United States of America

William Snow, Executive Director of the Global AIDS Vaccine Enterprise, organizer of the conference, speaking during the opening ceremony. Credit: Rick Friedman

From 9-12 September, more than a thousand HIV researchers and advocates, meeting in Boston for the AIDS Vaccine 2012 Conference, discussed the contribution of vaccine science to achieving the goal of zero new HIV infections in an increasingly complex HIV prevention landscape.

Several HIV prevention approaches such as male and female condom use, voluntary medical male circumcision, prevention of new HIV infections in children, post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) and treatment as prevention, are now established tools to enable people to avoid exposure to HIV or to reduce their infectiousness. Modelling studies predict that by scaling up access to strategic combinations of these approaches that are adapted to local needs, national HIV programmes can significantly reduce the number of new HIV infections.

Do we need a vaccine?

Despite recent evidence that HIV treatment prevents onward transmission of HIV as well as the fact that vaccine discovery and development is costly in time and funding (US$845 million in 2011 alone), leaders from across the spectrum of HIV research attending the conference unanimously agreed on the need to continue the quest for an HIV vaccine.

Professor Myron Cohen of the University of North Carolina at Chapel Hill, who led the multi-country study by the HIV Prevention Trials Network that proved the efficacy of AIDS treatment for prevention (the HPTN 052 study), said that scale-up of treatment is both a human rights imperative and an effective public health measure. At the same time, he threw his full weight behind the quest for a more effective HIV vaccine. “We recognize that suppressive treatment of HIV infection drastically reduces the probability of onward HIV transmission, which should eventually slow the spread of HIV. But the urgent and widespread treatment of HIV is not a substitute for a preventive vaccine. We need an HIV vaccine,” said Dr Cohen.

Vaccine trials

The RV144 vaccine trial in Thailand, which tested a combination of two vaccines, reported a modest 31% efficacy in 2009. However, it sparked a wide array of new questions about how and when the human immune system may respond to HIV. “Our knowledge is more sophisticated and moving much faster toward approaches and products that have a high likelihood of success in clinical trials,” said Professor Glenda Gray, Executive Director of the Perinatal HIV Research Unit, University of Witwatersrand and Director of the HIV Vaccine Trials Network Africa programmes. Currently there is only one HIV vaccine trial under way, which is testing a combination of experimental vaccines in men who have sex with men and transgender women in the United States (HVTN 505). Additional studies are planned, including three studies to pursue an improvement on the RV144 results in South Africa and Thailand, but these are not likely to begin before 2014.

Synergies between vaccine and non-vaccine prevention strategies

According to scientists at the conference, to evaluate any new technologies in human trials, the new product first must be proved safe, and then must be tested against the standard of care or prevention. They noted that, as the standard evolves to include new tools such as medical male circumcision, PrEP and early AIDS treatment, more complex trial designs are needed to evaluate the efficacy of the new technology, and larger sample sizes will be required.

L to r: Dr Dan Barouch, Professor of Medicine at Harvard Medical School, Chief of the Division of Vaccine Research at Beth Israel Deaconess Medical Center, and Co-Chair of the AIDS Vaccine 2012 conference and Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. Credit: Rick Friedman

Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases pointed out that given the availability of other partially effective prevention strategies, the world may not need a vaccine that provides 95% protection. According to him, a vaccine that reduces risk in combination with other prevention strategies may be sufficient. Researchers at the conference said that there are also indications that antiretroviral-based prevention approaches could increase the vaccine effects or offer protection during the post-vaccination period when the immune system has to ramp up production of a protective antibody response.

Building knowledge one trial at a time

Participants agreed that large scale production of a prophylactic HIV vaccine is well over a decade away under the best of assumptions. Vaccine discovery, development, obtaining official license and scaling up production and delivery take many years and large investments. Mathew Rose, Policy Chair for the Young Black Gay Men’s Leadership Initiative, used a boxing metaphor to explain the challenge ahead. To sustain enthusiasm and commitment until a more effective AIDS vaccine is discovered, “we need to stop waiting for a single, knock-out punch, and instead, we must perfect the art of the jab,” said Mr Rose. “Each clinical trial may produce the final answer, or it may open up more key questions,” he added. According to Mr Rose, each new question will require a strategic study—a new “jab” that will build general knowledge about how the human body recognizes and fights infection, and will build the scientific capacity to finally outwit HIV. 

