Mexico City Highlights: Looking at AIDS Globally and Locally
by CFSC Consortium Staff
2008 UNAIDS Report: Global AIDS Epidemic Slowing; Need for New Prevention Tools Urgent
- The latest UNAIDS report indicates, among other things, that new HIV infections and AIDS-related deaths are declining. With nearly 7,500 new infections every day, however, new prevention tools, such as an AIDS vaccine, are still urgently needed to turn the tide on the epidemic.
United States Government Passes $48 Billion Global AIDS, TB and Malaria Plan
- On July 30, the United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008 was signed into law. International AIDS Vaccine Initiative applauds this historic bipartisan effort, which marks a significant step forward in addressing three of the largest global killers, HIV/AIDS, TB and malaria.
Focus on Prevention
- It is one thing to know the numbers of people with HIV are increasing. And it’s a whole different matter to stop the progression throughout our community. "Today, there are many effective strategies to prevent HIV, and all nations of the world must commit fully to their implementation," said Dr. Luís Soto Ramírez, local co-chair of AIDS 2008 and head of the molecular virology unit at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Coordinator of the Clinical Care Committee of CONASIDA, Mexico's National AIDS Council.
Time is Wasting, National Plan Needed, Black Leaders Say
- Founded in 1999, the Black AIDS Institute is the only national HIV/AIDS think tank in the United States focused exclusively on black people. The mission of the Institute is to stop AIDS in black communities by engaging and mobilizing traditional black institutions, leaders, celebrities, media organizations and clergy in efforts to confront AIDS. The Institute offers training and mobilisation from a uniquely and unapologetically black point of view.
- Reporting for the Institute’s Web site, Jerry Thomas wrote from Mexico City: “Angered that the HIV/AIDS epidemic in the African American community has been neglected and is on the rise, while U.S government funding has been stagnant and its priorities have been global, Black leaders gathered in Mexico City called for the U.S. government to create and implement a new National AIDS strategy. …[Institute representatives] also appealed for the U.S. government to commit $1.3 billion annually to HIV prevention, an amount they said is needed to reverse the large and growing AIDS epidemic in the United States, especially in the African American community where the largest growth is occurring.
Bill Clinton: More to Do at Home
- Reporting for the Institute’s Web site, George Curry wrote from Mexico City: “Former President Bill Clinton, who has focused much of his private foundation activities on AIDS in Africa and the Caribbean, acknowledged … much work still needs to be done in the United States and indicated his foundation will now shift some of its resources to the domestic front, especially targeted for African-Americans. "For Americans, this should be a wake-up call," Clinton told an enthusiastic audience. "Even as we fight the epidemic globally, we must focus at home. And I intend to do so with my foundation."
- Meanwhile the Centres for Disease Control and Prevention acknowledged that it has been underestimating the number of people infected with HIV, the virus that causes AIDS, by 40 percent.
Experts: Scale Up HIV Vaccine Research
- Even though true results of HIV vaccine research have been "unrelentingly negative,” scientists still should increase efforts to develop a vaccine, HIV/AIDS experts said. According to AFP/Google.com, of the 50 HIV vaccine candidates that have been tested in humans, only two reached Phase III trials. Neither was effective. Today some 30 vaccine candidates are in trials, AFP/Google.com reports (AFP/Google.com, August 4, 2008).
- Tadataka Yamada, executive director of the global health program at the Bill & Melinda Gates Foundation, said that although HIV vaccine development is difficult, its benefits could be dramatic.
Social Exclusion and Lack of Prevention Programmes
- International AIDS Society (IAS) is the world’s leading independent association of HIV/AIDS professionals, with 10,000-plus members from 185 countries. As the convener of the International AIDS Conference and the IAS Conference on HIV Pathogenesis, Treatment and Prevention, IAS has a unique opportunity to bring together individuals working in diverse settings and disciplines, from areas of the world separated by geography, culture, language and resources, and to leverage the expertise and knowledge of its members in an effective, sustained global response.
- The Global Forum on MSM & HIV (MSMGF) is a network of community-based organizations, AIDS service organizations, MSM groups and other agencies that work at the global and national levels to advocate for improved HIV programming for MSM. With a secretariat housed at AIDS Project Los Angeles, and a steering committee of 21 members from 17 countries in the Global North and South, MSMGF is committed to responding to HIV/AIDS among gay men through advocacy, education and programmes that promote human rights and support the empowerment of MSM around the world.
