Making headway

The 17th International Aids Conference swung into action in Mexico last week.

Eight years—and four conferences—ago, South Africa’s erratic policies on the disease entered global consciousness when the International Aids Conference was held in Durban.

This year, at the 17th International Aids Conference in Mexico, the anticipation of fireworks that has accompanied the Aids conferences since Durban—at least largely for the South Africans—was missing because South Africa’s Minister of Health, Manto Tshabalala-Msimang, did not attend. Instead Deputy President Phumzile Mlambo-Ngcuka represented the country at the conference. International Aids conferences are not regarded as the most scientifically important meetings on the disease, but they are the most high-profile.

The heads of the United Nations, UNAids and the World Health Organisation all opened the conference with Mexican President Felipe Felipe Calderón.

Two South Africans addressed plenary sessions at the conference.
Professor Linda Richter of the Human Sciences Research Council called for more attention to be paid to the needs of children living with HIV. In 2007 it was estimated that 2,1-million children under 15 were living with the virus, 90% of whom live in sub-Saharan Africa. Richter said that children make headlines, but too little attention is paid to their physical, emotional and socio-economic needs.

With the development pipeline for a vaccine against HIV effectively empty, attention is being focused on a boots-and-braces approach to preventing the spread of the virus by combining different strategies. University of North Carolina professor Myron Cohen told the conference that it would be impossible to “treat our way out of the epidemic”. He called for the treatment and prevention strategies against HIV to be combined to create an effective response.

Previously, Swedish researchers said that, subject to certain conditions, successful antiretroviral therapy effectively drops the risks of transmitting HIV to zero.

The potential impact of anti-retroviral treatment (ART) as a prevention and life-saving tool was highlighted by Canadian researchers. A mathematical model by Julio Montaner, the president-elect of the International Aids Society, of the HIV epidemic found that increasing ART rollout from 50% of those needing it to 75% or 90% or 100% would lead to an annual drop in new infections of 30%, 50% and 60% respectively.

Although successful ART reduces the transmission of HIV, it doesn’t address the issue of newly infected people, who tend to be highly infectious and at greater risk of passing on the virus. The conference was reminded that encouraging people to learn their HIV status has benefits both for individuals who can access medical care and for public health.

One way of tackling this area of HIV transmission could be the use of pre-exposure prophylaxis—giving antiretroviral drugs to high-risk individuals before they become infected. The concept is to prevent the virus replicating in sufficient numbers to become entrenched in the body while the immune system gears itself up to deal with the new pathogen. Several ongoing or planned clinical trials on pre-exposure prophylaxis could confirm the effectiveness of this prevention strategy. Conference speakers repeatedly emphasised the need for forthright leadership and cohesive action to reduce the spread and impact of HIV in the present and future.

Former Botswanan president Festus Mogae announced the launch of “Champions for an HIV-free Generation”, which includes the former presidents of Mozambique, Zambia and Tanzania, as well as religious leaders and celebrities. The group includes South African Appeal Court Judge Edwin Cameron, who has been outspoken about his own HIV-positive status. Mogae was quoted saying: “We need to innovate and reinvigorate our approach to HIV, focusing on prevention.

“Our current practices are somewhat dated. We need to think out of the box. We need a creative new approach to catalyse country and regional-level leadership.”

Cameron praised Mogae’s stance: “When my own country was mired in the ghastly nightmare of President [Thabo] Mbeki’s Aids denial, President Mogae was coming out very clearly on the importance of offering his people HIV treatment and care.”

Another former president, this time of the United States—Bill Clinton—addressed a packed session of the conference, saying that Africans might be more vulnerable to HIV because of genetic adaptations that help combat malaria. After leaving office the former president created the Clinton Foundation, which works to reduce drug costs and increase access to ART.

Clinton said that about half of the three million people globally receiving ART were using medication purchased through the Clinton Foundation and that costs of paediatric treatment had seen a 10-fold decrease in three years. The World Health Organisation recently recommended that infants start antiretroviral therapy as soon as they are diagnosed with HIV.

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