Bill Clinton addressing delegates at the closing session of the XIX International AIDS Conference in Washington, D.C. The conference was held from 22-27 July.
Credit: UNAIDS/C.Kleponis

The XIX International AIDS Conference concluded in Washington, DC on Friday after five days of hundreds of sessions, programme activities, workshops, poster presentations and side-events aimed at bringing forward the latest thinking and developments in the global HIV response.

The conference, which opened on 22 July, was organized under the theme “Turning the Tide Together.” Presenters at AIDS 2012, from senior government officials and heads of international organizations to civil society leaders and scientists, all echoed that for the first time in the history of AIDS, an end to the epidemic is on the horizon. However, speakers cautioned that there are still numerous challenges that must be addressed before the international community reaches zero new HIV infections and zero AIDS-related deaths.

Throughout the conference, much attention focused on the 10 global AIDS targets agreed upon by UN Member States at the UN High Level Meeting on AIDS held in June 2011—in particular the goal of eliminating new HIV infections among children, reducing sexual transmission of HIV by 50% and getting 15 million people on HIV treatment, all by 2015. Representatives of both international organizations and civil society stressed that unless investments in the HIV response are increased, the goals will not be realized.

Ahead of AIDS 2012, UNAIDS released a new report, titled Together we will end AIDS, that outlined the recent gains made in achieving the global AIDS targets, including increases in HIV treatment coverage and domestic investments in low- and middle-income countries.

Leaders reiterate commitment to an AIDS-free generation

The conference also provided an opportunity for many people from the worlds of politics, science, civil society and the arts to reiterate their support to the effort to end new HIV infections among children by 2015 and keep their mothers alive. An event held on the eve of the conference, Uniting for an AIDS-free generation, brought together musicians, politicians, scientists and activists to rally more support for the goal.

Elly Katabira, IAS President and AIDS 2012 Chair, introducing Nobel Laureate Françoise Barré-Sinoussi, Incoming President of the IAS.

At the conference, several sessions focused on sharing progress to date in stopping mother to child transmission of HIV. UNAIDS Executive Director Michel Sidibé, and Ambassador Eric Goosby, U.S. Global AIDS Coordinator, participated in many events to update partners on the Global Plan, a joint initiative focusing on the 22 countries in which 90% of new HIV infections in children occur, 21 of which are in sub-Saharan Africa.

AIDS 2012 concludes, delegates look to AIDS 2014

The closing session on 27 July featured several addresses from prominent advocates in the global HIV response. Speakers included: Diane Havlir, AIDS 2012 U.S. Co-Chair; Nancy Pelosi, Minority Leader, US House of Representatives; Anna Zakowicz, Global Network of People Living with HIV (GNP+); Elly Katabira, IAS President and AIDS 2012 Chair; Nobel Laureate Françoise Barré-Sinoussi, Incoming President of the IAS; Tanya Plibersek, Australian Minister of Health; and President Bill Clinton.

At the end of the opening session, the conference was handed over to officials representing the organizing committee of the XX International AIDS Conference, which will be held in Melbourne, Australia in 2014.

AIDS 2012 was the first International AIDS Conference to be held in the US in 22 years. The decision by President Obama to lift an HIV travel ban in 2009 was widely acclaimed by all delegates, as a sign of the continued bi-partisan commitment of the US government in responding to HIV, both domestically and internationally.

An estimated 23 000 participants from some 200 countries, and 1800 media representatives attended AIDS 2012. Hundreds of sessions, programme activities, workshops, poster presentations and side-events were held between 22-27 July.

Members of the High-Level panel participating in the session to assess progress made against AIDS and challenges remaining. Washington DC, 26 July 2012. Credit: UNAIDS

How have countries across sub-Saharan Africa fared in responding to the HIV epidemic? What further actions are needed to reach the goal of universal access to HIV prevention, treatment, care and support in the region? These were among the key questions addressed by a high-level panel of African leaders at the XIX International AIDS Conference in Washington DC.

