11 Oct 2012

'Turning the Tide Together' AIDS 2012 in retrospect

It’s been a few weeks since the 19th International AIDS Conference /AIDS 2012/ organized in Washington DC ended. The week long biennial conference is the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic.

AIDS 2012 present new scientific knowledge and offer many opportunities for structured dialogue on the major issues facing the global response to HIV. A variety of session types – from abstract-driven presentations to symposia, bridging sessions and plenaries – meet the needs of various participants.

This year conference themed “Turing the Tide Together” took in the US in recognition to President Obama ban on travel restriction of those people living with HIV/AIDS in 2009. It is after 22 years that the conference took place in the US.

Where is Africa’s voice?

AIDS 2012 has been attended by 24,000 people coming from 180 countries including 2,000 media representatives. From this 70% of the participants come from the United States. Africa participation in this important conference was unacceptably very low. From the current 34 million people living with HIV/AIDS in the world, 70% are living in sub-Saharan African countries. Sub-Saharan African countries continues to be the region most affected by HIV, almost all of the regions’ nations have generalized HIV epidemics (i.e national HIV prevalence rates which are higher than 1%), women comprise 59% of PLHIV in this region. Sub-Saharan Africa is the region with the highest number of pregnant women living with HIV. In 2012, young women accounted for 71% of the young PLHIV.    

It is obvious that the problem related to HIV/AIDS in sub-Sahara Africa is quite different from that of the Caribbean or Latin America. I don’t understand why the conference is not providing adequate space for African voice to be heard. There is an African regional conference every three years called the International Conference on AIDS and STI’s in Africa (ICASA). The 16th ICASA held in Addis Abeba, Ethiopia in December 2011 has deliberated on HIV/AIDS issues on the continent level, but the outcome was not communicated to the global AIDS 2012 conference. 

The outcome of AIDS 2012 has direct and indirect influence on how the funding to HIV/AIDS needs to be prioritized. The missing African voice means the outcome will not be representative of this highly affected region. Not only that but also the issues discussed during the conference might not reflect the current realities in Africa. One of this is the discussion regarding treatment as prevention, as a viable option to tackle the AIDS pandemic.

Treatment as Prevention is it a viable option for Africa?

In 2011 the treatment as prevention HPTN 052 study demonstrated that a 96% reduction in transmission occurred when an HIV-positive partner began treatment early (a CD4 count between 350 and 550 cells/mm3).

“Treatment as prevention is the biggest scientific revolution in HIV/AIDS since the first antiretroviral /ARV/ become available in 1996, and access to ARV has saved millions of lives” said Dr. Elly Katabira, AIDS 2012 International Chair and President of the International AIDS Society.

“A coordinated and effectively roll out of programmes promoting and implementing early diagnosis followed by early treatment is those countries most affected by the epidemic, also has the potential to be a game changer in the fade out of the epidemic. In some countries more than others it is going to be a huge challenge to implement and it will require committed national political will and action”.

As has been explained by the chair, treatment as prevention is not something that can be implemented as one size fits all approach. It is not a viable option for Africa. Prevention efforts on behavioural change targeting most at risk populations are found to be a viable option for Africa. Treatment, even if it is an important aspect in the fight against HIV/AIDS it does have to overshadow prevention.

According to a report by UNAIDS, in 2010 in countries representing 98% of pregnant women living with HIV, the coverage of pregnant women receiving the most effective regiments for prevention was 48%. An estimated 32% of the 1.49 million pregnant women with HIV needing ARV medicine to prevent mother to child prevention of HIV were unaware of their HIV status. In low and middle income countries, 35% of pregnant women received an HIV test. Very low public health coverage coupled with weak health system which characterizes Africa’s health landscape, it would be impossible to think of applying treatment as prevention. In the context of large number of people do not know their HIV status it would be difficult to apply treatment. Treatment need to go hand in hand with massive prevention efforts.    

In the US an estimated 1.1 million are living with HIV almost one in five is not aware of their infection. This is a country considered to have the highest public health coverage and improved health system in the world. What this signifies is that in a situation where the public health coverage is low and health system how can treatment as prevention be a viable option?

Africa context has to be taken into consideration in discussion related to HIV/AIDS, in order to come up with a workable solution. Vaccine for Polio was found in the 60’s, but there are cases of polio in Africa even after 5 decades. In 2011 there are 11 reported cases of polio in Nigeria alone.

According to the World Bank issue brief disseminated at the conference, the incidence of HIV infection peaked in the mid 1990’s in Africa, and is now declining in nearly half the countries in the region. In 2010, 1.9 million people become newly infected with HIV in Africa, down 16% from 2001.

Prevention efforts need to be scaled up combined with treatment programs for those people living with HIV. Behavioural change programs targeting key populations at higher risk of HIV infection, in addition to programs addressing gender based inequality, discrimination and violence need to be prioritized.

Funding the AIDS response is other contending issue which the conference debated. How much does it cost to turn the tide together? As rightly answered by the UNAIDS executive director Michel Sidebe, “It’s not very expensive and as well not very cheap but it is priceless”. 

Ephrem Berhanu (NAYD CEO)

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