Post AIDS 2012 – The race to save lives

Activists participate in a civil disobedience outside the White House after a march from the Washington Convention Center 24 July, 2012 in Washington, DC. (Credit Getty Images)

The 19th International AIDS conference may have concluded last week but the work to really end AIDS continues. There are old strategies that need revisiting and new ones that need fine tuning, but the challenge is how to prioritise. Where should we be investing our energies and resources? Depending on who you talk to, what to prioritise is going to be different from one person to the next. However, these are some of my thoughts, not necessarily in any order of priority, but very much influenced by what I heard, observed and learnt at the conference.

There is a need to revisit HIV information campaigns. It sounds very basic and obvious but the lack of information is making people vulnerable to HIV infection, in both the global north and south. Depending on the context, more HIV awareness and education campaigns need to be re-invigorated so that people know that HIV prevention and treatment has moved on. Although it is a known fact that anyone can get HIV, many people still do not realise or have consciously refused to accept this. For instance, many information campaigns have never included married couples and older people in their HIV prevention messages. We now know that because of marriage trends, divorce rates and other social factors, in some places around the world, married and older people are becoming more vulnerable to HIV infections than ‘key’ populations, due to lack of information or right messaging in awareness campaigns.

The work of empowering religious leaders and supporting them to work with communities on HIV is also critical. As someone who works for a faith-based organisation, I know that we now have more HIV-friendly faith leaders as well as HIV competent places of worship than we have ever had, but a lot of work still needs to be done. The right comprehensive strategies are necessary and there is evidence to show that strategies like the SAVE Approach are effective in giving faith leaders the confidence to talk about HIV to their congregations. But we need to go further and not let them work in isolation – we have to build effective and meaningful partnerships with them for a robust HIV response.

Once people have the most up-to-date information, it is a step forward to reducing HIV related stigma and discrimination as well as getting them test for HIV. People have to be given as much support to access and deal with HIV test results, whether negative or positive.

Countries that still have travel bans for people living with HIV entering their countries need penalising – the time for a softly, softly approach has expired. They need to get be told in no uncertain terms that they are contributing to increasing HIV stigma and discrimination, and they might be given a taste of their own medicine by being side-lined at HIV international meetings or conferences until they lift their restrictions.

Access to HIV treatment for all has to continue to be one of the leading areas for investment. We know what treatment can do in terms of preventing infections and keeping people alive – truly a modern day miracle. Even in places like Washington DC where HIV could be dealt with much, much better, one of the best pieces of news is that not a single baby has been born with HIV this year! Now that is truly amazing and should be replicated everywhere.

The HIV treatment pipeline is relatively healthy with possibly about 15 different drugs already in phase II to III trials. The challenges are access in terms of cost, healthcare centres, and transparency and accountability processes within countries that become barriers for people in developing countries getting the treatment they need.

Investment in HIV treatment should be matched with investment treatment literacy. It is critical for people who are going to take treatment for the rest of their lives to know as much about their treatment as possible and to then educate communities in which they live, building on the work of health workers and other treatment activists, especially as ‘treatment as prevention’ gets rolled out.

Research in vaccines and better treatment for opportunistic infections like tuberculosis (TB), still the biggest killer of people living with HIV, is also necessary. Fortunately some of this work is already happening.  Clinical trials of new TB vaccines over the last decade have resulted in a dozen vaccine candidates, and researchers are about to learn results of the largest study of a new TB vaccine in infants since the development of the partially effective BCG vaccine in 1921. While an effective vaccine is still far off, this is considered a very exciting milestone in the TB vaccine field. Watch this space!

There are a lot of things that need to come together to help revive and accelerate the progress of the HIV response, but ultimately, an effective HIV vaccine and a cure are what we need to end AIDS. Huge financial resources are required among other things, but I am optimistic that we will make sensible decisions going forward because too many lives are at stake.

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• http://twitter.com/DeGuyz_n_MS Jimmy

  Have you noticed that as soon as the patents started expiring for some current HIV/AIDS medications these vaccines started making news? Just a thought.