AIDS2014 2014 International AIDS Conference Australia

At the 2014 International AIDS Conference in Melbourne, Australia, one of the questions being asked is: “Where should the world focus its attention in the AIDS response?” 

In the recent Gap report, UNAIDS highlighted the importance of location and population. The report shows that 15 countries account for more than 75% of the 2.1 million new HIV infections that occurred in 2013. The countries—Brazil, Cameroon, China, India, Indonesia, Kenya, Mozambique, Nigeria, Russian Federation, South Africa, Uganda, United Republic of Tanzania, United States of America, Zambia and Zimbabwe—can all make a positive impact by scaling up HIV services where they are most needed to reduce new HIV infections.

This was one of the issues highlighted by the UNAIDS Executive Director, Michel Sidibé, when he met with Nafsiah Mboi, the Minister of Health of Indonesia—which is working to increase access to HIV testing and early treatment—at the conference.

“I know that Indonesia can quickly change the trajectory,” said Mr Sidibé. “The government is committed and has the capacity to accelerate scale-up and I expect we will see the results soon.”

Countries often face multiple epidemics and hence there is an increased urgency to focus at the city and district level in order to effectively reach the people currently being left behind.

“Countries with the highest burden have to do the heavy lifting to end the AIDS epidemic and provide services to all affected people—location by location, population by population,” said Mr Sidibé.

Populations at higher risk of HIV infection are often difficult to reach. India has sustained investments in key populations for more than a decade and expanded outreach in more than a thousand locations within the country. In the Russian Federation, despite clear scientific evidence of the impact of harm reduction services, very few people who inject drugs have access to opioid substitution therapy and needle–syringe programmes.

Brazil, which has been a pioneer in the AIDS response, has recently seen HIV infections rise among young gay men and other men who have sex with men. Health authorities and civil society groups in Brazil are exploring innovative new ways to get life-saving information and treatment to a new generation of young men who may not know they are at higher risk of becoming infected.

In Mozambique, new data analysis shows that the districts with the highest density of people living with HIV are located along transport corridors and in important seaports in the central and southern regions of the country, and the country is now beginning to expand access to HIV services in these areas.

In Nigeria, a similar analysis led to a focus on 13 states, including the Federal Capital Territory, which includes Abuja, for intensifying scale-up. South Africa, the country with the largest number of people living with HIV, has made significant gains in stopping the AIDS epidemic. A national HIV testing campaign, combined with intense civil society engagement, led to more than 2.5 million people having access to antiretroviral therapy.

“This is why the exchange of ideas is so important,” said Mr Sidibé. “When we can share data and best practices, we can close the programmatic gaps.”

Partners will advocate for increased funding and price reductions, strengthen efforts to ensure highest quality diagnostic services and forge partnerships to close diagnostic access gaps.   

MEBOURNE/GENEVA, 23 July 2014—The Joint United Nations Programme on HIV/AIDS (UNAIDS) has joined with global and regional partners to launch the Diagnostics Access Initiative which calls for improving laboratory capacity to ensure that all people living with HIV can be linked to effective, high-quality HIV treatment services.

Partners in the initiative include UNAIDS, the World Health Organization (WHO), the Clinton Health Access Initiative, the African Society for Laboratory Medicine (ASLM), UNICEF, and the US President’s Emergency Plan for AIDS Relief (PEPFAR).

"Around 19 million of the 35 million people living with HIV don’t know they have the virus. If they don’t find out they will die,” said Michel Sidibé, UNAIDS Executive Director. “This is why we have to make it simpler for people to test for HIV to be able to start lifesaving treatment when they need it.”

The Diagnostics Access Initiative specifically focuses on ensuring that at least 90% of all people living with HIV know their HIV status. It also aims to ensure that all people accessing HIV treatment have ready access to tests that monitor the levels of the virus in their bodies.

