Insights from AIDS 2018

This story was updated on August 8, 2018.

Why would 16,000 people from around the world travel to Amsterdam last week to attend a five-day conference in the midst of a heat wave? Why would activists, researchers, health care professionals, government officials, funders, and community leaders from more than 160 different countries come together to review data, share stories, and discuss strategies?

Because while the global fight against HIV/AIDS has made significant progress over the past three and half decades, it is far from over, and that fight requires a diverse, but united, front.

The International AIDS Conference is the largest conference on any global health issue in the world and it first convened in 1985, at the height of the epidemic. This year’s conference, AIDS 2018, was the 22nd installment and was held in Amsterdam with a theme of “Breaking Barriers, Building Bridges.”

For me, what makes this such a powerful conference is the welcome and active participation of advocates and the communities impacted by this epidemic.

I also appreciate the passionate debate among attendees—space for that is necessary when you’re talking about issues like sex, sexuality, gender inequity, sexual orientation, gender identity, injection drug use, and sex work.

Within this context, there were several key themes that carried throughout the conference:

• HIV/AIDS is not close to being over. We are not on track to end AIDS, especially among key population groups. Even though the international community has invested decades of effort into this fight, there remains an estimated 21.7 million people on treatment that they will require for the remainder of their lives, with more people becoming infected each year (1.8 million in 2017). We have a long way to go before this epidemic will be a thing of the past
  
  
• Risk of epidemic resurgence. The majority of presenters cautioned that reducing focus on the epidemic will result in a resurgence of the disease, often citing malaria as an example. This would be disastrous and jeopardize the billions of dollars that have been invested by global donors and national governments to date. A backslide would be particularly devastating given the youth population surge in sub-Saharan Africa, where millions are aging into the sexually active and risk-taking period of their lives.
  
  
• Investments in prevention are essential to ending the epidemic. While treatment remains a frontline topic, conference attendees recognized that treatment alone will not end the epidemic. Important sessions focused on biomedical interventions such as vaccines, broadly neutralizing antibodies, pre-exposure prophylaxis (PrEP), and condoms. These sessions were numerous and well-attended.
  
  
• Structural barriers continue to hinder the response. While this is not a new theme, many speakers discussed the need to address the many socio-cultural issues that perpetuate the disease.
  
  
• Integrated health services. While vertical funding and services are currently needed to address the HIV epidemic, the future response should look towards integrating HIV with other health services.

The theme of HIV prevention is one that I work on daily at the Gates Foundation. What’s clear now is that the data support the need for this continued focus on prevention, and that the broad community in attendance seemed to agree on this point. But a challenge remains: if we are to truly deliver effective prevention options to people at risk of acquiring HIV, these options need to fit into people’s daily lives.

That’s one reason why the foundation supported a satellite session at the conference to look at what we’ve learned about delivering daily oral PrEP in communities around the globe.

Oral PrEP is a single pill that, when taken as directed, has been shown to be effective at preventing HIV acquisition (for a great primer on PrEP, checkout AVAC’s Fact Sheet). It has strong uptake in the US (approximately 220,000 users to date, according to PrEPwatch.org) and other high-income countries, and while daily pill taking may not be appealing to all people, oral PrEP has the opportunity to play an important role in the prevention agenda.

While much of this session showcased data from implementation research around uptake and continuation numbers, speakers also shared lessons learned about shaping programs and policy to reach people with PrEP and help them continue with the product. One highlighted example was how community involvement and leadership has played a key role in making PrEP an accessible, and acceptable, tool for sex workers through Ashodaya Samithi in India.

Gathering lessons like these from implementation research is vital for informing how the field approaches both the deliverability of oral PrEP as well as other prevention products that might become available in the future.

One moment I won’t forget is when a young man living with HIV spoke in a session and chided us all when he said, “we are addicted to numbers [in this response]”.

While understanding the data is important to inform how we design effective programs, we cannot forget that at the heart of this epidemic are people, with complex lives and tough choices in front of them every day.

That is why it is so crucial that we continue to have a diverse set of stakeholders contributing to this conversation. We need to be reminded that all pieces of this response are needed: the drug and vaccine research and development, the program design and implementation, the global guidance, and the local policies and community engagement. When it comes to the fight against HIV/AIDS, it takes a village.