AIDS 2014: Confronting tragedy and progress, 20th International AIDS Conference brought approaches, community together

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Left to right: Stephen Morrison, Dr. Chris Beyrer, Ambassador Deborah Birx, and Kaiser Family Foundation Director of Global Health and HIV Policy Jen Kates.

“Unity” was the word that incoming International AIDS Society President Chris Beyrer used to characterize AIDS 2014 in Melbourne, Australia. The word, he said, at a panel discussion last week, described the response to the loss of six HIV movement leaders, who, en route to the conference died in the attack on Malaysia Airlines Flight 17. It also described a growing consensus on the path forward to control the HIV pandemic, he said. The need for more effective targeting of resources and to the prevention and care needs of key populations—those at highest risk and least served in many places — was a central element of that consensus.

Stephen Morrison, senior vice-president of the Center for Strategic and International Studies and a panelist at the event, echoed what he called the “convergence of opinions” on next steps and also noted the maturity and continuity of leadership in the global AIDS response reflected by U.S. Global AIDS Coordinator Ambassador Deborah Birx, Global Fund to Fight AIDS, Tuberculosis and Malaria leader Mark Dybul, World Health Organization HIV lead Gottfried Hirnschall, and UNAIDS executive director Michel Sidibe.

Ambassador Deborah Birx repeated her commitments to ensure that PEPFAR does better in linking HIV/TB co-infected patients to both TB treatment and antiretroviral therapy and to scale-up treatment for children. She also remarked on sessions about the development of long-acting AIDS2014postantitretrovirals as greatly anticipated new tools for both treatment and prevention, with a special mention of the young women of southern Africa whose persistent high infection rates continue to haunt her.

Beyrer took the crowd that packed the event sponsored by the Kaiser Family Foundation and Center for Strategic and International Studies, through conference highlights by track.

Track A featured basic science with presentations about quests for a cure and a vaccine, and discussion of the critical need, in the meantime, for better antiretroviral treatment coverage and earlier initiation of HIV treatment, since those initiated early will be more likely to benefit from the next discoveries.

Track B, featuring clinical science, brought presentations on the value of targeting resources to transmission and population “hot spots.” It offered further evidence that greater community treatment coverage reduces infection risk at the population level. Beyrer also flagged tuberculosis as a vibrant area of discussion and newer discussions of viewing chronic obstructive pulmonary disease as an HIV-related co-morbidity.

Track C, with its focus on prevention and epidemiology, brought new evidence from the IPREX open label extension trial showing even higher effectiveness than the randomized controlled trial itself—50 percent—and an astounding 100 percent efficacy for people who used the drug every day. Importantly, the study found high levels of protection from HIV infection even in less frequent dosing—4, 5 and 6 times a week. Long-awaited evidence on the benefits to women when men are circumcised also was presented in the prevention track. The World Health Organization guidelines on key populations with a call for consideration of PrEP for men who have sex with men and for community distribution of naloxone for drug overdose prevention also were important highlights of the track.

Track D, featuring presentations on human rights and the law, was the frame for sessions on the criminalization of risk behaviors and of HIV transmission itself. The Lancet supplement on HIV and sex work brought more attention and programming for this high risk community, the community’s own value in effective responses, and to the risk-heightening effect of sex work criminalization.

Track E, featuring implementation science, drew the largest number of abstracts, according to Beyrer, and delivered presentations aimed at making programs more effective. Presentations included evidence that early disclosure to HIV-infected adolescents about their status improves their adherence to life-saving medications. It also brought presentations on the ongoing challenges of keeping women in care as Option B+ is rolled out in countries to protect women and their babies from illness and death.

Missing, Beyrer said, were prominent divisions between approaches and priorities that have been integral to past conferences.

“There really was,” he said, “a unanimity of purpose and engagement.”

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