For treatment to be optimally effective, it is essential that all people accessing HIV treatment monitor their viral load frequently. Currently very few high-burden countries routinely offer viral load testing to people receiving HIV treatment. New viral load testing technologies which are made available when people first come in for care, offer promise for expanding access to viral load testing. However they will need to be affordable, appropriately deployed and used effectively.

“To achieve control of the HIV/AIDS epidemic, it’s essential that all people have access to high-quality HIV laboratory services, both for accurate HIV diagnosis and treatment monitoring.  Building a country’s capacity for virologic testing is critical for early identification of virologic failure, drug resistance and overall improved impact of the country’s HIV care and treatment programs,” said Ambassador Deborah Birx, U.S. Global AIDS Coordinator. “The Diagnostic Access Initiative represents an important step in ensuring the close collaboration among all donors and stakeholders to expand access and enable strategic scale-up of HIV laboratory services.”

To ensure early diagnosis of HIV, laboratory procedures need to be simplified and multiple testing tools and strategies made available. These also need to be integrated into community-centred health campaigns that focus on multiple diseases.

“It is essential that people know whether they have HIV infection, and that people who take treatment know whether their medicines are controlling the virus,” said Dr Hiroki Nakatani, Assistant Director-General, WHO.  “As diagnostic technology changes rapidly, and our Member States need guidance on how to use it, WHO will play a key role in this initiative.”

HIV treatment is effective in reducing HIV-related illness and AIDS-related deaths. It also helps to prevent new HIV infections, by sharply suppressing viral load and decreasing the risk of HIV transmission.

“The Diagnostic Access Initiative focuses urgent attention on the importance of developing new, affordable viral load and infant diagnosis technologies and effectively using the laboratory capacity we currently have,” said Dr. Tsehaynesh Messele, Chief Executive Officer of ASLM. “Effectively using existing and emerging viral load and infant diagnosis technologies will demand substantially stronger laboratory capacity as well as strategic planning to ensure that all technologies are optimally used.”

Partners in the initiative will advocate for greater funding for laboratory services and for the development of new diagnostic tools. They will also strengthen efforts to ensure that diagnostic services are of the highest quality and forge well-coordinated partnerships to close diagnostic access gaps.

On 22 July, UNICEF, along with Katy Perry, released the #ShowYourLove video, made to help dispel the stigma and discrimination that too often surrounds HIV, especially for adolescents, and that is preventing access to HIV testing and treatment. Intended to celebrate life and love, the video imagines a world free of AIDS in which adolescents do not face inequality, exclusion, stigma or discrimination. This initiative also uses the #Zerodiscrimination hashtag, which is part of a campaign launched by UNAIDS earlier in 2014.

“I worked with UNICEF on this new Unconditionally video in support of the 35 million people living with HIV, especially the young people, who often suffer in silence,” said Katy Perry.

For this initiative, UNICEF collected images and short videos (15–20 seconds) that show what being young, loved, free and healthy means to adolescents (10–19 years) around the world. Submissions will be shared during the International AIDS Conference in Melbourne (20–25 July) via UNICEF’s social media channels: @UNICEF @unicef_aids.

Watch #ShowYourLove video

With the AIDS epidemic having entered its fourth decade, and given the wider availability of life-saving treatment, there is now a growing number of people who have been living with HIV for 20 years or more. Some have been born with the virus and are surviving into adulthood, while others are members of an ageing HIV population. According to a panel discussion that took place on 22 July at AIDS 2014, much more must be done to include the needs and concerns of both groups in a comprehensive AIDS response. 

The UNAIDS organized event, Twenty Plus Positive Dialogues, focused on the lives and experiences of several panellists who have been living with HIV for decades and debated emerging issues.

Stephen Watiti, a 60-year-old Ugandan medical doctor who has been living with the virus for more than 25 years is one of the world’s 3.6 million HIV-positive people aged over 50. He spoke of his concerns about the disease as he grows older, such as the long-term side-effects of being on treatment for 20, 30 or 40 years and how to cope with non-communicable diseases, such as diabetes, that may also hit people living with HIV as they age. 

