International AIDS Society Conferences come in two sizes. They alternate. Next year will be the big one in Amsterdam which deals with the whole panoply of HIV knowledge, including science and research and more. It will likely attract about 20,000 people.
This year’s alternate year conference was just about HIV science, a smaller affair with 8,000 or so of us in attendance from 40 countries with an agenda less community-based. In other words, it was potentially a bit dull. This one certainly wasn’t. The IAS themselves called it “an extraordinary week”. And for those like me, working in the Undetectable = Untransmittable campaign, it was intensely exciting, affirming of the role of people living with HIV in the response to the epidemic - and euphoric. More on that in Part Two.
I was privileged to be there. It’s important for us who, by hook or by crook, got to go to Paris - some of us paying our own way, some not - to acknowledge we are the lucky ones. We work like dogs there though. We seldom rest. We come home exhausted.
We also saw – and proved it ourselves - that activism is far from dead. Interruptions and protests during plenary sessions were commonplace. The people in U=U t-shirts were everywhere; many observers I spoke to acknowledged that U=U was a dominant theme, that we “owned” the conference. People saw the mainstreaming of the work of grass roots activists bloom in front of them – our work - like a rare and exotic flower. And they applauded.
Here are some of the other main themes that emerged;
We have come a long way. This was the first international conference ever that saw more people globally on treatment than are not. Said the UN about this “more than half of all people living with HIV (53%) now have access to HIV treatment and AIDS-related deaths have almost halved since 2005. In 2016, 19.5 million of the 36.7 million people living with HIV had access to treatment, and AIDS-related deaths have fallen from 1.9 million in 2005 to 1 million in 2016. Provided that scale-up continues, this progress puts the world on track to reach the global target of 30 million people on treatment by 2020” said Michel Sidibé, Executive Director of UNAIDS.(left) “We will continue to scale up to reach everyone in need and honour our commitment of leaving no one behind.”
90-90-90 is attainable. In fact seven countries have already achieved the 90–90–90 targets—Botswana, Cambodia, Denmark, Iceland, Singapore, Sweden and the United Kingdom and many more are close to achieving it. The latest UNAIDS report says that two thirds of people living with HIV now know their HIV status. Of these, 77% were accessing treatment, and of the people accessing treatment, 82% were virally suppressed, protecting their health and helping to prevent transmission of the virus. Thus instead of 90-90-90 we are currently at 70-77-82. Meanwhile new infection rates have declined by 29% globally since 2010.
But it all depends on money Scientists are getting jittery; donation levels fell by 7% last year. “President Linda-Gail Bekker warned in her speech at the opening ceremony that if the proposed funding cuts by the US administration to HIV programs and research become a reality, the impact on current and future scientific advances would be “devastating” for the global response to the epidemic.” In response the IAS had earlier issued something they called “The Paris Statement” whose theme was “Science Matters.” “We cannot achieve ambitious global goals, provide life-long treatment to the 37 million people living with HIV and reduce the epidemic without an unfaltering commitment to research” it says. It goes on to name areas like vaccine development, drug formulations and adherence support where the need is most apparent. My minority opinion was that this was all motherhood, a bit ho-hum and that the Paris Statement will not have a lasting impact. Much better was the community response to it – Paris 2017- Key Populations - Community Actor’s Declaration. Designed as an update on the Denver Principles, it’s an admirable but jargon-heavy document worked on by good people that made all the right points. Better still, it includes a nod to U=U: “Universally adopt the U=U Consensus Statement on undetectability and transmission risk through sexual contact and utilize this scientific fact as a leverage for increased investments into the global HIV/AIDS response to realize universal access treatment and care.” It was presented to the Mayor of Paris who then forwarded it to the President of France. But will it make a difference? These documents seldom do, but let’s hope, Watch for a report back at IAS2018 to prove me wrong.
Injectable drugs may be the way of the future. Don’t like needles? Watch out. Both HIV treatment for those infected and PrEP for those avoiding it may soon be delivered in long lasting monthly or bi-monthly injections. Meanwhile our knowledge of and enthusiasm for PrEP is growing by leaps and bounds with occasional use for those who don’t often have sex (PrEP on demand) being as effective as the more often discussed daily dosage.
Treatment as prevention really does work just fine including for men who have sex with men.. My home province of Ontario denied this for years with disastrous consequences. Opposites Attract proved them very wrong. More on that in Part Two.
Early diagnosis makes more and more sense. Like within seven days. It means that people are more likely to be retained in care, more likely to quickly reach an undetectable viral loid. (That’s good for them, good for public health, I say.) We knew this instinctively but research from Haiti and now Uganda proves it. Now it forms the basis for a new World Health Organization (WHO) recommendation. Is your community ready for it? Ask your service providers.
Want more? For the best HIV science reporting on the web I recommend Gus Cairns from NAM/aidsmap. Go here for detailed reports on everything discussed here, the most important sessions at IAS 2107 ad links to abstracts and videos of many official sessions.
Watch for Part Two of my conference report, “U=U makes a huge splash.”