The co-chairs of the panel session—Robert Soudre, President of the Society for AIDS in Africa, and Morolake Odetoyinbo, Chief Executive Officer of Positive Action for Treatment Access, a Nigerian non-governmental organization—noted in their opening remarks the significant strides in reducing new HIV infections and expanding access to HIV treatment across the continent.

Over the past decade, the rate of new HIV infections has declined by more than 25% in 22 countries of sub-Saharan Africa. An estimated 6.2 million people in the region were receiving antiretroviral therapy in 2011—up from just 100 000 in 2003. The most dramatic progress was seen in South Africa, where at least 300 000 people were newly enrolled in HIV treatment in 2011 alone.

Jackline Akinyi Odongo, Mentor Mother with the Mothers2Mothers peer-support group at the Nyanza Provincial Hospital in Kenya, described her despair when she found that she was HIV positive and pregnant. She joined the support group, followed guidelines for prevention of mother-to-child transmission of HIV, and took her antiretroviral medications regularly. Her daughter was born HIV-negative.

Madame Penehupifo Pohamba, First Lady of Namibia and Chair of the Organization of African First Ladies against HIV/AIDS, highlighted the considerable gains in reducing new HIV infections among children. About 300 000 children were newly infected with HIV in sub-Saharan Africa in 2011—a 26% decline since 2009. However, more than 90% of children living with HIV globally continue to reside in sub-Saharan Africa.

Madame Pohamba called for strengthening the African ladies' role in promoting the elimination of new HIV infection among children by 2015. “Effective prevention programmes are an unfailing vehicle that will take us to the elimination of mother-to-child transmission and to zero new HIV infections among children,” she said.

Alioune Gueye, President of the West African Youth Leadership Network for the Millennium Development Goals, emphasized the critical role that youth can play in the continent’s HIV prevention revolution. “Young people are at the centre of the AIDS epidemic and youth-led initiatives deserve encouragement and support at the national and international level,” said Mr Gueye.

Between 2001 and 2010, HIV prevalence declined among young people (aged 15-24) in at least 21 of 24 countries with a high HIV burden. However, an estimated 2 400 new HIV infections occur each day in this population.

Organized by the Sub-Saharan Africa Work Group of the AIDS 2012 conference, the High-Level panel also sought to identify set of practical solutions to bring about progress across health and development. Speaking on behalf of the UNAIDS Executive Director, Dr Djibril Diallo, UNAIDS Senior Advisor and Chair of the Sub-Saharan Africa Work Group, emphasized that cooperation between UNAIDS, the African Union and the New Partnership for Africa's Development (NEPAD) led to adopting the landmark roadmap on shared responsibility and global solidarity at the AU Summit this month.

He noted that the Roadmap promotes African-owned solutions which will reinforce the response to AIDS; defines clear goals, expected results and defines role and responsibilities for each stakeholder; and is structured around three pillars: health governance, diversified financing and access to medicine.

Credit: White House

President of the United States of America Barack Obama hosted a reception for the leaders of the AIDS response attending the XIX International AIDS Conference in Washington DC on Thursday 26 July. “The US is in this fight to win this fight—I don't like to lose,” said President Obama. “We share a very special moment—it is the moment when an AIDS-free generation is finally in sight.”

The International AIDS Conference is being held in the United States for the first time in 20 years. This was made possible after President Obama lifted HIV-related travel restrictions allowing people living with HIV to once again enter the United States.

More than 20 000 people are attending the conference. Thanks to advances in science and progress in implementation the general mood of the conference has been largely optimistic. Delegates are focusing on how to meet the challenges in reaching the 2015 global targets on AIDS. The call to end AIDS has resonated across the conference as has the appeal for sustained international support for AIDS.

“President Obama’s pledge to continue United States' support to end AIDS could not have come at a more important time,” said UNAIDS Executive Director Michel Sidibé. “We owe a big thank you to the American people for their leadership and contribution to the AIDS response—within the United States and abroad. No country has done more. Millions of people would be dead today without American compassion, generosity and solidarity.”

