03 August 2009

IAS Applauds SA Commitment to Treatment Scale Up

IAS Applauds South African Government for Commitment to Dramatically Scale Up HIV Treatment and Urges All Countries to Meet Their HIV/AIDS Commitments

New Evidence Presented in Cape Town Shows Dramatic Reductions in AIDS and Non-AIDS Mortality and Morbidity with Earlier Treatment

31 July 2009 (Cape Town, South Africa) - The International AIDS Society (IAS) today applauded the South African government for moving quickly to consider a more aggressive approach to scaling up provision of antiretroviral therapy (ART) for people living with HIV across the country, in the wake of strong evidence of individual and community benefits of earlier treatment presented at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, held two weeks ago in Cape Town. The South African Health Council is reviewing its ART roll-out plans over the coming weeks.

Recent reports from WHO and UNAIDS on the global AIDS pandemic have indicated that substantial increases in HIV investments over the past several years have expanded access to ART and HIV prevention interventions, reducing AIDS-related morbidity, mortality and HIV incidence in many high-burden countries. The success of the global response to AIDS has also catalyzed increased funding for tuberculosis and malaria.

Evidence presented at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, held two weeks ago in Cape Town, demonstrated dramatic reductions in TB and malaria incidence in HIV-positive individuals. Furthermore, a number of presentations urged that universal provision of antiretroviral therapy (ART) to people living with HIV would have a major impact on reducing HIV transmission, in addition to keeping people alive, well and productive in their communities.

IAS President Dr. Julio Montaner noted, "The evidence is absolutely clear. We must treat people earlier, and we must achieve universal access to ART for all people living with HIV who need it. Future generations will judge how quickly the global community responds to this urgent priority. We must move from an emergency response to a sustainably financed plan to control the HIV epidemic within a generation."

At their July 2005 summit in Gleneagles, G8 leaders committed to universal access to HIV prevention, care and treatment interventions by 2010, commitments which all UN Member States committed to at the end of that year. However, progress on these commitments was noticeably absent from this year's G8 communiqué, and most countries are not on target to meet universal access goals.

A report released by Medecins Sans Frontières (MSF) immediately prior to the Cape Town conference noted that delays, logistical failures and reductions in HIV financing are already having an impact on the availability of antiretroviral (ARV) drug supplies and other medical commodities. The report provided details of stock-outs of ARVs and other medical commodities in six African countries.

"G8 nations have committed billions of dollars in economic stimulus packages and bailouts for the very institutions that triggered this recession, while AIDS and other health care priorities have diminished on the political agenda", said Dr Montaner. "HIV is not in recession, and greater investments in HIV and other public health priorities are required from the international community, particularly given that ART is now known to have preventive as well as therapeutic benefits." He added, "Health is a fundamental prerequisite of global development, not a fringe benefit which can be cut during difficult economic times."
About the IAS

The IAS is the world's independent association of HIV professionals, with over 14,000 members in 188 countries working at all levels of the global response to HIV/AIDS. IAS members represent scientists, clinicians, public health, policy experts and community practitioners on the frontlines of the epidemic. The IAS is the lead organizer of the biennial International AIDS Conference and the IAS Conference on HIV Pathogenesis, Treatment and Prevention.


For more information:
Lindsey Rodger (Communications Officer)
International AIDS Society
Geneva, Switzerland
Tel: +41 22 710 0832
Email: media@iasociety.org

22 July 2009

IAS: New Evidence of Broad Benefits of HIV Investments

At the conclusion of IAS 2009, the International AIDS Society released a statement highlighting new evidence illustrating how investments in HIV have contributed to reductions in infant mortality and TB incidence, improved access to health services for women, and expanded health systems capacity.

Research presented at the conference -- as well as an IAS two-day meeting on health systems strengthening, sponsored by the Rockefeller Foundation and the World Bank, in conjunction with IAS 2009 -- included evidence suggesting that the scaling up of HIV programmes can lead to improvements in outcomes related to other health conditions and bolster health care infrastructure overall.

As a result of investments in HIV, clinics and hospitals are being refurbished; laboratory and diagnostic capacity is being strengthened; additional cadres of health workers are being mobilized; and morale among health workers is greatly lifted.

