Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, published three new blog posts last week examining issues discussed at the XIX International AIDS Conference (AIDS 2012). The mood at the conference was “strangely optimistic,” as scientists, politicians, and advocates discussed the “end of AIDS,” she writes in one, adding, “The pandemic will not be over until the number of new infections hits zero, and the annual death toll plummets to insignificant levels.” In another, she states, “The newfound optimism that imbues this gathering of some 25,000 people in Washington, DC, is based on a few genuinely important breakthroughs. But while these insights offer hope of saving millions of lives and limiting a tidal wave of human suffering, they do not add up to the much-vaunted ‘end of AIDS.'” In a third, Garrett examines funding for the HIV/AIDS response and describes a debate that took place among experts and economists at the World Bank (7/27).
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“Charged by Secretary of State Hillary Clinton with developing a blueprint for the next phase of the [U.S. government’s] involvement in the fight against HIV and AIDS, [U.S. Global AIDS Coordinator Ambassador Eric Goosby] … will lead an interagency effort to give clearer meaning to the term, ‘AIDS-free generation,’ and provide a basis for programming,” Sharon Stash, a senior fellow at the Center for Strategic & International Studies’ (CSIS) Global Health Policy Center, writes in the CSIS “Smart Global Health” blog. “Clearly the notion of an ‘AIDS-free generation’ within our reach is a powerful one,” she writes, and asks, “Is the meaning it inspires powerful enough to attract and keep the attention of national policymakers, already burdened with competing priorities in a tight economic environment?” (7/29).
Noting that “[t]he XIX International AIDS Conference [AIDS 2012] has just come to a close amid much talk of the beginning of the end of AIDS, turning the tide on HIV and even a potential cure,” Julio Montaner, former president of the International AIDS Society (IAS) and director of the B.C. Centre for Excellence in HIV/AIDS, writes in a Globe and Mail opinion piece, “It is now more certain than ever that we have the tools, medicines and expertise to stop this epidemic.” He continues, “However, without the political will to expand antiretroviral treatment to everyone in need, the audacious goals set before us in Washington last week will never be met and infection may spiral out of control once again.” He writes, “Politicians have paid little more than lip service to supporting the rollout of antiretroviral treatment in their home countries and around the globe,” and concludes, “Treatment as prevention represents the fundamental building block to achieve our goal. We must find the resolve to deliver on the promise of an ‘AIDS-free generation'” (7/30).
Highlighting the XIX International AIDS Conference (AIDS 2012), which concluded in Washington, D.C., on Friday, this New York Times editorial examines the future of the global AIDS response. “There is no prospect that scientists will any time soon find the ultimate solutions to the AIDS epidemic, namely a vaccine that would prevent infection with the AIDS virus or a ‘cure’ for people already infected with the virus,” the editorial states, adding, “Even so, health care leaders already have many tools that have been shown in rigorous trials to prevent transmission of the virus, making it feasible to talk of controlling the epidemic within the foreseeable future.” The editorial continues, “Instead of waiting for these future possibilities, [NIAID Director Anthony Fauci] and other health leaders are proposing the broad adoption of other available tools to reduce the spread of the virus so as to produce an ‘AIDS-free generation,’ a goal enunciated last year by Secretary of State Hillary Rodham Clinton.” The editorial adds, “The only question is whether the nations of the world are willing to put up enough money and make the effort to do it” (7/27).
“Health efforts are close to wiping out polio, but two significant challenges remain: money and the operational logistics of getting the vaccine to people who need it,” CNN writes in an article examining “how far we’ve come with polio and what’s left to be done.” The news service provides statistics of polio infection globally and a history of polio in the U.S., and compares polio eradication efforts to those of other diseases. “The World Health Organization has an action plan for the next 18 months that could very well lead to eradication, says Oliver Rosenbauer, spokesman for polio efforts at the organization,” the news service writes and highlights a number of challenges moving forward (Landau, 7/30).
GlobalPost correspondents John Donnelly and Charles Sennott interview USAID Administrator Rajiv Shah “about his perspectives on the AIDS fight,” in this entry in GlobalPost’s “Global Pulse” blog. They discuss U.S. Secretary of State Hillary Clinton’s announcement last week that the administration would put together a “blueprint” for achieving an “AIDS-free generation,” approaches to increasing demand for voluntary medical male circumcision in the developing world, and the closure of the Global Health Initiative office, among other topics, according to the interview transcript (7/27).