The reception was attended by UNAIDS Executive Director Michel Sidibé, the President of the International AIDS Society and Co-chair of the conference Elly Katabira, US Co-Chair and Professor of Medicine and Chief of HIV/AIDS Division, University of California, Diane Havlir, US Global AIDS Coordinator Ambassador Eric Goosby and other prominent AIDS activists, scientists and health workers from the United States and around the world.

The CONDOMIZE! Campaign seeks to raise awareness about the importance of condom use in a lively and engaging way.
Credit: Scott Henderson

There is a renewed emphasis on condoms at the XIX International AIDS Conference being held in Washington, DC from 22-27 July as a campaign promoting their use and availability has been re-launched with the distribution of 850 000 condoms.

The CONDOMIZE! Campaign aims to highlight the effectiveness of condoms, male and female, for HIV prevention and calls on governments, donors and users to intensify access to, and demand for, quality condoms as a primary defence against HIV.  It advocates investing significant resources and materials into promoting condom use as the most efficient and available prevention technology in the global AIDS response. Challenging the stigma that still often surrounds condoms is also a key objective.

“Let us not forget that the condom remains the cheapest and highly effective method we have to stop the spread of HIV,” said UNAIDS Executive Director Michel Sidibé championing the importance of condoms during his opening speech at the conference. “It is time for all of us to condomize!,” he added.

The initiative was born during the 2010 International AIDS Conference in Vienna and is a partnership between UNFPA and The Condom Project, in close collaboration with Bahamas Red Cross; DKT International, a social marketing NGO; Durex, the Female Health Company, the International AIDS Society and UNAIDS.

In addition to mass condom distribution, rap music with short videos has been created, using key messages from senior international leaders about the importance of condom use. These messages are being shown on TV screens throughout the conference.

Franck DeRose, Executive Director of the Condom Project and Global Coordinator of the CONDOMIZE! Campaign, says “In a modern and exciting way, we are helping people understand very serious issues and the need to promote condom use. We must ensure that those who need condoms can access them when they need them and where they feel most comfortable. The awareness campaign at AIDS 2012 is one step towards making this happen.”

The campaign noted that there is a considerable shortfall in condom availability in a number of countries. For example, in 2011 in sub-Saharan Africa there were only nine condoms available per man per year and only one female condom for every 10 women. These condoms were mostly provided by donors as most low- and middle-income countries do not have a budget line for condom procurement.

According to UNFPA more support and funding are needed from governments themselves to increase the availability of male and female condoms. They should create awareness initiatives and encourage people to use condoms as an important facet of a combination HIV prevention approach which uses all proven methods of avoiding infection.

“We know that sexual transmission accounts for more than 80% of new HIV infections worldwide – if we increase protected sex, we could reduce HIV incidence,” said Bidia Deperthes, UNFPA’s Senior HIV Technical Advisor.

The social marketing of these commodities is highlighted by the involvement of DKT International whose President Philip Harvey says he wants to make condoms as “attractive and convenient to buy as Coca-Cola”. Condoms manufacturer Durex welcomes the chance to be involved in such an awareness-raising intervention.  Charles Shepherd, the company’s Head of Health Promotion comments: “We are delighted to help, not only by donating half a million condoms for the CONDOMIZE! programme at AIDS 2012, but also engaging with the educational sessions.”

Organisers say there has already been a great deal of interest shown with many conference participants urging them to roll out the campaign at country level.

Sex worker initiative Veshya Anyay Mukti Parishad (VAMP) give a performance at the opening of the Sex Workers’ Freedom Festival in Kolkata, India.
Credit : UNFPA/J.Cabassi

As thousands of delegates gather for the XIX International AIDS Conference (AIDS 2012) in Washington, D.C. this week, a parallel satellite hub, the Sex Worker Freedom Festival, is taking place in Kolkata, India, from 22-26 July.

The event brings together over 600 sex workers, international and national partners from more than 40 countries. The Freedom Festival has been organized by sex workers as a response to extensive visa regulations for sex workers and people who use drugs, which may have prevented many from attending the International AIDS Conference event in Washington DC. The five-day festival gives participants the opportunity to be part of the Washington event through video-conferencing link up with major conference sessions and with the Global Village.