Lwendo Mbulo, a 23-year-old Zambian activist who was born with HIV and is now the mother of an HIV-negative child, championed greater access to prevention of mother-to-child HIV transmission services, including family planning services. She also supported comprehensive reproductive health interventions for young people and increased social protection focused on children born to HIV-affected families.

A 70-year-old gay man, John Rock, stressed how your birthplace can be a determinant for accessing HIV services.

The participants agreed that it was time to adapt to the changing profile of an increasingly complex AIDS epidemic. It was argued that in a life cycle approach people can be reached with a spectrum of HIV prevention, treatment, care and support services throughout their lives.

According to UNAIDS Executive Director Michel Sidibé, the 20th International AIDS Conference could spark a “Melbourne moment” and ignite a global movement to end the HIV epidemic as a public health threat by 2030.

Mr Sidibé was speaking at a conference symposium that explored the positioning of HIV in the post-2015 development agenda, at which emphasis was put on renewed political leadership and a mobilized civil society working to ensure that, within a generation, AIDS will no longer represent a significant risk to any population or country.

The gathering brought together heads of international agencies, including Mark Dybul, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, civil society representatives, including singer and activist Yvonne Chaka Chaka, and political leaders, such as former President of Botswana Festus Mogae.

They agreed that despite unprecedented progress there was little room for complacency regarding the gains of the AIDS response and that, with ending the epidemic now a definable and realistic goal, there was no time to lose.

It was argued that ending the AIDS epidemic can only be achieved by focusing efforts on where the epidemic is located and through a rights-based prism that challenges the socioeconomic determinants of the epidemic and leaves no one behind. Participants concluded that there was no better way to reflect the theme of AIDS 2014, “Stepping up the pace”, than to strive to end the epidemic by 2030.

A satellite event on 21 July at the 20th International AIDS Conference in Melbourne, Australia, explored how public–private partnerships are leveraged in the response to HIV in Papua New Guinea. The event highlighted in particular the role of the private sector in building innovative partnerships that form the foundation for successful public health interventions.

Papua New Guinea remains the most HIV affected country in the Pacific region, with a prevalence of 0.7%. It is a very challenging environment in which to operate, especially to implement and scale‐up HIV interventions in rural and remote regions. In many of these difficult to reach regions the private sector, and in particular the resource industry, has a strong operational and logistical capacity that can be leveraged to strengthen health systems.

One significant public–private partnership in Papua New Guinea is between Oil Search (the largest oil and gas exploration and development company incorporated in Papua New Guinea), the National Department of Health and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), which brings together corporate business systems, technical country expertise and multilateral funding.

Speaking at the meeting, UNAIDS Deputy Executive Director Jan Beagle commended such initiatives and stressed the vital importance of building multisectoral alliances to broaden and deepen the AIDS response, especially as the post-2015 development agenda is being defined. She also emphasized the importance of collective leadership from governments, civil society, international organizations and the private sector. Her sentiments were echoed by other high-level speakers, including Michael Malabag, Minister of Health of Papua New Guinea, Brett Mason, Parliamentary Secretary to the Minister for Foreign Affairs of Australia, Oil Search Managing Director Peter Botten and Mark Dybul, the Executive Director of the Global Fund. END

Parliamentarians from around the world attending the 20th International AIDS Conference met in Melbourne at the State Parliament of Victoria on 21 July to discuss the latest developments and challenges in the HIV response, and to share ideas and best parliamentary experiences in responding to the HIV epidemic.

The meeting stressed the importance of political leaders and called on their renewed commitment to help tackle the main barriers that hinder an effective response to HIV, including stigma, discrimination, restrictive intellectual property norms and other legal barriers that affect people living with HIV and members of key populations. Parliamentarians are critical to advancing the vision of ending AIDS by 2030 through their leadership, advocacy role and ability to authorize and oversee AIDS spending.

Members of parliament reviewed progress made in improving legal environments in their own countries and acknowledged the importance of human rights to the HIV response. They also discussed examples of parliamentary leadership and collaborations between countries and regions to ensure that all people have access to HIV prevention, treatment and care services.

