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.
22 July 2009
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.
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.
"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.
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: 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?
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.
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.
21 July 2009
"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 (firstname.lastname@example.org).
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?
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.
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.
20 July 2009
U.S. Ambassador at Large and Global AIDS Coordinator Eric Goosby and National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci today addressed U.S. global HIV policy, research and implementation under the Obama Administration in a special session. Addressing the current debate over when to initiate antiretroviral therapy, Dr. Goosby noted that the science clearly shows starting treatment at CD4 cell counts of 350 is better than starting at counts of 200. He assured delegates that this science will inform discussion of whether the World Health Organization's HIV treatment guidelines should be revised, but also noted that fiscal realities of what countries can afford will be a consideration. Dr. Goosby also said that PEPFAR is committed to mainstreaming responses to gender inequality in its activities and the programmes it supports. "We know we must place a special emphasis on women and girls to address gender inequity," he said.
Dr. Fauci reviewed the current state of HIV science and U.S. health policy, noting the benefit and cost-effectiveness of beginning treatment earlier. He cited research showing that the annual cost of caring for someone who starts treatment late in the course of disease (with a CD4 cell count of less than 50) is twice as high as the cost of care for someone who began treatment earlier. Dr. Fauci also said that he is confident the U.S. entry ban on people living with HIV will be lifted, as will the ban on federal funding of needle exchange programmes operating in the U.S. Both issues are under active consideration in the U.S. at present.
The special session was chaired by Global Fund Executive Director Michel Kazatchkine.
Additional notable quotes from the session included:
"I hope that Obama's stated commitment to restoring science to its rightful place applies to all the responses to HIV."
"Many of us are hoping for change in US policies on abstinence, needle exchange and addressing populations most at risk."
"Every bit of data we accumulate, we move to the realization of starting HAART earlier."
"Everything points to earlier HIV therapy."
"With regard to the science and the policy, we will stay on the right path."
To the delegates, "You've permanently changed the landscape of global health."
"PEPFAR is committed to mainstreaming responses to gender inequality in its activities and the programmes it supports."
"The end goal is for each country to be in a position to control its response to HIV."
Update: the Center for Global Health Policy also blogged about this session on Science Speaks.
Researchers speaking in the first plenary session of the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009) offered insights into current and future HIV prevention research and examined genetics and HIV-related inflammation as avenues for new treatments. The presentations, which also included data on the use of highly active antiretroviral therapy (HAART) for prevention and an update on strategies to reduce maternal transmission of HIV, reflect the breadth of expertise among the more than 5,000 researchers, clinicians and community leaders attending the conference, which runs from 19-22 July in Cape Town.
The press release is available here.
19 July 2009
The speakers at tonight's opening session included a number of powerful messages in their remarks. Click on read more to see selected quotes.
Hoosen (Jerry) Coovadia, IAS 2009 Local Co-Chair, Chairman of Dira Sengwe and Scientific Director of the Doris Duke Medical Research Institute at the University of KwaZulu-Natal
"HIV is the hand-maiden to tuberculosis."
Julio Montaner, IAS 2009 Chair and Director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada
"Earlier this month, another G8 Summit came and went. HIV/AIDS was indeed the elephant in the room. In 2009 the eight most powerful economies in the world left HIV off their priority agenda. They parted with no progress report on HIV, and they even failed to renew their prior commitments to the goal of universal access to HIV, prevention, care and treatment by 2010. This is totally unacceptable. This is a tragedy."
"HAART is no longer viewed as just a cost-effective intervention that prolongs the life of a person living with HIV or AIDS. HAART is now additionally viewed as an essential tool to curb the growth of the epidemic."
"We need a comprehensive approach to HIV and AIDS. This means that as we invest in treatment, we must also invest in prevention, care, and support."
"Unless we redouble our efforts to conquer this disease it will define the 21st century for sub-Saharan Africa."
Vuyiseka Dubula, General Secretary of the Treatment Action Campaign
"Mandela's legacy is about health, dignity and freedom."
"Health is not in recession."
"I want a guarantee that when the time comes when I need second line treatment, I will have access to it."
Françoise Barré-Sinoussi, 2008 Nobel Laureate and IAS Governing Council
"Reducing the international efforts on universal access to HAART because of the global recession will be a disaster. Governing bodies and leaders will be responsible for this disaster if they don't uphold their commitment. HIV is not in recession."
