An IAS 2017 wrap-up: Between unprecedented success and unprecedented threats, HIV fight confronts complacency, apathy — and resistance

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Science Speaks continues coverage this week of the July 23-26 9th IAS Conference on HIV Science.

PARIS – For all the more incremental advances and continuing challenges that would be discussed during the days that followed, the report released by UNAIDS before the 9th International AIDS Society conference began in Paris last week offered an irrefutably validating and concrete measure of progress: For the first time since HIV had been recognized, more people living with the virus were receiving treatment than not.

That news, along with data indicating that testing and treatment goals for 2020, set with the aim of ending the global health threat posed by HIV by 2030, could be reached, highlighted another measure of progress: Global health, funding and policy leaders had travelled too far from the time when some had questioned the point of fighting the pandemic in low-income countries to turn back now.

Scientists and activists who spoke in the days that followed also highlighted how the HIV pandemic and the responses it required had altered the landscapes of health and policy, with recognition that responses to infectious diseases are not optional, that funding to fight those diseases represent investments rather than expenses, and that services must adapt to reach those who need them.

And science continued to offer possibilities for distant but lasting gains with new additions to understanding of how the virus works and can be thwarted, including through developments in vaccine research, and findings that a South African girl, started on brief early aggressive treatment for HIV as part of a clinical trial, had lived in remission for eight years.

But the news of progress was accompanied by news in the same UNAIDS report of stagnating efforts, in some countries, and among neglected populations that include men, children, people who are incarcerated, inject drugs or earn income through sex work, migrants, and sexual minorities.

At the same time another report, also released before the start of the conference, highlighted the need for urgent action, and more comprehensive reach. That report, from the World Health Organization was the agency’s second on prevalence of HIV drug resistance and it highlighted another unprecedented development, in the speed with which rates of resistance to first line antiretroviral medicines are growing.

And yet amid both validation of the efforts made, and strong reasons to accelerate them, speakers noted that with donor funding for global HIV responses at its lowest level in seven years, and signs that it could drop steeply lower still, a $7 billion funding gap stands between current available resources and immediate needs. Speakers from Botswana’s health minister to UNAIDS leader Michel Sidibe cautioned against complacency, and of “becoming a victim of success.”

But a civil society advocate offered another reason that donor giving was dwindling, asking: “Is the problem complacency, or that people in donor countries don’t care anymore?”

Providing some basis for that question was the Trump Administration’s proposal to limit U.S. funding and leadership against the pandemic to maintaining those already on treatment, and to “epidemic control” efforts in about a dozen countries.

U.S. Global AIDS Coordinator Ambassador Deborah Birx countered questions about that proposal by saying the administration had called for focused attention on a dozen or so “model countries,” before conceding that she now works for a President who would like her to “do more with less.”

Presentations over the days that followed, on HIV self-testing, on lower prices for medicines, on paid community health workers, on mobile technologies, on countries that had expanded treatment eligibility without a cost to services for those already enrolled, showed how that could be done.

But with donor funding at 2010 levels, but more than three times the number of people receiving treatment, “We’re wringing water from a stone,” Sharon Ann Lynch of Medecins Sans Frontiere said.

And yet dominating IAS 2017 were presentations on how to reach more people, more effectively, more lastingly with drying resources. The scientists, activists, providers, policy makers, and people living with HIV who had gathered there, at least, had come too far to even know the way back.

At the same time, presentations reiterated, the most treacherous leg of the road remains ahead with the hardest people to reach still the last to be reached, and the knowledge, carried from the start of the pandemic, that if they are not, the road will lead to the past.

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