- The AIDS 2008 Web site reported: “Social exclusion and lack of HIV prevention programmes for men who have sex with men are escalating new HIV infections in major cities of the global south. 25 years into the AIDS epidemic, only one in 20 men who have sex with men has access to HIV prevention programmes; 91 out of 128 low- and middle-income countries fail to report on access for MSM to HIV prevention programmes.
- “The invisibility of men who have sex with men (MSM) in many low- and middle-income countries across the globe is contributing to inadequate resources being given to HIV prevention programmes despite MSM accounting for significant proportions of new infections in those countries, delegates were told today at the XVII International AIDS Conference (AIDS 2008). Criminalisation, prejudice, social hostility and human rights abuses towards MSM are boosting the spread of HIV.
Speakers urge family-centred approach to children’s and sex workers’ rights
- AIDS 2008 attendees received an update on the future prospects of eradicating HIV and were urged to give greater attention and resources to the needs of affected children. Plenary speakers argued for a focus on the realities of sex workers’ lives.
- “’The persistence of HIV in latent reservoirs presents a major challenge to the ultimate goal of eradicating HIV from the human body,” said Dr. Pedro Cahn, International co-chair of AIDS 2008 and president of the International AIDS Society and Fundación Huésped in Buenos Aires , Argentina. “While researchers strive to answer this and other key scientific questions, we cannot afford to squander the prevention and treatment knowledge that already exists today.”
- “Ignoring the needs of children affected by HIV, and continuing to marginalise groups at greatest risk for infection will only lead to more new infections and fewer people on treatment,” said Dr. Luís Soto Ramírez, Local Co-Chair of AIDS 2008 and head of the molecular virology unit at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and coordinator of the clinical care committee of CONASIDA, Mexico’s National AIDS Council. He warned attendees: “We will pay for such foolishness in the future.”
Re-evaluating Prospects for Eradicating HIV
- The AIDS 2008 Web site reports: “Dr. Robert Siliciano (United States) of the Howard Hughes Medical Institute and Johns Hopkins University presented data on HIV persistence in people on highly active antiretroviral therapy (HAART) and the prospects for eradication of HIV. Siliciano demonstrated that HAART can stop viral replication of HIV but cannot eradicate it from the body because of the persistence of HIV in a reservoir in resting CD4 T cells. The reservoir, which researchers have characterized in detail, allows the ongoing production of the virus during HAART.
- “According to Siliciano, HAART’s demonstrated ability to stop replication is one of the three steps needed to cure HIV. The other two are identifying all the stable reservoirs for the virus, and finding ways to subsequently eliminate them.”
No Small Issue: Children and Families
- The AIDS 2008 Web site reports: “An estimated 2.1 million children younger than 15 years were living with HIV in 2007, 90 percent of whom are in sub-Saharan Africa. More than 90 percent were infected through mother-to-child transmission. Pregnant women’s access to antiretrovirals to prevent transmission to their children has increased substantially in recent years, from 10 percent in 2004 to an estimated 33percent in 2007. Though children’s access to antiretroviral treatment has also increased, from 75,000 in 2005 to 198,000 in 2007, it is substantially lower than the coverage rate for adults.
- “In her plenary address, Linda Richter argued that, while affected children have been highly visible in photo opportunities and headlines about AIDS, their real needs have been consistently overlooked. An estimated two million children are living with HIV today, and many millions more are directly affected by the epidemic through the illness and death of their parents or caregivers, emotional distress, material deprivation, and lack of access to treatment, support, basic health services and education.
- Richter called for the development of family-centred approaches to address the needs of all children affected by HIV and AIDS. She advocated that social protection services that support families and communities in caring for children be central to such efforts. In addition, economic assistance for poor families, particularly through income transfers, is a crucial missing ingredient in a comprehensive response to children affected by HIV in both low- and high-prevalence settings.”
Some Good News—and Sobering Insights—on AIDS
- The Black AIDS Institute runs a conference update with some good news—and sobering insights as to why African Americans are so hard-hit by the pandemic: “In the 1980’s, 1,500 infants were born with HIV,” said Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. That number dropped to less than 60 for 2006. This is due to better screening, better awareness and infants being provided with antiretoviral therapy. The decline of mother-to-child infections is perhaps the major success story in the fight against HIV/AIDS.