Stephen Lewis, AIDS Free World Co-Director
"No one should underestimate the power and influence of science when it decides to take a stand."
"When, as now, there's a backlash against funding for AIDS, with mindless charges against AIDS exceptionalism, you should find a way collectively to shoot down the pinched bureaucrats and publicity-seeking academics who advocate exchanging the health of some for the health of others."
"We must never allow them to play one part of the health sector against the other...HIV/AIDS, for all the horrendous human consequences, has objectively strengthened health systems."
"When the G8 won't renew its 2005 commitment to universal access...then it's time for science to speak with one powerful voice of accusation."
"There's no such thing as the enjoyment of good health for the women who live in constant fear of rape...bringing an end to sexual violence is a vital component in bringing an end to AIDS."
In addition to this blog -- and our Twitter feed and Facebook page -- other groups are also following IAS 2009 live.
As the official provider of online news coverage for the conference, NAM will offer news stories on major scientific presentations and host online discussion forums for HIV implementers on aidsmap.com. They are also providing a free daily email update, which you can subscribe to here.
Clinical Care Options is the official online provider of scientific analysis for IAS 2009. Online coverage will include capsule summaries of important clinical data, expert analyses and audio highlights, and downloadable slidesets.
Also, Science Speaks will be live blogging the conference. The blog -- published by the Infectious Diseases Society of America's Center for Global Health Policy -- recently provided comprehensive coverage of the HIV Implementers Meeting in Namibia.
As part of its professional development efforts, the IAS brought together HIV programme managers for a two-day pre-conference workshop to learn how to improve the effectiveness, efficiency and quality of service delivery through operations research (OR). Twenty-five managers from 19 different countries -- including 17 in Africa -- participated in the session.
Presentations from leading faculty members – Dr. George Schmid (WHO/CDC), Dr. Tony Harries (International Union Against Tuberculosis and Lung Disease) and Dr. Rony Zachariah (Médecins Sans Frontières) – gave participants an overview of OR, demystifying the concept and the processes involved in it. As Dr. Schmid remarked, "OR does not have to be complex to be effective."
The global economic climate has stimulated further interest in OR as a way to improve the efficiency of HIV programmes. The session emphasized that effective OR need not be expensive. For example, it presented case studies from Malawi showing how small research grants of US$450-1,800 to study programmes to scale up treatment and better manage TB yielded results that influenced national policy and changed practice.
On a visit to the Khayelitsha HIV-TB clinic, participants met with staff from MSF and saw first-hand how OR could be used to improve care in a resource-poor setting. The example of integrating OR into a busy primary care delivery site demolished the naïve but too-common conception that research cannot be a routine part of health care programmes.
Dr. Harries advised participants to be strategic in conducting research by getting stakeholders involved from the start, building partnerships, and being pragmatic in their choice of research questions. It is also important to provide "bits of information" that can be digested by decision makers. The workshop also emphasized the need to publish research and disseminate findings at meetings and conferences, and to integrate scientific writing and publishing skills into capacity-building initiatives.
As a pilot project, this IAS Professional Development Programme benefitted from a partnership with the WHO Department of HIV/AIDS, WHO Tropical Diseases Research, The Global Fund, The Lung Union and MSF.
The IAS 2009 conference is featuring a new track on operations research, which is intended to further emphasize one of the defining characteristics of the meeting: examining how scientific advances can be translated into practical interventions that respond to current challenges in HIV prevention, treatment and care, particularly in low- and middle-income countries. On Sunday, the IAS and the Lung Union are hosting a satellite session on OR -- Learning by Doing? Operational Research to Strengthen HIV Prevention, Care and Treatment Scale-up in Resource-Limited Settings: What, Why and How? On Wednesday, a plenary presentation by Gerald Friedland will address Advances in Operations Research Addressing the Convergent HIV and TB Epidemics.
Update from Gurmit Singh (3 August 2009):
George Schmid and his rapporteur team's Operations Research Track D reports are now available here.
Check them out and see if the lessons learnt from this research presented could help you with developing your OR protocols.
