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World Aids Day 2013: No time for complacency

Dr Sima Barmania
aids 300x193 World Aids Day 2013: No time for complacency

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Sitting in conversation with Professor Sharon Lewin in Bangkok, it is difficult not to be stunned into silence by her encyclopaedic knowledge of HIV. Lewin is a basic scientist, physician and head of the Department of Infectious Diseases, Monash University and Co-Chair of the international AIDS conference (AIDS 2014) being held in Melbourne next year.

She also spearheads the ‘Towards an HIV Cure project’, an initiative of the International AIDS Society (IAS) which advocates a greater investment in HIV cure research.

She explains the central immunological principle of ‘latently infected cells’ which she says “has  redefined what a cure for HIV would be”, thus moving to the more appropriate term of what she describes as a ‘functional cure’, akin to when cancer is described as ‘in remission’.

Although, current treatment for HIV is ‘excellent’, she says animatedly; she also emphasizes the need for long term investment.

However, there have been critics that have questioned whether there has been, in fact, too much investment to combat HIV which has been to the detriment of other diseases. I put forth the question to Lewin, who is quick to express emphatically how there has been “minimal investment in a cure” and that there are “lessons learnt” from HIV that are transferrable to other diseases.

“Progress in HIV is unparalleled” says Lewin and explains that the development of Anti Retrovirals (ARVs) have not just been of benefit to sufferers of HIV but also to other viruses such as Hepatitis C, because they may be a “different virus, but share the same common pathway.”

In addition, she says the story of HIV “has taught us how to integrate communities into health care decisions.” But Lewin is careful to balance the quest for a cure with the ever present need for prevention. It is a concern also resonant with Professor Chris Beyrer of the Johns Hopkins Bloomberg School of Public Health in the United States, who believes it’s a challenging time in the world of HIV prevention.

Speaking with Beyrer he explains that in his opinion: “the current prevention efforts are not working”.

“We have a limited number of prevention tools, insufficient tools and tools that are not reaching sufficient coverage”.

Beyrer led an international team of researchers who published a series in the Lancet medical journal last year on HIV among men who have sex with men. He explains that in this group there is an “expanding epidemic in Thailand, China, and Malaysia and even in UK and Australia”.

“I know an epidemic when I see one”. He states forebodingly, referring to the Asia Pacific region.

“Men are hidden – either actively excluded or exclude themselves…as well as structural barriers and stigma. Laws do make a difference. It undermines stability, when you have repression the only places available where men can have sex are furtive, such as saunas, high risk environments.”

This is particularly the case in the Asia Pacific region and young men who have sex with men are particularly at risk. A 27 year old Bangkok resident named Tung Bui is well versed on the subject and is the coordinator of Youth Voices count!, a regional network to tackle HIV related health issues of young men who have sex with men.

“HIV is taboo,” says Bui but explains that we can utilize social networks to leverage the power of online platforms. Bui calls for HIV programming that is more people centred.

He explains: “if it’s all about HIV, it’s scary and you can’t scare people any more.”

Adding further, he explains the need to tackle psychosocial issues: “Youth feel they don’t have a future, they have low self-esteem, self stigma and engage in self-destructive behaviours.” All of this makes them more vulnerable to HIV. He feels there is a need to create a “supporting environment, rather than one of criminalization”.

It is certainly timely then on December 1st, UNAIDS is launching the #Zerodiscrimination campaign . The campaign in collaboration with Nobel Laureate UNAIDS and Aung San Suu Kyi serves to spread awareness about stigma and discrimination surrounding HIV, for example travel and work restrictions for people living with HIV as well as other laws which discriminate people who are already living with HIV and punitive laws that make it difficult to prevent HIV.

Certainly, it is an interesting time in the field of HIV, while there has been optimism at the unprecedented scientific discovery over the past few years there is also concern over emerging new epidemics as well as how HIV will fit in with the post 2015 Millennium Development Goal agenda.

On World Aids Day 2013, there is certainly cause for congratulations on the astounding achievements made, there is equally cause to reflect on the fact that there is still much to be done, challenges ahead and definitely not time for complacency.

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