“The Sex Worker Freedom Festival is an alternative event for sex workers and our allies to protest our exclusion and ensure the voices of those excluded are heard in Washington.” said Ruth Morgan the Global Coordinator of the Global Network of Sex Work Projects (NSWP) and Co-Organizer of the Kolkata event.

Speaking at the opening of the Kolkata hub, United Nations Secretary General’s Special Envoy on AIDS in Asia and the Pacific, Prasada Rao, stressed that freedoms and rights of sex workers are being denied on a daily basis.

“Aspects of sex work are criminalized in 116 countries around the world. Laws in many countries conflate adult consensual sex work with human trafficking. Routine police raids, often in the name of anti-trafficking, lead to arrest and harassment of adult consenting sex workers,” said Mr Rao. “These discriminatory practices drive sex workers to social exclusion and into a socially disadvantageous position, accentuating their vulnerability to HIV,” he added.

Despite progress made in reducing the spread of HIV within sex work communities, sex workers are still at increased risk of HIV infection. In the Asia-Pacific region for example, while a number of countries have reduced their HIV infection rates with intensive HIV prevention programmes among people who buy and sell sex, hotspots of high prevalence remain. Surveys of female sex workers in India show prevalence of 18% in Maharashtra and 41% in Pune—the overall adult level in the country is an estimated 0.3%.

Sharing experiences, driving progress

The Sex Worker Freedom Festival programme is structured around fundamental freedoms; human rights that all people are entitled to. These include freedom of movement; freedom to access quality health services; freedom to work and choose occupation; freedom to unionise; freedom to be protected by the law; freedom from violence; and freedom from stigma and discrimination.The Festival aims to facilitate the sharing of experiences as well as dialogue around key issues and priorities for the sex work community and HIV programming.

“Without the right to organize and unionize the sex worker community cannot advance our rights,” stated Bharati Dey, General Secretary, Durbar Mahila Samanwaya Committee (DMSC), co-organizer of the Kolkata Hub.

The stigma and discrimination experienced by sex workers was identified as a major obstacle to an effective response to AIDS. “Every day and in every location, we have to battle against stigma and discrimination,” said Lakshmi, a sex worker and the Director of Programmes at the Ashodaya sex worker initiative in Mysore, India, said. “We have found a way to be part of the solution. Our team of HIV positive sex worker volunteers has built an effective partnership between communities and health services. This has changed attitudes of health care providers and has created community confidence to access health services.”

Annah Pickering, a sex worker and Manager of the Auckland Region, New Zealand Prostitutes Collective, underlined the multiple benefits of decriminalization of sex work in her country, both for sex worker rights and the HIV response. “We appreciate many legal freedoms. We can report corrupt officials who demand free sex. We don’t hide our condoms in our bras or behind the picture or in the thermos flask. We can put up signs and promote safe sex and insist on it. Does decriminalising sex work prevent the transmission of HIV?  I strongly believe so. When you put all these elements together they contribute significantly to support sex workers in preventing the transmission of HIV,” she said.

A central theme of discussions at the Kolkata Hub has been the widespread experiences of violence faced by sex workers around the globe on a daily basis. Sessions have underlined how documentation of sex workers’ experience of violence is critical to ensuring evidence is used to inform effective responses. A sex worker led research project being conducted in Sri Lanka, Myanmar, Nepal and Indonesia by the Center for Advocacy on Stigma and Marginalization (CASAM), the Asia Pacific Network of Sex Workers (APNSW), UNFPA, UNDP, UNAIDS and Partners for Prevention was highlighted as an important initiative in better identifying the risks and factors that help protect sex workers’ from violence.

UN Secretary General’s Special Envoy for AIDS in Asia and the Pacific Mr Prasada Rao speaks at the opening of the Sex Workers’ Freedom Festival in Kolkata, India.
Credit: UNAIDS

“This research is designed to generate quality data, that ensures sex workers’ lived experiences are used to advocate for better policy and programmes to prevent and respond to violence,” said Meena Seshu, Director of the Sampada Gramin Mahila Sanstha (SANGRAM) sex worker peer education project.