Organized by the Inter-Parliamentary Union, UNAIDS and the United Nations Development Programme (UNDP), the meeting was attended by the Speaker of the Parliament of Australia, Bronwyn Bishop, UNDP Administrator Helen Clark and UNAIDS Deputy Executive Director Luiz Loures, who gave keynotes addresses, and UNAIDS Executive Director Michel Sidibé, who made closing remarks.

Punitive laws and law enforcement practices continue to be barriers to effective HIV responses. On 21 July, a session at the 20th International AIDS Conference entitled No One Left Behind: Stepping up the Pace on the Removal of Punitive Laws to Advance Human Rights and Gender Equality explored how such laws are preventing individuals from accessing health and HIV services and are increasing their vulnerability to HIV infection.

The participants presented examples of existing punitive laws and the negative effects they are having among the most vulnerable populations. Participants also stressed that, even in countries where protective laws have been introduced to support HIV responses and uphold the rights of people living with HIV, women and girls, and key populations, their enforcement is often inappropriate and their impact remains limited.

At the session, the participants highlighted that, responding to these concerns, the UNAIDS 2011–2015 Strategy as well as the 2011 United Nations Political Declaration on HIV and AIDS called for laws and law enforcement that support effective HIV responses. From 2010 to 2012, the Global Commission on HIV and the Law conducted a review of laws and law enforcement practices globally and their impact on HIV responses, and issued bold recommendations for advancing human rights in the context of HIV.

Harnessing the power and reach of the media to challenge HIV-related stigma and discrimination and champion human rights has long been a goal of the AIDS response. At this week’s 20th International AIDS Conference in Melbourne, Australia, UNAIDS and the Pulitzer Center on Crisis Reporting cohosted an event to explore exactly how this can be done.

During the 21 July meeting, entitled The Dual Crisis: HIV and Human Rights, participants debated the key issues involved in producing reports, features and documentaries that deal in a balanced, informative and compassionate way with key populations most affected by HIV. Invited journalists, who had received grants from the Pulitzer Center to complete their work, discussed their experiences of creating material in collaboration with such communities, including lesbian, gay, bisexual and transgender people in Uganda, transgender women in India and women living with HIV in northern Nigeria.

The participants explored the ethical dilemmas that can emerge, such as how to share the stories of affected and stigmatized groups in their work while at the same time accepting that individuals could face further discrimination as a result of this exposure.

The Pulitzer Center also presented a new interactive data visualization showing a collection of case studies of several key populations around the world. The project aims to explore how the media might use these vivid narratives to promote greater understanding of the lives and needs of the most affected, and often most marginalized, communities.

The Global Health Sector Strategy on HIV/AIDS 2011–2015, adopted by World Health Organization Member States in 2011, provides an ambitious framework for the health sector response to HIV. As the 2015 deadline approaches, what has been achieved so far? This critical question was addressed during a high-level session at the International AIDS Conference in Melbourne, Australia.

The participants recognized the huge progress made in the response to HIV in the past three years: the numbers of new HIV infections and AIDS-related deaths have fallen faster than ever before and there has been a dramatic growth in HIV treatment coverage, alongside great strides made in the elimination of mother-to-child transmission of HIV. Service quality and broader health outcomes were said to have improved following new and innovative policies and guidance on HIV prevention, diagnosis and treatment.

Examples of advances were provided from a number of countries, including Viet Nam, which is spearheading a significant treatment scale-up, and Zimbabwe, seen as a major success story in expanding access to elimination of mother-to-child HIV transmission services.

However, it was acknowledged that considerable challenges remain, such as low treatment coverage in some regions, too few people knowing their HIV status, too many presenting for testing and treatment at a very late stage, and key populations not having access to the services they need.

During a closing discussion, civil society and development partners explored how to tackle the challenges that remain and build on hard-won achievements to ensure that the AIDS response is effective, equitable and leaves no one behind.