“The XIX International AIDS Conference [AIDS 2012] drew to a close Friday without the physical presence of President Obama but with a full cast of other high-profile U.S. politicians who expressed their commitment to ending the disease,” CQ HealthBeat reports (Norman, 7/27). The conference closed “with the message that getting treatment to more of the world’s 34 million people with HIV is key to curbing the epidemic, short of a vaccine and cure that still are years away,” the Associated Press adds (Neergaard, 7/27). “Presenters at AIDS 2012, from senior government officials and heads of international organizations to civil society leaders and scientists, all echoed that for the first time in the history of AIDS, an end to the epidemic is on the horizon,” an UNAIDS feature article writes, adding, “However, speakers cautioned that there are still numerous challenges that must be addressed before the international community reaches zero new HIV infections and zero AIDS-related deaths” (7/27).
“Excitement about turning the tide in the fight against HIV is being tempered by researchers who worry some of the most vulnerable populations will miss out on medical advances,” delegates of the XIX International AIDS Conference (AIDS 2012) heard at Thursday’s plenary session, VOA News reports (Seldin, 7/26). Ugandan physician Paul Semugoma, who works with homosexual and transgender patients, told the session that one of the biggest challenges is reaching people at risk of HIV infection with prevention information, especially when stigma and discrimination are prevalent, VOA says in another article (7/26). “Semugoma says too many physicians fail to ask their patients about their sexual histories in a misguided effort not to discriminate,” VOA writes (7/26). Researcher Cheryl Overs of Australia’s Monash University spoke about how discrimination and stigma hinder the AIDS response among sex workers, VOA reports in yet another article (Seldin, 7/26). Speaking about new HIV prevention methods, Overs said, “The risk to sex workers of all genders will be enormous if condoms are replaced by partially effective HIV methods that do not protect against STIs [i.e., sexually transmitted infections] or unwanted pregnancies,” according to the news service.
Sen. Dick Lugar (R-Ind.) “announced Thursday that he would release his hold on the $250 million meant to go from the President’s Emergency Plan for AIDS Relief (PEPFAR) to the Global Fund to Fight AIDS, Tuberculosis and Malaria,” saying “he was swayed by conversations at the International AIDS Conference [AIDS 2012] under way in Washington, D.C.,” The Hill’s “Healthwatch” blog reports (Viebeck, 7/26). “My biggest concern about the transfer was the shortfalls this may cause in our bilateral efforts to combat HIV/AIDS,” Lugar said, according to a press release from the senator’s office (7/26). “‘The leaders I met with this week expressed their confidence that the money is a worthy investment, and, given their strong leadership, I have decided to lift my hold on the transfer funds,’ Lugar, the ranking Republican on the Foreign Relations Committee, said in a written statement,” CQ HealthBeat notes (Ethridge/Cadei, 7/26). In related news, the U.S. Senate on Thursday introduced and passed a resolution “expressing support for the XIX International AIDS Conference and the sense of the Senate that continued commitment by the United States to HIV/AIDS research, prevention, and treatment programs is crucial to protecting global health,” the New York Times’ “Inside Congress” reports (7/26).
“What stands out in my mind from this week’s presentations [at the XIX International AIDS Conference (AIDS 2012)] is that [HIV] interventions previously proved to work in controlled clinical trials are now — over and over again — proving effective outside the research setting, in the real world, in poor and rich communities alike. The pieces are coming together,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, writes in a Washington Post opinion piece. He discusses several of the interventions, including the scale up of antiretroviral therapy (ART), treatment as prevention, voluntary medical male circumcision, and pre-exposure prophylaxis (PrEP). “Ending the HIV pandemic is an enormous and multifaceted challenge, but we know it is possible,” Fauci writes, adding that it will require “commitment” and “investments.” He continues, “We must enhance what works and eliminate what does not, overcome legal and political barriers, and remove the stigma associated with HIV.” Fauci concludes, “The global community has a historic opportunity based on solid scientific evidence to end the AIDS pandemic, opening the door to an AIDS-free generation” (7/26).