AIDS 2018: Harm reduction, human rights, meaningful involvement of most affected get focus, raise questions of commitment

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Science Speaks covered the 22nd International AIDS Conference this week live from Amsterdam, the Netherlands, with breaking news, updates and analysis of new research findings, evidence-based responses, and community action for global access to HIV treatment and prevention from July 23 -26.

While the next conference is set to be hosted in the United States, answers lie with those still excluded, speakers and protesters agree . . .

AMSTERDAM – With growing epidemics in Eastern Europe and Central Asia, as well as continuing barriers to health services for marginalized populations everywhere serving as stubborn reminders that opportunities to end HIV as a global health threat could well go unrealized, sessions here focused on the still largely untapped resources of harm reduction, human rights, and on the meaningful inclusion of those most affected by the pandemic.

A plenary talk from Anna Deryabina of ICAP at Columbia University noted that of the estimated 250 million people worldwide who use drugs, nearly 30 million suffer from drug use disorders, and from 12 to 13 million of them inject drugs. With roughly 24 times the risks, including through sexual transmission as well as shared needles, of HIV infection than those of people who don’t inject drugs, people who inject drugs also face challenges in accessing and remaining on treatment, she noted.

In another plenary talk, Stefan Baral of Johns Hopkins School of Public Health noted that unmet treatment needs among people who inject drugs continue to drive incidence among larger populations — starting with their partners.

Still another plenary talk, from Olena Stryzhak of Positive Women, Ukraine, argued that redirecting just a little more than 7 percent of funding currently spent on drug enforcement and control to harm reduction programs that include needle and syringe exchange, safe consumption sites and opioid substitution therapy over the next two years would lead to a 94 percent drop in infections among people who inject drugs. 

Presentations from a safe injection program in Australia — where treatment for hepatitis C is not administered on site — and from an opioid substitution therapy program in Tajikistan, where miscommunications surrounding treatment requirements and outcomes compromised success — both recognized needs to change their approaches to better meet clients’ needs.

And at a press conference highlighting promising strides toward testing and treatment goals in Botswana, which took an early lead on universal treatment coverage, in eSwatini, an early adopter of test-and-start policies, and in the SEARCH trial’s multi-disease approach at an added cost of just a dollar a patient, the good news was balanced by a warning from Kenyan lawyer Allan Achesa Maleche, that those gains would not spread far without efforts to address discriminatory barriers to services and to involve those affected by them.

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And, as women with HIV strode to the front of the room during a World Health Organization talk, protesting guidelines limiting their access to dolutegravir, a medicine with fewer side effects than the alternative, but linked to possible birth defects, the slide projected overhead greeted them. “We welcome protests at AIDS 2018,” it said. ” We endorse freedom of expression as an essential principal in the fight against HIV and AIDS.”

But as they continued to enumerate the reasons for their protest, including a reminder of the days when doubters said that large scale treatment access would not work in Africa, because, it was assumed people there did not keep track of time, the slide overhead was replaced.

“Thank you for your advocacy,” it said. “Please retake your seats and allow the session to continue.”

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Throughout the conference, speakers on the stage and protesters in the halls noted that with continuing bans preventing people who have used drugs or earned income through sex work from entering the country, while HIV-specific criminalization will discourage still more, participation of those who could inform the next such gathering will be more limited in 2020 when the 23rd International AIDS Conference is scheduled to be set in the United States. 

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