The importance of increasing sex workers’ access to quality, integrated, health services has also been a key issue of emphasis. Kay Thi Win, Director of the Targeted Outreach Programme (TOP) initiative in Myanmar, which provides peer-to-peer HIV prevention and support for sex workers said: “There are few sex worker friendly clinics. When TOP started, there was no comprehensive sexual health intervention in Myanmar for sex workers. However through our work we have been able to increase the linkages by providing a comprehensive sexual and reproductive health package that also includes HIV services.”

The Kolkata Hub is hosted by Durbar Mahila Samanwaya Committee (DMSC), and is co-organized with the Global Network of Sex Workers (NWSP) and the All India Network of Sex Workers (AINSW). It is supported by the Open Society Foundation’s Sexual Health and Rights Program, UNAIDS, the Dutch Ministry of Foreign Affairs, UNFPA, HIVOS (the Humanist Institute for Development Cooperation), AIDS Fonds (a Netherlands-based HIV project funder) and the AIDS 2012 conference secretariat.

UNAIDS Director, Evidence, Innovation and Policy, Dr Bernhard Schwartländer speaking at a plenary session at the XIX International AIDS Conference. Washington DC, 24 July 2012.
Credit: UNAIDS/C.Kleponis

At the plenary session titled What will it take to turn the tide? UNAIDS Director, Evidence, Innovation and Policy, Dr Bernhard Schwartländer, highlighted the many new possibilities for collaboration, activism and financing for the AIDS response as economic growth is rapidly changing the global order.

According to Dr Schwartländer, if we continue with the same investment level as we have thus far and doing business usual, over the coming ten years it will lead to stagnation and there will be no positive change in the number of new HIV infections. However, if we focus on successful programs and bring down costs substantial progress can be made. It requires a certain boost in investments for a while—peaking at an additional $7 billion in 2015. This will result in driving down new HIV infections by well over half in less than a decade.

“We should abandon the concepts of dependency and charity, as well as habitual ways of thinking and acting. We should explore new possibilities for collaboration, activism and financing,” said Dr Schwartländer.

Calling on countries to end their dependency on international resources, Dr Schwartländer highlighted the efforts made by low and middle-income countries to increase their domestic funding for HIV. However, there will be a number of low and lower middle-income countries that will continue to need significant amounts of outside assistance for the next decade and beyond.

During the plenary session, Dr Schwartländer provided an overview of the current financial situation but also outlined a number of innovative financing methods to increase reliable sources of predictable government revenue such as the financial transaction tax; front-loading investments for health through bonds; or utilizing fines paid by pharmaceutical companies for anti-competitive practices for health assistance.

“Let me be clear, let us not take the pressure off the world’s richest countries to meet their commitments and obligations,” said Dr Schwartländer. “Let us not forget that despite the global financial crisis, there is still economic growth in OECD countries. If we did nothing else but applied this increasing wealth to current levels of ODA, there could be another 50 billion dollars annually by 2020, in addition to the 133 billion today,” he added.

“It would be exactly the wrong moment for international donors to cut back funding, now that the dynamic is going the right way. When we are finally on a path towards sustainability and equity - a truly shared responsibility and true global solidarity,” he concluded.

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UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle speaking at the session titled "Securing Investment in HIV and Gender Equality for Social Change". Washington DC, 24 July 2012.

Investing in HIV responses that address the needs and rights of women and girls was the main focus of a High-Level Panel meeting held at the 19th International AIDS Conference titled "Securing Investment in HIV and Gender Equality for Social Change". The aim of the panel was to find ways to secure investment in HIV and gender equality, and to unlock innovative solutions to broader challenges of women’s health, social justice and development.

“We need to have shared responsibility and global solidarity for investing in women and girls,” said UNAIDS Deputy Executive Director, Management and Governance, Jan Beagle. “We also need close collaboration with communities, including women cultural and traditional leaders and women living with HIV. Only together, we can end AIDS,” she added.

Gender inequality and social injustice exacerbates the biological vulnerability of women and girls to HIV. This has resulted in them accounting for 49% of all people living with HIV. In sub-Saharan Africa, in fact, women account for 58% of all people living with HIV. HIV remains the leading cause of death of women of reproductive age whilst maternal mortality would be 20% lower in the absence of HIV.  

