[dropcap]O[/dropcap] ver the last week, your Nigeria Health Watch team has been at the 21st International AIDS Conference, the largest conference on any global health or development issue globally. Many of the burning issues on HIV/AIDS discussed at the conference, which was back in Africa after 16 years, have significantly moved on from the dark years of AIDS denialism during the Thabo Mbeki presidency. This conference always provides a unique forum for the intersection of science and advocacy – it was the same this year. Below we bring you our highlights of the conference.
- South Africa’s Progress: The first highlight of the conference has to be the progress reported by South Africa over the past 16 years, since the conference was last held in Durban in 2000. It has put 3.4 million people on treatment, funded by the South African government itself. By being the single largest procurer of ARVs in the world, it has pushed down prices, which benefits all other countries. As South Africa completes its plans to fully implement, from September 2016, WHO’s new recommendation of “Test and Treat” for HIV, removing the previous limitation based on CD4 count, the number on treatment will increase further, and they will benefit from the benefits of treatment on prevention. In addition, South Africa has reduced mother-to-child transmission by 85%, from 90,000 to about 5,000 per year. There is absolutely no doubt about it – South Africa has shown real leadership on HIV/AIDS on the continent. Globally, however, we still have a long way to go: only 41% of the people living with HIV are using ART, but this is still massive progress as compared to less than 2% in 2000.
- Lack of progress on prevention: Worldwide the reduction of new infections across the world has stalled at about 2 million annually. A study, published in The Lancet during the conference showed that 74 countries saw increases in rates of new infections between 2005 and 2015. Despite the progress seen with access to ARVs, it is obvious that we cannot treat ourselves out of this epidemic. Efforts on prevention need new tools, and combining available tools. The community is hoping for a prevention tool that enables women to have more power in decision-making. Results presented at the conference of innovative approaches such as efficacy trials on the Dapivirine vaginal ring only showed modest success at about 30%. There was consensus among delegates that we need intensified and accelerated development efforts for prevention tools, as well as more investment in HIV vaccine research.
- The role of Key Populations: It is now clear (if it ever was not) that it is impossible to reverse the epidemic’s trajectory by hiding our heads in the sand. As Charlize Theron said at the opening ceremony, “As long as we let racism, sexism, poverty and homophobia get in our way – the epidemic will continue.” One of the most moving presentations was by activist Michael Ighodalu, who eloquently described the danger of living as a gay man in Nigeria. Ighodalu shared the story of his friend Danny, a gay man, who was HIV positive and coping, until his employers found out his status. They sacked him, depriving him access to his medicines, and he eventually died. Ighodalu ended by saying, “I am an African, but I am gay. This is who I am.” The question; on how much the new laws criminalising homosexuality in countries like Nigeria have deprived key populations of access to health services and HIV care and treatment arose during the conference, with few answers.
- High infection rates in young girls: A disturbing trend was reported in South Africa and a few other African countries: a cycle of HIV transmission driven by high rates of new HIV infections in adolescent girls and young women, from men who were on average eight years older, as reported by a recent CAPRISA study, which was presented at the conference. It is obvious that this is an increasing and persisting problem and conventional forms of prevention, such as using condoms, where men control most of the power, will not be enough to prevent this. Salim S. Abdool Karim, based in Durban and one of the leading researchers on HIV said, “Reducing new HIV infections in young women is one of the greatest challenges in Africa.” Throughout AIDS 2016 we were reminded of the enormous impact of HIV on adolescent girls and young women, especially in Africa. Those interested in how high quality/ high impact research happens should read the about the CAPRISA Institute in Durban, South Africa.
- Justice Edwin Cameron’s second speech: One of the highlights of the 2000 International AIDS conference was a speech delivered by Judge Edwin Cameron, drawing attention to his privileged position of being on ARVs in a continent in which almost no one else did. Sixteen years later, he was invited again to deliver the Jonathan Mann Lecture, and again, he received a standing ovation for his stirring talk on the role of stigma, especially self-stigma, in driving the epidemic. He described this, “ The effect of the internalisation of stigma within the minds of those who have HIV and who are at risk of it … is located deeply within the self… self-blame, self-stigma and self-paralysing fear are all too often deadly. To close, he noted that much progress has been made with HIV/AIDS but challenged the community to continue working on the social and political determinants of HIV– gender, education, access to health care, and access to justice. He ended by reminding us that: “All it requires is a passion and a commitment and a courage starting within ourselves… starting within each of ourselves… starting now.”
