PHA-Exchange> Toronto summary: AIDS conference focuses on prevention

[Claudio]

From: RKoppenleitner 


JOHANNESBURG, 22 August (PLUSNEWS) - As the 26,000 delegates who attended the 16th International AIDS Conference in Toronto, Canada, prepared to head home on Friday, the pervading mood was one of guarded optimism.



The conference theme, 'Time To Deliver', set the tone for a week of reflection on lessons learned from the past 25 years of the AIDS epidemic. UN Special Envoy for HIV/AIDS in Africa Stephen Lewis used it as a rallying call in his closing speech to define the needs of the next 25 years, with a special focus on prevention.



At the previous conference, two years ago in Bangkok, the issue of prevention was largely eclipsed by the push for treatment access. In Toronto there was consensus that the goal of universal access to treatment would remain beyond reach as long as new HIV infections outpaced the ability of governments to deliver treatment and care.



According to UNAIDS, new HIV infections every year are outrunning AIDS-related deaths. In Sub-Saharan Africa, for example, there were 2.7 million new infections in 2005 compared to 2 million deaths, but less than one in five people at risk of becoming infected has access to basic prevention services.



Lewis echoed the view of many speakers in Toronto who criticised abstinence-only prevention programmes as both ineffective and dictated by the ideological bias of funders. Others argued that behaviour-based prevention programmes could work when they were based on evidence rather than ideology, but were overshadowed by the nearly unanimous bashing of the 'ABC' approach - 'Abstinence, Be faithful, Condom use' - advocated by President Bush's Emergency Fund for AIDS Relief (PEPFAR). 



The UN envoy added his voice to those of Bill Gates and former US President Bill Clinton who put their considerable weight behind the delivery of an effective female-controlled microbicide, and the rapid rollout of male circumcision that initial data suggested could be 60 percent effective in reducing HIV transmissions among men.



Lewis also pointed out that existing prevention methods, such as the use of combination antiretroviral (ARV) therapy for the prevention of mother-to-child transmission, were being severely underutilised in the developing world, where most countries were still giving HIV-positive pregnant women less effective single-dose nevirapine, if anything at all.



"This means that hundreds of thousands of babies continue to be born HIV-positive rather than reducing the transmission rate virtually to zero," he said.



Earlier in the week, delegates learned that ARV treatment itself has a role to play in prevention. Efficacy trials of an approach called pre-exposure prophylaxis (PREP), in which ARV drugs are administered to prevent infection, are underway in three countries and could produce results as early as 2007. Julio Montaner, the director of British Columbia's AIDS Centre in Vancouver, presented a mathematical model showing that if all identified cases of HIV were treated, prevalence would drop to virtually zero by 2050 because treated people were much less infectious.



The likelihood of achieving universal access anytime soon looks remote at current rollout rates. Lewis said the number of people on treatment only rose by 350,000 in the last six months, bringing the total to 1.65 million of an estimated 6.5 million people in immediate need of the drugs. 



According to Lewis, "a huge financial crisis" threatens closing of the treatment gap - commitments by G8 leaders in Gleneagles last year are already unravelling and no one is sure where the billions of dollars needed to achieve universal access, prevention and care will come from.     



The focus on prevention and treatment was not popular with everyone at the conference. Several delegates from organisations working in Africa pointed out that ARVs and new prevention methods were beside the point when the real drivers of the pandemic in developing countries were economic and gender inequality.    



"We need to go far, far beyond the technologies that are being highlighted here," said Stuart Gillespie of the Regional Network on HIV/AIDS, Rural Livelihoods and Food Security (RENEWAL). "We need to go beyond even food aid; we need to look at livelihood security."



On the final day of the conference, Lois Chingandu, executive director of the Southern Africa HIV/AIDS Information Dissemination Service (SAFAIDS), expressed disappointment that governments had not used the conference as an opportunity to set long-term financial targets for combating the epidemic. 



She told journalists that community-based organisations and health workers were already well-positioned to deliver treatment, prevention and care, but needed political leaders to make good on promises of "sustainable, predictable and flexible financing that allows us to respond in our own way".



Lewis agreed that the key to capitalising on the cautious optimism of the conference lay at country-level. "If the next 25 years are to link, inseparably, poverty and disease ... then it has to happen in-country, on the ground - organised and orchestrated by the countries themselves." 






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