18 July 2009
Médecins Sans Frontières (MSF) reported yesterday on disruptions in supplies of antiretroviral (ARV) drugs in six African countries. Citing the catastrophic consequences of drug shortages on new patients and those already in care, the MSF report called on national governments, donors and their partners to take swift action to address the funding gaps and supply distribution problems hampering access to lifesaving drugs. The six countries cited were the Democratic Republic of Congo, Guinea, Malawi, South Africa, Uganda and Zimbabwe. The report will be the subject of an MSF satellite meeting on Sunday, 19 July entitled, The Emergency Is Not Over: Access to Treatment and the Challenges of Long-Term Survival on Antiretrovirals. A plenary presentation on Tuesday by Dr. Stefano Bertozzi of the National Institute of Public Health in Mexico will focus on financing the long-term response to HIV.IAS 2009 organizers have expressed deep concerns about the impact of funding shortages on access to treatment and will reiterate those concerns in Sunday's opening session, where Treatment Action Campaign's Vuyiseka Dubul will also speak. The interruption of ARVs is potentially life-threatening for those now on treatment, and also poses a serious public health risk from the potential development of resistance. The threat of shortages also complicates the current push to revise normative treatment guidelines on when people living with HIV should begin treatment, which will be another hot topic in Cape Town and will be discussed in a symposium on Monday 20 July. Treatment Action Campaign is also planning a march and rally for Sunday afternoon to call for the resources needed to meet treatment targets in the country.
Webcasts of the opening session and all plenary sessions will be available on www.ias2009.org.
16 July 2009
by Craig McClure, Executive Director, International AIDS Society
IAS 2009 comes at a critical time. There has been huge progress since the International AIDS Conference was held in Durban nine years ago. Well over 3 million people are on ARV treatment in poor countries, prevention programmes have been scaled up, and health care workers and policy makers are leveraging HIV programmes to strengthen other areas of health care.
Great strides have also been made with malaria and tuberculosis on the back of the global movement to fight AIDS. Sexual and reproductive health, primary care, and maternal and child health are all benefiting from the scale up of HIV programmes. We know more than ever about how to prevent and treat HIV, and we know we must combine. Combine the right prevention interventions for each specific community with early testing and treatment. Combine prevention and treatment with human rights promotion and protection for all people. We just may be at the beginning of the end, or at least the end of the beginning.
And yet, just as we are finally beginning to put a dent in the epidemic, HIV is at risk of falling off the agenda of the world’s leaders. As the global recession sets in, reports of stock outs of ARVs in a number of countries in Africa are beginning to circulate, putting lives at risk for those who already have, or thought they had, access to treatment.
At the international level, there are voices calling for resources to be shifted to “health systems strengthening”. These people argue that disease-specific programmes are “distorting” overall health systems. What a load of rubbish. We must remember the disastrous state many national health care systems were in before the HIV movement raised the alarm over and over and over again, finally mobilizing political leaders to do something. We must remember the thirty million people who died of AIDS before treatment programmes began to be scaled up. We must remember the millions who still have no access to treatment. And we must remember the example the HIV movement has set for global health, by forging a true global, multi-stakeholder partnership.
The issue of resource needs is real and very urgent. We need more, not fewer, resources for HIV. We need resources for other diseases, too. We need resources for primary care. And we need resources for health systems more broadly. Health is a prerequisite for development, and we must remind our leaders of that over and over again. South Africa, at the heart of the HIV epidemic, is the perfect place from which to make our voices heard once again.
09 July 2009
Conference organizers announced today that recently confirmed US Global AIDS Coordinator Eric Goosby and NIAID Director Anthony Fauci will speak at an IAS 2009 special session entitled, Global HIV Research and Policy and Programme Implementation under the New United States Administration. The session will be held on Monday, 20 July at 13:00 and chaired by Global Fund Executive Director Michel Kazatchkine.
This is the first major international AIDS conference for Ambassador Goosby in his role as Coordinator of the President’s Emergency Plan for AIDS Relief (PEPFAR), the US government’s multi-billion dollar global AIDS programme. Dr. Fauci, who has spoken at previous IAS conferences and is always a big draw, will discuss US government-funded HIV research. The session is sure to attract a standing room only crowd eager to hear details of the Obama Administration’s plans. Those unable to watch in person can access a free webcast of the session on the conference website later that day.
06 July 2009
Many of the highlights from IAS 2009, including a scientific keynote address by 2008 Nobel Laureate Françoise Barré-Sinoussi during the opening session, will be available as free webcasts. In addition to the opening and closing sessions, all plenaries and special sessions, as well as final rapporteur reports and some late breaker sessions, will be webcast. Click here for the full webcast schedule.