Despite these facts, 60% of low- and middle-income countries do not allocate dedicated resources to address the specific needs of women and girls in their national HIV responses. Current global policy dialogue also reveals divided views on advancing women’s rights, in particular their sexual and reproductive health and rights, in the context of sustainable development.

The panel discussed ways to capitalize on the experience of the global HIV response and to advance strategic and ground-breaking thinking on securing investment in HIV and gender equality. Panellists exchanged views on innovative and sustainable financing for improved HIV, women's health outcomes and social change, including AIDS tax levy modelled by Zimbabwe, gender-sensitive budgeting, to assess the impact of budget on women and men, and cash transfer, in particular for most vulnerable women and girls.

Discussions also focused on accountability for these health outcomes, utilizing as a reference the Harare Call to Action —a call for a unified action plan for women’s health with specific focus on sexual and reproductive health and rights in the context of HIV. The Harare Call to Action resulted from the inaugural GlobalPower Africa Women Network meeting in May 2011 that brought together women political, cultural and traditional leaders, as well as civil society. The Call to Action aims to serve as an important political and advocacy tool, strongly promoting regional ownership and shared responsibility to advance the AIDS response and the wider gender equality agenda. Hon Thokozane Khupe, Deputy Prime Minister of Zimbabwe and President of the Global Power Africa Women Network stressed “We need to deal with HIV from the source. Let the funding deal with the drivers of the epidemic, particularly those affecting women and girls, and we will succeed in ending AIDS”.

Gender inequality

Gender inequality is a key driver of the HIV epidemic. Women can face barriers in accessing HIV prevention, treatment and care services due to limited decision-making power, lack of control over financial resources, restricted mobility and child-care responsibilities. Often, violence and the threat of violence hamper women’s ability to protect themselves from HIV infection and/or to assert healthy sexual decision making.

According to participants, some progress has been achieved, much of it stemming from increased investment in the leadership and meaningful engagement of women and girls, in particular those living with and affected by HIV. However, ensuring that women and girl’s needs and rights are well-addressed and accountability secured remains a promise and a challenge. In line with the 2011 Political Declaration, UNAIDS has committed to advancing human rights, gender equality and zero tolerance for violence in its 2011-2015 Strategy, using the UNAIDS Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV.

UNAIDS Director, Regional Support Team, Eastern and Southern Africa, Professor Sheila Tlou speaking at a plenary session of the XIX International AIDS Conference. Washington DC, 23 July 2012.
Credit: UNAIDS/K.Cleponis

At the plenary session titled Turning the Tide in Affected Countries (leadership, accountability and targets), UNAIDS Director, Regional Support Team, Eastern and Southern Africa, Professor Sheila Tlou, took stock of the progress made in the AIDS response to date and pointed out the challenges remaining to overcome the AIDS epidemic.

According to Professor Tlou, much progress has been made in the AIDS response. The world is on course to achieve elimination of new HIV infections among children and it is on course to put 15 million people on antiretroviral treatment. Access to HIV treatment in Sub Saharan Africa increased more than 100-fold in less than a decade. In 22 countries, annual new infections declined by more than 25% between 2001 and 2011.

However, challenges still remain as punitive laws, stigma and discrimination, gender inequality, violence against women and human rights violations are hindering the AIDS response. Proferssor Tlou spoke about the key requirements for turning the tide. “To end AIDS, we need innovation, shared responsibility, mutual accountability and global solidarity,” said Professor Tlou.

Other key factors to turn the tide of the epidemic according to Professor Tlou include the development of evidence-informed and rights-based HIV responses; enactment of laws that facilitate effective HIV responses; addressing sexual and reproductive health needs of women and girls; Gender equality and involvement of men, and the use of the expertise of communities and people living with HIV.

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Report released at AIDS 2012 calls for sustained funding of HIV prevention research to achieve our collective vision of zero new HIV infections

Washington DC (23 July 2012) – A decade of unprecedented investment in HIV prevention research has led to major scientific breakthroughs in vaccines, microbicides, voluntary medical male circumcision, treatment as prevention and pre-exposure prophylaxis, or PrEP, but sustained financing will be needed to capitalize on these breakthroughs to deliver new options that can help end the AIDS pandemic, according to a new report released today at the XIX International AIDS Conference in Washington, DC.

