ROME, 18 July 2011 (PlusNews) - The sixth International AIDS
Society Conference on HIV Pathogenesis, Treatment and Prevention
started optimistically as the hype surrounding the use of
antiretroviral treatment to prevent HIV infection gained
momentum. But the focus of much discussion in Rome from 17-20
July will undoubtedly be on how to transform the recent promising
research findings into workable policy.
The most significant of these is the HPTN052 randomized control
trial, which found that earlier antiretroviral treatment can
reduce the risk of heterosexual HIV transmission by as much as 96
percent; other studies have proven the efficacy of ARVs for
prevention in HIV-negative people.
"We need to ensure that the advances we are making in research -
such as the now proven concept of antiretroviral treatment as a
means of HIV prevention - are translated into action for people
in developing countries," said IAS local co-chair Stefano Vella,
research director at Italy's Istituto Superiore di Sanita, at the
official opening of the conference.
But translating the research into action will require money, and
if recent trends are any indication, that will be difficult, and
there is much scepticism about the ability to significantly
increase the numbers on treatment with such limited funds.
"We need to keep up the pressure on donors... Donors are used to
seeing costs rising year after year, but now we can show them a
light at the end of the tunnel... We can show them that investing
today will lead to lower costs tomorrow," Brenda Waning,
coordinator of market dynamics with the health financing
mechanism, UNITAID, said. "We also need to learn how to do more
with limited resources."
Treatment as prevention will mean putting significantly more
people on treatment earlier; at present, 15 million people are
estimated to need ARVs - only 6.6 million have access to them.
"Treatment as prevention is possible, it is feasible, but we must
not fool ourselves into thinking it's going to be easy," said
Paul de Lay, deputy executive director of UNAIDS. "We put an
additional 1.4 million new people on treatment in 2010 - if we
maintain that momentum we will not achieve the goal of 15 million
on treatment by 2015.
"We need to get to US$22 to $24 billion a year from the $15
billion a year we are currently spending; we need African
governments to abide by the Abuja Declaration commitment to spend
15 percent of national budgets on health and we need donors to
meet their commitments," he added.
"If we can convince donors that we can stop the epidemic within a
finite amount of time, the money will be found," said Brian
Williams, an epidemiologist with the UN World Health Organization
Scaling-up HIV testing
Key to putting more people on treatment earlier will be finding
those who need it; according to De Lay, most countries with
hyper-endemic epidemics are testing just 4 percent of their
"We can't rely on VCT alone; there has to be a massive push for
provider-initiated counselling and testing," he added. However,
"we have seen some classic human rights violations when it comes
to HIV testing: lack of confidentiality, stigma and
discriminatory practices and mandatory testing... we must ensure
testing is done with respect for human rights."
According to Reuben Granich, medical officer for TB and HIV at
WHO, testing will have to expand in innovative ways to achieve
the levels necessary for treatment to be effective as prevention.
"We have to go beyond the health facility to community-based
testing; for example, household testing, multi-disease prevention
campaigns - malaria, safe water, HIV testing and so on," he said.
"None of this will work without community demand and engagement."
UNAIDS executive director Michel Sidibe said his organization was
working with Jeffrey Sachs and the Earth Institute to mobilize
more than one million community health workers in Africa by 2015.
Millions more people on treatment will create a need for
increased monitoring - including CD4 testing, which measures
immune strength, and the more accurate but more expensive viral
load testing - to keep tabs on treatment failure and prevent drug
In sub-Saharan Africa, most tests are conducted at centralized
laboratories, often taking weeks and losing patients needing
treatment in the process.
"New diagnostic technology will help overcome barriers to
treatment and testing," said UNITAID's Waning. "We are hoping to
see disposable CD4 tests and expect the first viral load
point-of-care tests to be available by 2012 at an affordable
Pharmaceutical companies will have a role to play, both in
lowering the cost of drugs and in ensuring new ARVs.
"Pharmaceutical companies need a new business model - one in
which they can make profits and continue to conduct research and
development while keeping the price of drugs affordable," said De
"We must oppose trade agreements that seek to limit TRIPS [Trade
Related Aspects of Intellectual Property Rights] flexibilities. I
want to salute the government of India for refusing to accept
provisions on data exclusivity. And I want to recognize the
leadership of the BRICS
1/july/20110711bchinabrics ] [Brazil, Russia, India, China and
South Africa] ministers of health in ensuring that trade does not
undermine access to medications, especially generics," said
He pointed out the importance of using all the prevention tools
available, and the need to keep using tried-and-tested methods
like condoms. HIV prevention has also recently received a boost
in the area of pre-exposure prophylaxis, with a number of studies
- including a large randomized control trial based on daily oral
ARVs and a separate study involving a microbicide gel - also
showing efficacy in preventing HIV.
"Even if treatment as prevention is rolled out in the most
optimum way, it is unlikely to capture everyone infected... PrEP
does have a role, especially microbicide gels in hyper-endemic
countries," said De Lay.
"We have to remember that history will judge us not by our
scientific breakthroughs, but how we apply them," Sidibe.