- With increasingly advanced technology and with health care provided for these children, it enables them to fight the virus more effectively. That all sounds good. But while the numbers are declining for other populations, the numbers are not declining in the black communities. In 2005, out of the 141 prenatal infections among infants, 65 percent of them were black, and they continue to make up the vast majority today.
- “AIDS is a disease of poverty. Just like in Africa, the poor have less knowledge about it, and even when they do know, the supply is not there,” said Dr. Agnes Binagwaho, executive secretary for the National Commission for the Fight Against AIDS in Rwanda. She is a specialist on HIV/AIDS in Africa and around the world. …HIV/AIDS in infants can be transmitted in several ways, including before labor, during labor, and even afterward with the feeding of breast milk. However, experts say that many Black women are uneducated on this issue and therefore do not take the proper precautions.
In Binagwaho’s opinion, there is still a long way to go to diminish the number of Black children born with HIV. “There is a need for strong structural innovation and change,” she said. “We need to increase the access to care and the quality.”
Sex Workers: Part of the Solution
- The AIDS 2008 Web site reports: “Elena Reynaga (Argentina) of RedTraSex issued a stirring call for the full recognition of sex workers’ rights and for the ability of sex worker organizations to develop and implement effective HIV/AIDS programmes rooted in the realities of their lives.
- “Evidence shows HIV prevalence has been lowered in regions such as South America, where sex work is actually recognised as “work” and sex worker organizations receive direct support. In Brazil, for example, programmes based on strategies that incorporate peer outreach, promotion of sex workers’ rights and the abolition of laws that repress sex work have been shown to be successful. Critical to reducing HIV infections among sex workers is fighting stigma and discrimination by continued efforts to decriminalize sexual work, end police violence and sensitise the media.”
One-Size-Fits-All Fix For US HIV-AIDS Epidemic Wrong
- Linda Villarosa writes for the Black AIDS Institute’s Web site: “At past international AIDS conferences, a session on prevention wouldn't have drawn enough attention to fill a large meeting room. In previous years, treatment dominated the conversation. “But this year the theme of prevention has bubbled to the surface among the tangle of panels and workshops, debates and discussion among the 22,000 attendees.”
- Tuesday's morning plenary on the topic was filled to capacity and several other sessions hummed with interest and energy. Later, at The Lancet Series on HIV Prevention session, hundreds of people packed into the session room and many others stood outside, unable to get in. And it's not just prevention as usual. Throughout the conference, scientists and activists have called for new ways to staunch the spread of HIV throughout the world. Last year, 2.7 million people were newly infected, most in sub-Saharan Africa.
- “Prevention has not only been marginalised, but in some places it's been suppressed for political, religious or social purposes,” said Richard Horton, editor of The Lancet, the British medical magazine that devoted its most recent issue to HIV prevention. “We have to redefine prevention, to create a new dialogue of what we mean by prevention."
CDC´s New Technology
- Writing for the Black AIDS Institute’s Web site, Jerry Thomas reports: “Dr. Kevin Fenton, who oversees the CDC's [Centre for Disease Control] prevention efforts for HIV/AIDS, said new data from the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) will be available in the fall to provide the “clearest picture of the U.S. epidemic.”
- “STARHS is able to determine how many people become infected with HIV during the year, and it can gauge the spread of the disease among African-American heterosexuals, women and children. The test, officials said, is also able to determine if the HIV infection occurred within the last five months.”
Experts Call for Ending AIDS Through a Vaccine
- The AIDS 2008 conference Web site reports: “The end of AIDS is nowhere in sight,” said Dr. Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS in remarks made during the opening ceremony of the conference.
“It’s true that the number of infections is declining, but consider this: if the world can be satisfied with 2.7 million people infected per year, 7,500 per day, then I’m not sure where the standards are for declaring something a total disaster. … What I see is that we are making progress through combination prevention, but in order to stop the epidemic, there’s no doubt that we’ll need a vaccine,” Piot later said at a press conference hosted by the International AIDS Vaccine Initiative (IAVI) announcing the release of the organization’s AIDS Vaccine Blueprint 2008.”
JULIO MONTANER (CANADA) BECOMES IAS PRESIDENT
ELLY KATABIRA (UGANDA) ELECTED IAS PRESIDENT-ELECT
The conference Web site announces: Dr Julio Montaner has been named new president of International AIDS Society as the XVII International AIDS Conference closes in Mexico. Dr Elly Katabira from Uganda becomes the new president elect, the first African to hold the position.