The new report, Investing to End the AIDS Epidemic: A New Era for HIV Prevention Research & Development, tracks investment in prevention research in 2011 and looks back at a decade of tremendous growth in funding, despite sometimes uncertain prospects for some HIV prevention options. Yet the authors note that capitalizing on recent breakthroughs in the field and ensuring a pipeline of new next generation products will require sustained and flexible investments from a range of donors in the coming years.

The eighth annual report from the HIV Vaccines and Microbicides Resource Tracking Working Group shows that funders invested a total of US$1.24 billion in research and development (R&D) for six key prevention options: preventive HIV vaccines, microbicides, PrEP using antiretroviral drugs, treatment as prevention, prevention of vertical transmission and operations research related to medical male circumcision. This investment is down slightly from the US$1.27 billion invested in 2010 for these six research areas. Investments in vaccine and microbicide R&D decreased in 2011, though decreases for microbicide R&D were attributed to funding disbursement cycles and did not represent declines as compared with past investments.

“This is a critical time. We now have 8 million people on antiretroviral treatment and we are seeing reductions in new HIV infections, even in the most affected communities. But it is not enough to think that HIV is a disease that can be managed with pills. HIV has to be brought to an end and funding shortfalls must not become the roadblocks that prevent us from achieving our goals,” said Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS, (UNAIDS).

“Recent advances toward the development of a preventive HIV vaccine have fueled optimism within the AIDS vaccine field. Researchers around the world are now working to build on this progress to develop next-generation vaccine candidates and advance the most promising of these candidates toward large-scale efficacy trials,” said Margaret McGlynn, IAVI President & CEO.  “I am more optimistic now than ever before that the development of a preventive AIDS vaccine is within reach. However, in order to build on this recent progress it is critical that we sustain financial commitment and support for HIV vaccine R&D.”

In the past two years, beginning with results from the landmark CAPRISA 004 microbicide trial announced at the last International AIDS Conference, we have seen tremendous breakthroughs in antiretroviral-based prevention, including TDF/FTC (Truvada) as daily oral PrEP, which was approved by the US Food and Drug Administration as a new prevention option last week, and the HPTN 052 treatment as prevention study which provided evidence that early treatment of HIV-positive people may also protect their HIV-negative partners.

Analyses completed in the past year have unveiled crucial clues as to how the candidate in the RV144 HIV vaccine trial provided protection against HIV. In addition, recent advances in identifying and characterizing broadly neutralizing antibodies to HIV are informing potentially powerful new vaccine candidates.

For microbicides, Phase III clinical trials are underway that could provide the results needed to license and deliver marketable products, including 1 % tenofovir gel and vaginal rings that could offer women protection for a month, two months or longer—and might eventually combine an antiretroviral drug with a contraceptive hormone to provide dual protection. Additional PrEP trials are looking at different drugs and less-than-daily dosing that might be easier for people to adhere to.

Recent positive results underscore the importance of preparing for success and capitalizing on areas of progress and promise. The prevention field continues to need funding structures that can adapt quickly and are sufficiently generous to allow for rapid expansion in the event of positive outcomes.

Indeed, the HIV prevention research field is facing a new and exciting era with many new HIV prevention options becoming available, including female condoms, voluntary medical male circumcision, antiretroviral treatment as prevention and PrEP.  The report notes that additional funding will be needed to effectively roll out all available options, which represents an investment opportunity for countries heavily impacted by HIV, particularly emerging economies.

As the rallying cry to end AIDS is heard this week from policymakers, researchers, funders and advocates gathered in Washington, DC, and as we work together to craft a response to AIDS, the Working Group notes that research to develop and roll out new prevention options is a vital component for success and must be appropriately funded.

“For the first time, the end of the AIDS epidemic is within reach,” said Mitchell Warren, Executive Director of AVAC. “New prevention options – voluntary medical male circumcision, PrEP, treatment as prevention, microbicides and eventually vaccines – will play a critical role in reducing the cycle of new infections.  The past decade has been a period of increasing investment in HIV prevention R&D and has yielded unprecedented success. With sustained and flexible funding, the future of HIV prevention research will be even more promising.”

The report is available online at: www.hivresourcetracking.org.