Experts call for accelerating progress towards universal HIV treatment access

  • Ending AIDS is within reach, participants at the International HIV Treatment as Prevention Workshop in Vancouver, Canada, were told on Tuesday, 1 April. However, they were cautioned that success is not guaranteed and ending AIDS will demand new ways of operating.

    “Seeing what the epidemic was like years ago, I never thought in my lifetime we would be speaking about ending AIDS,” said Dr. Luiz Loures, UNAIDS Deputy Executive Director.

    “Progress is very uneven,” Dr. Loures said, “and the likelihood of access to treatment and prevention is much lower for certain key minorities such as LGBTI, prisoners, migrants, sex workers, persons who injects drugs, and young woman in Sub-Saharan Africa today.”

    Delegates from 41 countries have gathered in Vancouver for the four-day meeting to examine the latest evidence regarding the prevention benefits of antiretroviral therapy. The meeting is being co-convened by the British Columbia Centre for Excellence in HIV/AIDS, and UNAIDS.

    Citing both the therapeutic and preventive benefits of antiretroviral treatment, scientific experts emphasized that available evidence clearly justifies rapid implementation of the WHO 2013 antiretroviral guidelines, which markedly expanded the eligibility for antiretroviral therapy. An important focus of the meeting will be the development of new targets for ending AIDS, including a commitment to bring HIV treatment to all who need it.

    Vancouver is an apt location for the annual meeting, as the site of the 1996 International AIDS Conference, where evidence confirming the health benefits of antiretroviral therapy were produced. Since then, through proactive scale-up of HIV testing and treatment, Vancouver has laid the foundation for ending its epidemic.

    “AIDS-related deaths in British Columbia have decreased by more than 90% since 1996, and new HIV infections have dropped from 900 in the mid-1990s to 238 in 2012,” reported British Columbia Minister of Health Terry Lake. “The province’s ‘Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS)’ program actively supports health systems and community partners to diagnose HIV infection and link people who test HIV-positive to ongoing care and treatment, with a particular focus on vulnerable populations.”

    Vancouver’s approach is being emulated in countries and localities worldwide. In 2014, Panama signed a Memorandum of Understanding to use Vancouver’s Treatment-as-Prevention approach as a model for its AIDS response.

    “Having worked here, I witnessed the peak of the epidemic in British Columbia when HIV incidence among people who inject drugs hit a rate of 18,” said Dr. Steffanie Strathdee of the University of California San Diego. “The political will and investment of this province has made B.C. a model for the country and for the world.”

    “Finally there is a consensus emerging that the science clearly demonstrates treatment is highly effective in stopping transmission in all contexts,” said Dr. Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS. He cited interim evidence from the PARTNERS trial indicating no evidence of HIV transmission, among heterosexual and same-sex couples enrolled when the HIV-positive partner had viral suppression.

    Translating this evidence into reality was the focus of a panel discussion at the meeting’s opening session. Nikos Dedes, of Positive Voice, noted advances to date in the response stem in large measure from community pressure and activism, and speakers agreed community leadership and engagement would remain vital elements of long-term success. However, Dr. Christine Nabiryo, of The AIDS Support Organization in Uganda, warned “there is often lip service about community systems strengthening, however the money is not trickling down to the community.”

    “We need to understand and act on local epidemics,” said Loures. “We need to understand how they operate and understand how we can respond to them. This is much easier to do if you are bringing services closer to communities and to people.”

    Reaching those who are being missed will demand efforts to oppose and roll back punitive legal and policy frameworks that deter individuals from seeking the services they need, speakers advised. It was noted 77 countries criminalize same-sex relationships and children are substantially less likely than adults to receive HIV treatment when they are eligible.

    To prevent delays in implementation of evidence-based approaches, such as the 2013 WHO guidelines, Grenada’s Minister of Health Clarise Modeste-Curwen called for more forums that bring scientists and policy-makers together.

    Minister Modeste-Curwen also called for renewed global solidarity in the push to mobilize sufficient resources to finance rapid treatment scale-up. Noting the efforts of Grenada and other countries to increase domestic financing for the response, Minister Modest-Curwen expressed concern international HIV assistance is being phased out in the Caribbean and among other middle-income countries. Montaner seconded the Minister’s emphasis on global solidarity, arguing the international community had an obligation to follow through on its commitment to ensure universal access to HIV prevention, treatment, care and support.

    Read more at UNAIDS