Reflecting on AIDS 2016 – the return to Durban
By Sarah Hand, AVERT CEO
Treatment gains over 16 years
Much was made of the return of the International AIDS Conference to Durban and the phenomenal progress made in the 16 years since it was last held there – and rightly so. At AIDS 2000, South Africa was in a state of denial, and much of the continent was gripped by a shocking loss of life from a disease we were still trying to understand. Breakthroughs in treatment had been achieved, but failed to reach those who needed it most.
The call for treatment access in Durban in 2000 was loud. Today, 17 million people are on life-saving antiretroviral drugs, and South Africa now has the largest HIV treatment programme in the world.
The new World Health Organization (WHO) ‘test and treat’ strategy was a major focus at this year’s conference. Reaching the estimated 20 million people unaware of their status and getting them on treatment is a target that we couldn’t have dreamed of at Durban 2000. The successes of treatment as prevention, pre-exposure prophylaxis (PrEP) and prevention of mother-to-child transmission have also been impressive over the last 16 years.
However, many of those at the conference stressed that we should be cautious over celebrating early gains.
Young adolescent girls – a crisis unfolding
Two million people are newly infected with HIV each year and 1.4 million of those are in sub-Saharan Africa. New infections in adolescents, mostly young girls, has now reached crisis point, with a staggering 35% of new infections occurring in this age group. We heard from CAPRISA in South Africa that in certain districts in KwaZulu-Natal, one in four adolescent girls are HIV positive. This is a devastating reality and speaks firmly to our failure to address primary prevention.
Much was stressed about the challenges in treating adolescents with HIV, whether acquired vertically or later in life. We heard from many inspirational young speakers who have lived their young lives with HIV – but it is never easy. Depression is common, adherence poor, stigma and rejection an every day reality for some, and forming new friendships and relationships hard.
Teaching young girls about how HIV is transmitted in a school-funded programme, and then failing to fund and distribute condoms, address economic drivers, put in community safeguards, reach older male partners, and keep girls in school, simply does a disservice to the original efforts.
This same reality was echoed from those focused on addressing the complex needs of the most at risk populations, whether reaching sex workers in India, transgender women in the Caribbean, or people who inject drugs in the Ukraine – the delivery of simultaneous proven interventions is critical.
In recognition, a number of new funding and programmatic frameworks have been established, such as the UNAIDS Start Free, Stay Free, AIDS Free and the PEPFAR Dreams programmes. Long-term commitment and political support has to be given to these initiatives if their investment are to pay off.
But stigma against groups vulnerable to HIV continues to hold back progress. This remains unacceptable and featured heavily across the conference. Pervasive social norms, government laws, lack of funding, ignoring the evidence, and general deprioritising of these populations has resulted in rising new infections. As one activist said – “Ignore us at your peril.”
Digital technology – the missing piece
The power of digital technology was given some attention but not nearly enough. With an estimated 40% of the world’s population having access to an internet phone, significant potential exists for us to address that knowledge gap. Information and communications technology (ICT) could also prove effective in supporting treatment adherence, addressing stigma, providing peer support, and directing people to services.
Where’s the money gone?
As expected, significant attention was given to the ongoing decline in HIV financing – with calls for governments to fund the Global Fund taken at every opportunity. Financing initiatives such as UNITAID and the medicines patent pool, which brought over US$ 1.4 billion in savings to the global HIV treatment programme, highlight the need for us to think differently about the available funds to address the next 15 years of HIV effort.
While celebrating the success of the treatment revolution, the fact that we cannot treat our way out of HIV cannot be stressed enough. No disease has been ended without a vaccine, so finding a cure will require ongoing investment and support.
We need to focus our efforts on populations most at need and not shy away from the challenges this brings. There is nothing to be gained from spending money telling people who are not at risk about HIV, simply because we are not brave enough to tell those who need to know, now.
Stigma remains one of our most depressing and stubborn realities, and continues to slow our progress, holding people back from testing and treatment services, and leaving people isolated.
Political leadership is needed. Mark Dyball, Executive Director of the Global Fund, spoke passionately of the challenge of addressing gender equality. He hoped that in the way Durban 2000 marked the start of a treatment revolution, Durban 2016 would mark the start of our gender equality revolution – I completely agree. Addressing all that is tied into the consequences of gender inequality will bring about gains much wider than the eradication of HIV. This is surely a good thing, as we address HIV as a cross-cutting issue across the Sustainable Development Goals and not as a standalone disease.
As civil society, we fully recognise that this presents a number of challenges to how we organise ourselves, stay true to our constituency base, carve our niche, show our impact and compete for funding.
Responding to HIV through this wider lens is what our focus has to now be if we are to collectively bring about an end to AIDS. I remain positive that when the global HIV community comes together again in two years in Amsterdam we will have moved yet further towards our goal.