The scale-up of HIV antiretroviral therapy over the past five years has also served as a "pressure valve" for many poor countries with high HIV seroprevalence. Previously, hospital beds and clinics in resource-poor settings were overwhelmed by AIDS patients requiring extensive management for opportunistic infections and end-of-life care. Doctors and nurses were overworked and de-motivated. AIDS care displaced other health issues from many health systems. Recent investments in HIV and the resulting declines in morbidity and mortality have freed up resources for use on other health priorities. Investments in HIV have also led to innovative improvements to expand the health workforce to meet the broader health needs of communities

"Evidence presented here in Cape Town builds on earlier studies demonstrating that targeted investments in HIV are leveraging additional benefits to maternal and child health," said IAS President Julio Montaner. "In this way, the Millennium Development Goals 4, 5 and 6 - to reduce child mortality, improve maternal health and combat HIV - reinforce one another and must always be pursued in tandem."

The full statement is available here.

Advocates for Health MDGs Unite

In a show of unity, advocates for all the health Millennium Development Goals (MDGs) joined together on Tuesday, 21 July, in a statement charging the leaders of G-8 countries with reneging on their commitments to health by chronically underfunding programs for AIDS, TB, maternal and child health, sexual and reproductive health, and health systems strengthening across the globe.

The statement urged that each G-8 country pays 100% of the commitments they have made for 2010 including:

  • universal access to AIDS treatment, prevention, and care
  • full funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria
  • additional commitments made for maternal and child health and health systems strengthening.
According to the statement, the U.S. President's Emergency Fund for AIDS Relief (PEPFAR) has been flat funded for three years; the G-8 countries have underfunded the Global Fund for AIDS, Tuberculosis and Malaria by $4 to 9 billion; donor country promises to fund maternal and child health and sexual and reproductive health programs are wholly insufficient to the task; and no G-8 country has made sufficient commitments to contribute significantly to expanding and strengthening the health workforce, to supporting community-based prevention and care, or to strengthening health systems and health infrastructure.

"We are already seeing people die and families forced further into poverty by healthcare costs as a direct result of this global economic crisis," said Dr. Lola Dare, Executive Secretary of the African Council for Sustainable Health Development (ACOSHED). "The fickle policy decisions of world leaders and national government are further compounding these problems. The global health community is speaking with one voice on this urgent need. We can no longer permit the world to be distracted by false choices - between one disease and another, between a mother's life and that of her children, between treating sick people now, in their home communities, and building sustainable health systems for the future to deliver basic health care that can save lives."

"Investments now in HIV and health broadly are fundamental prerequisites for global development," said Julio Montaner, President of the International AIDS Society.

The full statement, signed by over 90 organizations, including the International AIDS Society, organizer of IAS 2009, is available here.

Shining Light on HIV and Health Systems Strengthening

The highlights of a two-day pre-conference meeting on Accelerating the Impact of HIV Programming on Health Systems Strengthening were presented in a satellite meeting on Tuesday, 21 July.

At the pre-conference meeting, 100 health systems and HIV researchers examined existing evidence on this crucial question and found that HIV scale-up has enhanced and strengthened key components of the health systems:

1. Health expenditures have increased.
2. The overall health workforce has become more innovative.
3. Human rights, social determinants and issues of equity are now at the forefront of primary health care.
4. There is global solidarity around the need for strengthened health systems.
5. Accountability and effectiveness of public health programmes and services has improved.

According to meeting participants, while scale-up of HIV treatment has enabled the building of emergency systems to put large numbers of people on antiretroviral therapy, HIV programmes must now evolve to allow for management of HIV as a chronic health condition.

Building integrated health services for broader health outcomes for people living with HIV is crucial. Countries that have strong maternal health services, for example, have been much more capable of managing and maintaining prevention of mother-to-child transmission programmes that support overall maternal health and child survival and not solely prevention of HIV transmission.

In the global downturn, it is also important to look more broadly at how HIV will drive broader social health insurance schemes. In public health programmes, antiretroviral therapy is usually free of charge, but people have to pay for transportation, nutrition, diagnostics and supplementary medicines. Financing strategies for HIV and health need to take this into account.

