Dr. Jim Yong Kim, of Harvard, called co-infection with TB “an absolutely critical issue”.

Jim Yong Kim

 

He said in some parts of Africa more than 90% of HIV-infected people have TB. The disease can be difficult to diagnose, but TB is curable. The reason for such a low screening rate, he said, is that systems designed for HIV intervention have been relatively narrow ones, focused on providing HIV drugs. What is now needed is an integrated approach to service delivery.

Faith McLellan

Bill Clinton, rock star, AIDS activist, has turned his attention to other matters. He spoke Monday at AIDS2008, where he received a an enormous welcome. Just back from Africa, where he had been checking out his foundation’s global health work, he gave a typically Clintonesque speech—eloquent and impassioned, with the occasional moment of improvisation.

He compared the HIV/AIDS epidemic to a “very big dragon”, one that “must be slain by millions and millions of foot soldiers”. One task for the foot soldiers, and one in which some success has been achieved, is making treatment affordable.

Among the organisations that have helped lower treatment costs is UNITAID. Clinton called their business model, which is based on a tax on airline tickets, “an inspired idea”. He also noted that 1.4 million people are now buying HIV drugs through agreements negotiated by his foundation, agreements that bring the total average yearly cost of treatment to $120 per year. The cost of pediatric drugs has fallen to $60/yr from $600, and the cost of second-line treatment to $670/yr, which he acknowledged is still too high.

President Clinton highlighted some of the challenges that remain: a shortage of health-care workers; a resurgence of infections in the USA, especially among African-Americans; weaknesses in the the overall strength of health systems; the persistence of “AIDS-only” approaches; and continuing gender inequities and violence against women.

He pointed out that there is still a lot of work to do in high-income countries. His declaration coincided with a silent demonstration in front of the podium by advocates for housing for homeless people with AIDS.

As they unfurled banners reading, “Sin casa, con SIDA”, Mr. Clinton said the problems of homelessness and rising poverty resulting from sharp increases in the prices of food, gas, and utilities are urgent problems, especially in the USA. Furthermore, he said, smiling, all those issues were in his speech before the demonstrators showed up. . . .

Faith McLellan

Getting ready

 

Greeting the speakers

 

The setup

 

Crowd beginning to assemble

 

Co-chairs Helene Gayle and Richard Horton

 

Richard Horton opens the session

 

Tom Coates

 

Nancy Padrian

 

Jessica Ogden

 

Stefano Bertozzi

 

Peter Piot

 

Faith McLellan 

.

But in the session halls, things are ticking along energetically. This morning’s plenary was a mix of science, policy, and personal stories. Some highlights:

• Jaime Sepulveda, of the Gates Foundation, addressed supranational, global efforts against HIV/AIDS, dissecting what has worked, what has been insufficient, and what reforms are now needed.
  • He highlighted these accomplishments from what he called “an unprecedented global response” to the disease: UNAIDS, the first UN organisation devoted to a single disease; the Global Fund; PEPFAR, “the largest bilateral programme in history”; and the global alliance of people living with HIV/AIDS.
  • But deficits persist, in research and prevention especially. Existing research mechanisms are well adapted for new technologies and treatment, but are not adequate for the kinds of behavioral interventions needed. The private sector has conquered marketing, for example, and that kind of expertise is needed to combat HIV. And not enough resources are being invested in prevention and in delivery of proven prevention methods, like male circumcision, integrated family planning services, and scaling up of combination prevention and combination therapy. “More and better prevention” must be our common goal.

• Alex Coutinho, from the Infectious Diseases Institute, Kampala, Uganda, said what is needed is “leadership, leadership, and more leadership”.
  • He highlighted Tanzania, Rwanda, Cambodia, and Mexico as countries that have demonstrated leadership and results. Ethiopia also has been able to establish more than 260 treatment sites, even in remote areas of the country. Villages in rural Uganda are now doing home-based testing, with one area alone reaching more than 400 000 people.
  • “Even the best orphans and vulnerable children programmes cannot replace parents”, he said. The best solution is to keep parents alive and healthy.
  • A number of community-based programmes have achieved good results–campaigns to stop violence against women; programmes to scale up services for sex workers; and support groups for HIV-positive people that dedicated to fighting stigma.

A session that followed sounded fascinating: “Is religion a barrier to HIV prevention?” Unfortunately, a lot of other people must have thought it would be intriguing as well. Dozens of people, including me, were turned away because the room was full to overflowing. Info to come, I hope.

Faith McLellan

At a press conference that previewed the opening ceremony, speakers highlighted some of the themes of the meeting. Stigma and discrimination continue to be obstacles to diagnosis and care, especially among marginalised groups–men who have sex with men, female sex workers, and intravenous drug users. The prevalence of HIV among men who have sex with men is high in some areas of the world, where homosexual sex may be illegal. According to Peter Piot, of UNAIDS, in Asia especially, these numbers recall the epidemic in the western world in the 1980s. “The epidemic still surprises”, Piot said.

There is also grumbling from some quarters that resources going to HIV/AIDS are robbing other important parts of health systems. Some people have derided universal access to treatment as unwarranted entitlement. To this Piot replied, “I say entitlement is good: this is entitlement to life”.

This is the first time the meeting has been held in Latin America. Latin American research comprised the second-highest number of abstracts submitted for presentation. 7500 abstracts will be presented this week. Needless to say, we won’t be covering them all here! Go to www.aids2008.org for more.

Faith McLellan