AIDS 2008: Living with complexity

There will be no simple solution to the HIV/AIDS crisis, delegates to the 17th International AIDS Society World AIDS Conference were told. More than 20,000 people assembled in Mexico City from August 3-8 to hear the latest in developments to try to control the global spread of the virus [1]A small infective organism which is incapable of reproducing outside a host cell..

“If we are going to get ahead of this epidemic, it is time to come to terms with complexity,” said Peter Piot, Executive Director of UNAIDS [2]Joint United Nations Programme on HIV/AIDS. UNAIDS is the main advocate for accelerated, comprehensive and coordinated global action on the epidemic. . “There is no shortcut in HIV prevention. Those who claim that we just need to do one or two things to prevent HIV and to forget about involving communities are playing with fire.”

Piot explained that prevention involves finding the right mixture of activities for the local epidemics in each country – strengthening health systems, harm reduction measures and human rights, including saying no to more stigma around HIV, homophobia, ostracism of sex workers and gender-based violence. This conference was most notable for its inclusion of marginalised groups, including men who have sex with men, with speaker after speaker condemning homophobia and laws that criminalise homosexuality as well as the transmission of HIV.

Graham Brown, President of AFAO [3]Australian Federation of AIDS Organisations. AFAO is the peak non-government organisation representing Australia's community-based response to HIV/AIDS. AFAO's work includes education, policy, advocacy and international projects. , who attended the conference, agreed that the response to HIV seemed to be getting more complex with discussions around access to and living with treatments, viral load [4]A measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. (and the Swiss Statement), circumcision, biomedical interventions (such as PreP), abstinence versus sex education and the idea of treatment as prevention being hotly debated. AFAO had been working with the Global Forum on MSM and HIV to help organise a prior summit on gay men’s issues, he said, and this helped inform some of the discussions at the conference.

David Wilson from Curtin University gave a presentation which showed, that contrary to previous thinking, there were significant populations of gay men in African and Asian countries who received little specific prevention campaigns which was showing up in HIV prevalence figures.

Professor Dennis Altman, another Australian attendee and a member of the IAS Program Committee said that it was important that this conference was held in Latin America which has not been given sufficient global attention in the past in relation to HIV. “Mexico City made a major effort to involve their population (20 million people) in the event, gave it huge publicity and ran a successful Global Village which attracted many locals. The Mexican Health Minister spoke about homophobia on a number of occasions and the HIV message got out to a large audience.”

There was significant activism during the conference including a March Against Homophobia, a March to Stop Violence Against Women and a prominent protest role played by sex worker activists who felt let down by UNAIDS in support for their work to overturn laws against sex work in many countries. HIV- positive people held their own leadership summit, Living 2008 prior to the conference.

The head of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Dr Michael Kazatachkine closed the conference with a concern that, while the US government was to be congratulated for agreeing to provide $48 billion for global HIV/AIDS prevention work (and for ending the ban against HIV positive travellers into their country) with the PEPFAR bill, the countries in the G8 had so far only delivered a third of their promised funds for the antiretroviral [5]A medication or other substance which is active against retroviruses such as HIV. treatment so essential to try to keep the millions infected with HIV in developing countries alive.

IMAGE: Annie Lennox attended the World AIDS Conference where she gave her support to greater access to treatments and stopping sexual violence against women.