Vacancy rates in the global health workforce are high and research shows the need for further investment in supervision and management of health staff. Nurse-driven management of service programmes have shown significant successes in places like Lesotho and South Africa and need to be analyzed for replication in other settings.

Presentations from the report-back satellite session are available here.

[Update: Session webcast available.]

[Update: All presentations from the pre-conference meeting are available here.]

The Science Speaks blog also has a post on the satellite session: Prioritize Fighting AIDS...or Health System Strengthening...Or Both?

Wednesday's Plenary Session

Studies presented in the new operations research track at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention this week offered new evidence of how to increase the effectiveness and efficiency of HIV prevention and treatment scale-up, while demonstrating that HIV programmes are strengthening health systems in low-income countries.

Scientists, implementers, clinicians and community leaders participating in the meeting heard new data on such topics as when to initiate antiretroviral therapy (ART), how best to monitor patients, and ways to expand access to HIV testing. Research also addressed strategies for implementing adult male circumcision and prevention of mother-to-child transmission programmes.

A webcast of the session is available here, and the official press release can be found here.

Also at Wednesday's session, the Young Investigator Prize: Women Girls and HIV was presented to Linnet N. Masese (Kenya). More information is available here.

Online Coverage Highlights Key Developments

Experts and correspondents from NAM (the official provider of online news coverage for the conference) and Clinical Care Options (the official online provider of scientific analysis) have been fanning out across the Cape Town International Convention Centre over the last several days to produce summaries of key developments from the conference. For those who are here but couldn't follow everything going on, and those who couldn't make it but want to feel like they were here, the stories from NAM (found here) and the analyses and audio highlights from CCO (found here) provide a great roundup of what's been happening at the event.

Webcasts of plenaries and special sessions are also available.

IAS 2009 Goes Green

The International AIDS Society (IAS) has taken extra steps to reduce the environmental impact of IAS 2009, including using local suppliers with good social responsibility policies, offsetting carbon emissions, reducing the number of printed publications, and printing on recycled/Forest Stewardship Council-certified paper. Surplus food and delegate bags will be donated to local schools, and Eco Points situated throughout the conference venue have provided delegates a place to recycle glass, cans, paper and plastic.

21 July 2009

Enhanced HIV/TB Collaboration

"There is clearly much broader support for collaborative TB/HIV programming, research and advocacy than ever before," said International AIDS Society Governing Council member Diane Havlir, speaking at a two-day pre-meeting entitled, Catalysing HIV/TB Research: Innovation, Funding, and Networking held just before the start of IAS 2009. Dr. Havlir is Chief of the HIV/AIDS Division and Professor of Medicine at the University of California, San Francisco, and a member of the World Health Organization's (WHO) STOP TB Partnership.

The meeting highlighted promising research on improved TB diagnosis, and exciting news on the first new TB vaccine trial begun recently in South Africa. At the same time, participants emphasized that the extremely limited access to a point of care TB diagnostic (dipstick TB test) is undermining efforts to stop TB and represents the single most important research priority today.

Discussion emphasized the importance of looking beyond health facilities, and engaging a broader network of community actors, in both HIV and TB strategies. A more customer-oriented approach to both diseases is crucial to addressing the needs of those who have undiagnosed HIV and TB, in addition to providing services for those already diagnosed.

More than 200 people living with HIV, activists, and researchers, including NIAID Director Anthony Fauci and Nobel Laureate Françoise Barrè-Sinoussi of the Institut Pasteur, participated in the meeting. It was organized by WHO and the HIV/TB Working Group of the Stop TB Partnership in collaboration with the IAS, the Consortium to Respond Effectively to the AIDS/TB Epidemic, Treatment Action Group and the Desmond Tutu HIV Centre.

Presentations from the meeting will be available online by the WHO Stop TB Partnership. For more information, please contact Dr. Haileyesus Getahun (getahunh@who.int).

The meeting agenda is available here.

Science Speaks blog report on the meeting.

Presentations from IAS/WHO satellite session on HIV/TB Research: Where Do We Stand and What Are the Priorities?

The Political Power of Science

By Robin Gorna, Incoming Executive Director of the International AIDS Society

"Aren't conferences just a big waste of money?"

