous populations, migrants, refugees, displaced persons.
• Programs like needle exchanges that reduce harm to drug addicts work well to slow HIV transmission wherever they have been tried. “The scientific debate is over.”
• Social science research will be needed to ensure that new prevention technologies, once available, are used.
• Missing issues at the conference included the origins of homophobia, religious and other “fundamentalisms” that threaten advances in HIV prevention and care, and the “patents, multinational drug monopolies, TRIPS [trade-related intellectual property rights] and free trade agreements that keep anti-retroviral therapy beyond the reach of the majority of people living with HIV/AIDS.”
• “Gender blindness” neglects to ask whether male circumcision will benefit women or microbicides benefit men, or whether the female condom might help HIV prevention among men having sex with men.
• “It may be be important to reflect not on what has been said, but on the silences.”

5. Policy: Bernard Forbes of the United Kingdom

• “Human rights are under attack in so many quarters, with the predictable consequence of undermining everything else that we do.”
• Youth, sex workers, injecting drug users, transgendered people and those in jail suffer from “the triumph of ideology over science” in the lack of programs for them.
• The criminalization of methadone in Russia and the U.S. ban on federal funding for needle exchange among the policies “undermining the application of human rights frameworks.”
• Mechanisms must be set for holding governments accountable for their human rights and other commitments.
• To scale up programs to meet the need, “We must build health systems, recruit health workers … and we need more nurses. Until we get them, universal access is just a mirage.”

Key messages from the 16th International AIDS Conference

The overall theme: it’s time to deliver on promises made over the past few years for money, medicines, and health care workers.

• Fund the Gap

Despite a quantum leap in financial resources for the fight against HIV/AIDS, the $8.3 billion made available from all sources in 2005 is little more than half the $14.9 billion needed in 2006. UNAIDS projected the need at more than $22 billion in 2008, while Stephen Lewis said that $30 billion would be needed by 2010.

• More health care workers are urgently needed.

Africa faces a shortfall of 1 million health care workers, while the world overall needs another 4 million health professionals, according to Lieve Fransen of the European Commission. Lack of AIDS treatments for themselves, low pay, burnout and lack of equipment induce many to migrate or leave the field.

• Women are central to success.

The majority of new infections are among women. Discrimination and violence make too many girls and women powerless to negotiate safer sex. Grandmothers are doing “heroic” work as caregivers for the sick and AIDS orphans, but they go unappreciated and unrewarded.

• Young people are being shortchanged.

Half of Earth’s population is under 25, but most are not getting the education and services they need to protect themselves from HIV. They want to be included in the debates on policies that will determine their lives. Very few children are being treated at all.

• New technologies offer hope.

Microbicides are on the horizon. Pills to prevent infection and vaccines are the subject of heavy research. But existing technologies are not yet being delivered to all who need them.

• Behavior change is difficult

“People do not intend to get infected,” stressed a Brazilian researcher, but are usually thinking about something else, like love or sex. AIDS education program offer dry information and facts, according to Mary Crewe, rather than equipping people to live.

• Condoms are important and still in short supply

New prevention technologies were hot news, but we still can’t get the old ones to all whose lives they would save. Male condoms remain the only proven technology for preventing HIV infection, yet only one-fifth of those in need have access, according to Quarraisha Abdool Karim of South Africa. Donors such as the United States and UNFPA provided 2.4 billion condoms in 2004, but at least 16 billion are needed each year, said Population Action International.

• Abstinence-only programs don’t work

An American ex-president and a priest from South Africa were among the many criticizing abstinence-only sexuality education programs. Former President Bill Clinton noted that they may delay slightly the age at which young people first have sex, but little else. “Gender inequities make ABC difficult to implement,” said rapporteur Michael Tan in probably the kindest description of the Abstinence, Be faithful and, if all else fails, use Condoms approach, which is most associated with the U.S. government. The Rev. J. P. Heath said such programs “put the entire burden of prevention on young girls.”

• Harm reduction programs for drug users do work

“The scientific debate is now over,” said Alex Wodak of Australia. Ten percent of HIV infections occur among injecting drug users, and they are fueling HIV epidemics in eastern Europe and Asia. But only about 4 percent have access to needle exchange programs, alternative drugs such as methadone, or other harm- reduction interventions.

• Mother-to-child transmission can be prevented

The success of programs to prevent mother-to-child transmission is well-established, yet fewer than 10 percent of HIV-positive women have access, according to Elaine Abrams of Columbia University. New WHO guidelines stress that mothers’ survival is key to that of their children, so many women who are not receiving long-term anti-retroviral therapy should be.

• Bring people living with HIV/AIDS into decision-making

In the Paris Declaration in 1994, 42 countries agreed to the principle of greater involvement of people living with HIV/AIDS in the design, development and implementation of AIDS programs. But most are still excluded, especially young people, sex workers, men having sex with men, injecting drug users and transgendered people.