Five Takeaways from the 21st International AIDS Conference

By Lucy Slater August 24, 2016

1. While great progress is being made toward achieving the 90-90-90 targets, stigma and discrimination is leaving key populations behind

17 million people around the world are now on treatment; the tipping point (where more people are getting on treatment than are being infected) has been achieved. Nevertheless, another 20 million people living with HIV are not receiving treatment. In practically all of the sessions I attended, the message was: “Treatment alone cannot end HIV – a comprehensive prevention and treatment response is needed that also addresses harmful cultural norms, reduces discrimination and stigma, and promotes equity.” As Charlize Theron movingly spoke in the opening plenary: "We value men more than women ... straight love more than gay love ... white skin more than black skin ... and adults more than adolescents," and until that changes, the epidemic will continue.

2. Engagement of civil society is a priority

Civil society was highly visible at the conference, with large demonstrations organized by Health GAP Treatment Action Campaign and Sector 27 to demand scale-up of HIV treatment and prevention, and vocal contingents of activists from sex worker, transgender and other key populations participating, and advocating at every opportunity. The conference was also the occasion of Call to Action petition to government donors.

Recognizing that civil society is a critical partner in representing and working with key populations, PEPFAR used the occasion of the conference to announce significant investments in funds to support civil society engagement in working with MSM, women and girls, and other key populations.

 “We will only end the AIDS epidemic by 2030 if no one is left behind,” said U.S. Global AIDS Coordinator Ambassador Deborah L. Birx, M.D. “It is unacceptable that key populations still face stigma, discrimination, and violence, which impede their ability to access quality HIV services. PEPFAR stands firmly and unequivocally with and for key populations, defined by UNAIDS as gay men and other men who have sex with men, transgender people, sex workers, and people who inject drugs, and prisoners, and we are deeply committed to protecting and promoting their health and human rights.”

3. We have to address gender inequities and improve access to services for women and girls

2,400 new HIV infections occur in adolescent young girls per week. 70% of new infections in Sub Saharan Africa in 15-19 year olds are occurring in girls. At the same time, Southern Africa is experiencing a demographic “youth bulge,” meaning that youth are becoming an increasingly large proportion of the total population in these countries. Unless we take significant action now to address HIV among this population, our efforts to control the epidemic are at risk.  Lower educational status, unequal power dynamics in relationships, intimate partner violence, and cultural norms that stigmatize young women seeking sexual reproductive health services all contribute to this dynamic. The answer is not contained just within the health sector and PEPFAR is modelling the way with its DREAMS initiative, which supports community based initiatives to address the structural drivers that directly and indirectly increase girls’ HIV risk, including poverty, gender inequality, sexual violence, and a lack of education. For more information, check out these fascinating sessions: Why Do Young Women in Africa Have High Rates of HIV Infection?, and Girls and HIV: What We Know, What We Don’t Know and What We Need to Do to Reach 10- to 19-year-olds.

4. We need more and better data

Resource allocation is being directly linked to progress in achieving the 90-90-90 goals, but data being used to measure these targets is primarily based on estimates, sentinel surveillance, and aggregated patient monitoring systems. NASTAD was able to participate in one session that focused on the importance and potential for using routine patient-level data to monitor the health sector response to HIV, including use of patient-level data for estimating the prevalence of HIV infection, measuring the reach of HIV services, and for decision-making. Other sessions, discussed scalable and sustainable HIV case-based surveillance to assess the effectiveness of interventions along the cascade of treatment and care, and to estimate the overall burden of HIV-associated mortality.

5. New technologies can help, but only if health systems are strengthened

I always go to a conference hoping, deep down, that the easy fix will be announced. This conference was no different in its take home message that while we have approaches and technologies that can help, there is no magic bullet. Several “new” technologies and approaches were discussed, including home testing/point of care testing,  improved tuberculosis diagnosis technologies, vaccine development, and Pre-Exposure Prophylaxis (PrEP). As always the challenge is bringing these technologies to scale and ensuring access to all who can benefit from them. Happily, effective health systems approaches that in the past might have been considered radical seem now to be considered standard practice, including decentralization of the health sector, development of community health workers, integrated health care, differentiated care, and community engagement. 

None of this is easy work, but it was inspiring to be in the company of 15,000 people from all around the world, and from all walks of life who shared a common passion and dedication to do something about this disease. I was proud to be one of their number.

Lucy Slater is a global health expert and the Senior Director of the Global Program at NASTAD. NASTAD strengthens state, territory and global-based public health leadership, expertise and advocacy and bring them to bear in reducing the incidence of HIV and hepatitis infections and on providing care and support to all who live with HIV and hepatitis.