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AIDS 2014: Reflections

Tuesday, 29 July, 2014

Reflections on the International AIDS Conference 2014, by AVERT's Information and Research Officer who attended the conference

Last week, Melbourne, Australia warmly welcomed nearly 14,000 delegates from over 200 countries to their city for the 20th International AIDS Conference - AIDS 2014. Advocates, key decision makers, donors, researchers, people living with and affected by HIV, politicians and celebrities from around the world came together to talk about the HIV epidemic and the way forward. The theme of this years conference was "Stepping up the pace", in recognition that the international community has made great strides to get where we are now - but in order to achieve the 'End of AIDS', efforts and funding need to be redoubled.

The conference commenced under the shadow of the disaster of MH17, where we lost some of our most esteemed and committed colleagues in the response. In the face of this disaster, the AIDS community came together and remembered their loss and commitment at every opportunity. A poignant moment for myself was when I was stopped in the street on the way to the conference centre one morning by a man who had seen my delegate badge and told me how sorry he was that we had lost so many of our friends.

Prior to the conference, the Melbourne Declaration was released, calling for the repeal of all discriminatory and punitive laws that violate human rights, marginalise entire populations, and hamper the HIV response. This was a running and highly vocalised theme throughout the conference, as it is increasingly recognised that biomedical interventions alone cannot end AIDS, and that there is also a need for structural interventions based on human rights and dignity to end the pandemic. During the closing ceremony this was addressed again when Eliot Ross Alberts, Executive Director of INPUD, commented on how people who inject drugs, and other key populations, are affected by the epidemic. "Stigma kills members of our very diverse, intermingled, and overlapping communities, not metaphorically, but in reality, and brutally". It is within this environment of prejudice and marginalisation that communities come together, find solidarity and build the most important and effective voices in the response.

These community voices were most loudly heard in the Global Village, the heart of AIDS 2014 and a space that was open to all - not just to conference delegates. It was in this space that one could truly see and feel the epidemic. This vibrancy was brought out into the streets of Melbourne for the traditional AIDS march. It was during this time that we further remembered our colleagues lost, and highlighted key and recurring issues throughout the years, such as: "Silence = Death"; "No Getting there without Women"; and "Stronger Together".

One of the groups most affected by HIV, but often not included in the response - young people also had a strong voice at the conference. Across many of the sessions at AIDS 2014 it was reiterated time and time again that young people and adolescents who are sexually active, are being marginalised, and most importantly, denied access to key health services because of age of consent, or because their activities are considered illegal. It was recognised that the methods of preventing HIV and reaching key affected populations have changed so dramatically with the onset of new media. Many of the Global Village Panel sessions discussed successful online campaigns and social media outreach to target those who need HIV and sexual health information. The evidence of targeting groups through these methods exists, but this needs to be translated into policy. As such, online mechanisms to reach key populations were called for and demanded in national strategies to combat HIV.

The Lancet convened a special session on Sex Work and HIV. Structural barriers to reach this group were identified, with research finding that decriminalisation and facilitating a safer sex environment has the greatest positive impact on the HIV epidemic among this group. Male sex workers and transgender sex workers were also presented as highly vulnerable to HIV, but largely missing from the literature and discourse on the response. 

Ultimately, there was a lot of discussion about inclusivity. HIV programming needs to be developed in recognition of local, cultural, contextual and historical perspectives. HIV responses need to take into account how people change throughout their lifetimes. Many of the sessions discussed pleasure and sex - something that has hampered prevention efforts because of taboo. Up until now, sex and pleasure had largely been removed from the discourse - a paradox, as it is so inherently important when understanding the driving risk factors, particularly where young people are concerned.

Another thoroughly discussed issue was the new proposed UNAIDS target by 2020: 90/90/90. The target is that by 2020, 90% of all people living with HIV know their status: 90% are on treatment: and 90% achieve viral suppression. However, unless there is a human rights-based approach for ALL targets, the end of AIDS will not be possible.

We also have to look critically at how resources are distributed to reach these targets. Currently, fifty percent of new infections are among key populations, but nowhere near 50 percent of the resources to prevent new infections are targeted towards these groups, representing a huge mismatch between funding and need. The same applies for funding human rights based interventions - only one percent of the global HIV budget. If we were to shift only a small amount of the money that goes into the criminal justice system towards human rights - we would a see marked improvement towards reaching our goals.

As a UK-based organisation, there was a notable lack of presence from the UK government. No representative from DFID was present at Melbourne - the fun hashtag #wheresDFID was circulating on Twitter, started by the large UK contingent of organisations that had travelled to Australia for this conference. Involvement of government in the fight against HIV & AIDS is essential, as Bob Geldof in the closing session stated: "On this last mile, on this last hurdle, we cannot allow indifference, and incapable governments to stop the final victory, which is coming."

AVERT used the conference as an opportunity to launch 'Update Your Status', a global campaign calling on young people to test regularly for HIV. The campaign also calls on key decision makers to invest in young people to overcome many of the structural barriers that stop young people from accessing HIV services. Many of these barriers were discussed in depth at AIDS 2014.