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Monday 25th June 2018

16th AIDS Conference

4th September 2006

15052006_aids1.jpgThe sixteenth Annual AIDS conference, held in Toronto from 13 - 18 August 2006, had the theme 'Time to Deliver'.  It focused on the promises and progress made to scale-up treatment, care and prevention, with representatives from science, government, community and leadership from around the world.

Here is a collection of articles around the main themes of the conference. Our Viewpoint of 4th September 'Is it just about the provision of ARVs?' also takes this as its focus.

Medicines, money and motivated

In a speech at the closing session of the 16th International AIDS Conference Dr Anders Nordström, Acting Director-General of the World Health Organization said that "drastic measures" were required to ensure there are enough health workers available to deliver universal access to HIV/AIDS prevention, treatment, care and support by 2010. He said
that "money, medicines and a motivated, skilled workforce" were key to delivering universal access. 

He emphasised that the funds available for HIV/AIDS globally were growing, but so were the needs. "Worldwide, resources for HIV/AIDS have increased to over US$ 8 billion a year. But that is still not enough. The estimated need in low- and middle-income countries is US$ 15 billion this year, and that will grow to US$ 22 billion in 2008." Dr Nordström praised recent initiatives aimed at providing sustainable financing mechanisms, such as the UNITAID initiative of France, Brazil, Chile, Norway and the United Kingdom, using a levy on airline taxes to provide money for HIV work.

He stressed that access to drugs remains critical, saying drug pricing was still an issue to ensure that both first-line and second-line treatments were affordable. "There is growing momentum for innovation, research and addressing intellectual property issues to ensure maximum access to new products that save lives." he said.

He called for "drastic measures" to urgently strengthen the workforce, as without health workers, universal access not possible.  A health system also required stronger information and surveillance systems, logistics and distribution systems.

Dr Nordström asked delegates to make universal access possible through "a borderless society for health. One that embraces all who can make a difference, from political leaders, scientists, health workers to young people, persons living with HIV, the poor, sex workers, injection drug users, people in prisons.?

Finally, Dr Nordström told delegates that, along with treatment, care and support, renewed attention must be paid to the prevention of HIV, and that it was not a case of doing one or the other. "Millions have died through lack of both" he added.

'Fight Aids in the way you battled apartheid'  
Jim Yong Kim, the former director of the World Health Organisation’s HIV programme, urged political leaders in Africa to encourage HIV tests to help fight the spread of Aids and to lift the stigma attached to it.

Dr Kim said that Thabo Mbeki, the President of South Africa, was fostering a social crisis by refusing to embrace the reality of Aids, adding that those who defended a person’s right to refuse a test were doing unrealised damage.

“There are people who are still saying that protecting a person’s right not to know [if they are HIV-positive] is the most important thing. But the particular human right is the right to die prematurely not knowing your HIV status. That just doesn’t make any sense to me. The conversation has to change because we now have different tools.? said Dr Kim, the director of Harvard’s Francois Xavier Bagnoud Centre for Health and Human Rights.

Singling out South Africa he said “I just wish that Mr Mbeki and the African National Congress would fight it the way they fought apartheid.?

G8 accused of failing Africa over Aids funds 

UN special envoy Stephen Lewis accused the G8 countries of betraying Africa by their failure to find the money to fulfil their Gleneagles promise on the treatment, care and prevention of Aids. Mr Lewis said that African governments attempting to treat their citizens were struggling with the cost and their main fear was that the money from donor countries would dry up. The G8 committed the rich world to fund universal access to drug treatment for Aids by 2010. The fund was $500m short of the money it needs even for this year's grants.

Women must take control of HIV prevention to curb spread of infection

A number of speakers at the 16th international AIDS conference claimed that until women take control of HIV prevention, it will be impossible to halt the global spread of HIV/AIDS. UNAIDS said that of the 39 million people in the world currently living with HIV or AIDS, half are women. Of the 45 million new cases expected between 2002 and 2010, 70% are likely to be in women in the developing world. They said there was an urgent need to prioritise methods of prevention that take control away from men, advocating greater investment in microbicide research and acknowledging the remoteness of an effective HIV vaccine and the soaring costs of treatments.

Microbicide gels and creams are relatively inexpensive and easy to manufacture and distribute, and can be applied before sex to prevent HIV and other sexually transmitted viruses from attaching to vaginal walls. They are designed to be used by women without the cooperation, consent, or knowledge of their partners.

Women’s health advocates at the conference said that due to engrained sexual male behaviour and inequality in African countries women needed to control prevention methods; they often lack the social and economic power to insist on abstinence, fidelity, and condom use in their partners, which are the tenets of the current ABC of HIV prevention policies.

Fears over drug-resistant TB in Aids patients

In a revelation that has shocked delegates scientists have said that a form of tuberculosis that does not respond to known drugs has emerged in a rural district of South Africa and is killing people being treated for Aids. 

Multi-drug resistant tuberculosis, or MDR TB, is mainly found in eastern Europe, but there has been an epidemic in New York and cases in the UK. It can be treated but the drugs are expensive and recovery takes a long time. Researchers have found that 41% of TB patients in a district of KwaZulu-Natal had MDR TB, although it had been thought there was little of the disease in Africa.

Potentially more alarming was that 10% of them had extensively drug-resistant TB (XDR TB), which does not respond to any drugs. All those found by the team with XDR TB whose HIV status was known were HIV positive. TB is a major risk for people with HIV because the virus depletes the immune system, making it hard to fight off infections.

Hope for reducing risks of HIV infection

Kevin De Cock, head of HIV/Aids at the World Health Organisation, said the WHO, with Unaids, Unicef and the World Bank, were developing guidance on safe ways to circumcise men, as evidence grows that the practice may significantly reduce the risk of HIV infection.

A French-funded study in Orange Farm, Johannesburg, South Africa, last year reported a lower rate of HIV infection among the young men circumcised as part of the research. Scientists believe that the lower levels of transmission may be explained by the elimination of cells in the foreskin most receptive to HIV, combined with reduced risk of abrasion and infection. UN officials cautioned that the findings remained preliminary.

Dr De Cock warned any use of circumcision would need to be accompanied by other preventive measures such as correct use of condoms and reduction in the number of sexual partners. Challenges include cultural acceptability of circumcision and concerns that it could generate a false sense of security that would encourage promiscuity.

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