- TB and HIV co-infection: It was sung like a hymn through out the conference, including a powerful plenary by Anton Pozniak, stating that attempts at dealing with one of these two diseases while ignoring the other would never succeed. He reminded us that TB causes more deaths than HIV, yet barely gets the recognition or indeed, the funding. “TB is the leading cause of death among PLWHIV, accounting for one in five HIV-related deaths”. He ended by prescribing three approaches that countries should vigorously implement:
1) Find the TB Cases- and treat them with TB drugs and ART (if HIV positive).
2) Find those at risk of TB –Treat them with ART and TB preventative therapy (IPT).
3.) Integrate TB and HIV services that deliver this care into a Universal Public Health approach. Patients with either HIV or TB are prevented from getting the maximum benefits of treatment if one is managed seperately from the other.
- Nigerian researchers thrive despite the absence of Nigerian research: While there was very little from Nigeria to address the many questions regarding the size of the epidemic in Nigeria as well as the response, there were still a number of Nigerians presenting their work. The highlight was Amara Ezeamama who was one of six recipients of the 2016 prize for Collaborative Initiative for Paediatric HIV Research for a study in Uganda. We met a handful of other Nigerian colleagues presenting mostly posters mainly about operational research on projects that they were implementing. But, they deserve a lot of credit for persevering, in a context where there is almost no funding dedicated to science.
- The critical role of Civil Society Organisations (CSOs): The conference, as we have mentioned, highlighted the role of advocacy in the continued fight against HIV. During the course of the conference, several speakers pointed out the fact that in South Africa part of the progress made over the past 16 years relied on the efforts of strong HIV/AIDS civil society advocacy groups. Several were visible during the week, most especially the Treatment Action Campaign (TAC), Section 27, and groups advocating for key populations. TAC has been at the forefront in putting and keeping the HIV struggle on the political agenda in South Africa. There was a call for civil society groups to continue holding their governments to account as well as a call to ensure that the freedoms of civil society groups were not encroached on by restrictive governments. It’s been a long struggle, but it definitely is not over.
- The Global Fund: The Global Fund, or more importantly, the funding of the Global Fund, featured frequently as one of the key calls to action at the end of many of the plenary speakers presentations at the Conference. Commitments to the Global Fund are waning, and advocates as well as researchers called on governments to increase or maintain their commitment to funding the Fund. Global Fund representatives at some of the sessions maintained that the goal was to raise $13 billion in the next round of the Fund, which will contribute to the overall funding for the HIV response. At the same time the importance of domestic funding was also highlighted, with political will and commitment to the fight highlighted as one of the positives that helped turn the tide in South Africa.
— Nigeria Health Watch (@nighealthwatch) July 20, 2016
- Addressing Pediatric HIV: It is estimated that around 1.5 million women living with HIV become pregnant each year. Without access to ARV treatment, up to 40% of babies born to these mothers will also get HIV. Nigeria has the highest burden of this in the world, with 60,000 new babies born HIV positive, every year. If these babies are unable to access treatment, 50% will die before their second birthday. There were several impassioned pleas during the conference for a more directed focus on pediatric HIV research, treatment and care, while at the same time working to reduce mother to child transmission. Organisations like the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) held satellite sessions during the conference which focused on closing in on virtual elimination of HIV: from tackling the disease in adolescents to realizing full-scale implementation of the 2015 WHO treatment guidelines. We have to move our ambitions on HIV in children and ensure that we prevent as many infections as we possibly can (for this we have the tools) and in those that are infected – ensure that they have a full and productive life.
Altogether, we at Nigeria Health Watch hope the AIDS 2016 Conference will be a watershed moment in the history of the HIV response, much as the 2000 Conference in Durban was. It clarified for researchers, advocates, policy makers and funders just how far we have come in this 35-year battle against a common, deadly, non-discriminatory enemy… and just how much still needs to be done… before 2030 which is the goal to end AIDS as a public health problem.
Photos from the AIDS 2016 Conference