Only a couple of my friends have failed to understand my over-whelming excitement at being appointed as the new IAS Executive Director - and when I left the opening ceremony late Sunday night, I knew I'd never struggle again to explain.

I've been to nearly every International AIDS Conference, but never before made it to the IAS Conference on HIV Pathogenesis, Treatment and Prevention. The opening ceremony line-up looked familiar - a healthy mix of politicians, activists and researchers, with great cultural performances thrown in. What threw me was the depth of scientific detail, and the fiery spirit of activism from all key speakers.

Stephen Lewis took Scientists as Activists as his topic and delivered a barnstormer of a speech describing how the policies of Nazi Germany, nuclear war and climate change have all been altered by science speaking truth to power. No stranger to controversy, few would expect anything less of Stephen Lewis. More significant, was how all of the scientists showed their activist side. Nobel Laureate Françoise Barrè-Sinoussi concluded her highly technical review of viral reservoirs by changing into a Treatment Action Campaign (TAC) "HIV Positive" t-shirt.

Prof. Barrè-Sinoussi discovered the virus and is now mobilising young basic scientists to join her in the quest for a cure - and on the way she had a slap on the wrist for the global community. This is not the moment to scale back resources from AIDS: "HIV is not in recession."

A constant theme from all speakers was the real concern that AIDS has dropped off the global political agenda. And what was striking about this focus and the strong advocacy was that it was so firmly rooted in evidence. Stephen Lewis highlighted the toxic, false debate that is raging between those who want to put resources behind health systems, arguing that AIDS has had too much. He called on us all to contest the size of the pie, not squabble about the size of pieces. And made it plain that his advocacy was always derived from what scientists of all disciplines had found. Vuyiseka Dubula, Secretary General of TAC, and a woman living with HIV, pointed out that steep rises in maternal and child mortality in South Africa are both due to HIV. The evidence shows that getting women on HAART and scaling up PMTCT will tackle all three health-related MDGs. Yet political interest in MDGs 4 and 5 (reduce child mortality, improve maternal health) is in the ascendancy, while commitment to MDG 6 (combat HIV, malaria and other diseases) is on the wane.

This shift in priorities is so ill-timed given that we are getting ever closer to knowing what is needed to halt and reverse HIV and AIDS. Evidence presented by IAS President Julio Montaner at the opening showed that treatment with HAART reduces morbidity, mortality and incidence. In 2005 the G8 committed "to develop and implement a package of HIV prevention, treatment and care, with the aim of as close as possible to Universal Access to treatment for all those who need it by 2010". This simple statement mobilized the world - and all UN countries signed up later that year. Yet this year's G8 in L'Aquila seems to have dropped the ball, and speaker after speaker called on the G8 to step back up to the mark to deliver on their promises in the next 17 months.

I am proud to be joining the IAS: the world's independent membership association of HIV professionals from all sectors, committed to advancing knowledge on HIV and AIDS, and most importantly, translating this knowledge into practice. This must include tackling the policies and funding decisions that block the progress towards this end.

Conferences, a waste of money? I don't think so. What this conference opening reminded me of is the real power of the IAS: to bring people together, to broker debates and to build consensus about how best to tackle current challenges. And the conferences are also the platform to speak out and tell the world what is known and what is right. People living with and affected by HIV and AIDS have the right to evidence-based responses. And we should not shirk from speaking that truth to power.

Robin Gorna commences as Executive Director of the International AIDS Society on 1st September 2009.

Tuesday's Plenary Session

Examinations of extremely drug resistant tuberculosis (XDR-TB) and immune control of HIV in South Africa’s KwaZulu-Natal Province highlighted the strategic location of the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009) in the world’s most HIV-impacted country. At Tuesday’s plenary session, the more than 5,000 researchers, clinicians and community leaders attending the conference also took a comprehensive look at research on biomedical interventions to prevent HIV infection and financing the long-term response to HIV amid growing concerns about the impact of the global recession on scale-up. The conference runs from 19-22 July in Cape Town.

A webcast of the session is available, and the official press release can be found here.

Also at Tuesday's session, the IAS TB/HIV Research Prize was presented to Dr. Clare van Halsema. More information is available here.