Hope and optimism were in abundance for tens of thousands of those in attendance at the the 19th International AIDS Conference (AIDS 2012) held this year in Washington D.C. "Turning the Tide Together" was the conference theme, and 24,000 activists, researchers and clinicians from 183 countries were in agreement that an end to the epidemic may be in sight.
Since the AIDS 2010 conference in Vienna there have been extraordinary breakthroughs in the fight against HIV. Although no gigantic advances were announced at AIDS 2012 what was presented demonstrated that HIV is becoming an increasingly vulnerable viral foe.
"AIDS 2012 represented many milestones in the history of the International AIDS Conference, but most importantly, it is
the first time we have been united around the one goal to end AIDS," said Dr. Diane Havlir, AIDS 2012 U.S. Co-Chair.
Defying tradition, the host countries head of state, President
Obama, failed to put in an appearance at the conference. Instead
he irked many in attendance by just sending a video tape message. However, other illustrious speakers did descend upon AIDS 2012, including Bill and Hillary Clinton, Elton John, Bill Gates and former First Lady Laura Bush. All sought to remind the experts in attendance what was at stake if the goal of ending AIDS is not achieved.
And the numbers are daunting. Around 35 million have died from HIV infection and 34 million now live with the virus worldwide. Of
those 34 million, well more than half will probably die unless they gain access to
Several topics dominated the conference: Finding
a cure for the virus (a topic for another article) and
Treatment as Prevention, or TasP. Tasp is the recent breakthrough demonstrating that
putting those with HIV infection on therapy can reduce transmission of the
virus to others by up to 96%. There was an overwhelming consensus on TasP at AIDS 2012.
"I think that this conference puts an end to any doubts or or any
discussion about this issue" said Dr. Julio Montaner, Director
of the British Columbia Centre for Excellence in HIV/AIDS. "The
evidence that treating people effectively with HIV is beneficial to them, but
secondarily, can dramatically decrease HIV transmission, is now
More importantly, Montaner added, is that that policy leaders
such as Hillary Clinton appreciate that these new prevention tools can end the
AIDS pandemic. But a worldwide scale-up up these new interventions will require
billions of dollars of funding at a time of government budget shortfalls and
An important cost/benefit study presented at AIDS 2012 showed
the viability of implementing TasP on a massive scale. The
analysis showed that early treatment interventions will keep new generations
from becoming infected making it more cost effective than delaying treatment. Study
author Dr. Rochelle Walensky of the Harvard Center for AIDS Research
"Early ART [antiretroviral therapy] is a
triple winner: HIV-infected patients do better, their
partners are protected and it is very cost-effective. Regardless
of the country setting, over the long term treatment as prevention offers excellent
return on its investment," she said.
Treating infected people to drastically reduce the spread of HIV will require
the international community to step-up and make widespread TasP a priority.
"These data call for decisive action by the US global AIDS
program, WHO and by national governments," said
Asia Russell of Health GAP.
Russell stressed that HIV treatment guidelines and government programs should
act to accelerate treatment access that will save lives and reduce new
infections. "There is no excuse," she
Dr. Montaner added "The return on investment has
increased so dramatically that we can no longer afford not to implement this [TasP]. It is
not a matter if we want or we can't, its a
matter that we have to do it!"
To coincide with AIDS 2012, the prestigious journal
The Lancet, published a special issue focusing on HIV and Men Who Have Sex
with Men (MSM). A conference symposium was held on The Lancet's data, which
had a global focus.
Dr. Stefan Baral started off the session noting that HIV prevalence
rates among MSM are 15% or higher in the USA, Spain, Chile, Thailand, Malaysia, South
Africa, as well as a cluster of African and Caribbean nations. Yet in
many high-income settings, overall HIV transmission rates, deaths, etc., are in
steep decline. Among MSM there and in poorer nations, the HIV
epidemic rages even where treatment is available. In the
U.S., MSM infection rates have been increasing by around 8% per
year since 2001. One reason? The transmission rate of receptive anal sex is roughly 18-times
greater than heterosexual intercourse.
symposium shed more light on why MSM continue to be infected with HIV: stigma
and homophobia. At a conference abundant with successes and optimism, Lancet
Editor, Richard Horton told of Thapelo Makutle, an
openly gay South African man who was targeted and murdered because of his
sexuality. Horton then described the recent brutal gay bashing of Michael
Hall and Michael Roike only a few miles from the Washington convention center.
Ken Mayer of the Boston's Fenway Institute added that same sex behavior and
gender nonconformity are still not accepted throughout the world. That
MSM are given a societal messages that they're not welcome or wanted. The
resulting isolation MSM feel from loss of peer and family support, religious
abandonment, as well as verbal or physical abuse, often
lead to risky behavior.
"This internalized stigma may lead to internalized homophobia, which
results in depression and substance use," Dr. Mayer
said. "We have to face the reality that sexual expression is happening
earlier so these internal tensions are occurring at earlier ages for younger, more
Dr. Mayer added that for MSM, early
self-acceptance results in better safe sexual practices. Particularly
so among racial, ethnic, and sexual gender minorities. However, for
many stigmatized MSM living in homophobic environments, the
challenge of surviving and thriving can be difficult.
In the U.S., black MSM now make up nearly one in six of all people with HIV. In
another session, Dr. Karen Oster presented data on the black MSM "brothers" study. It
found that over just one year, new HIV infections among these
men increased by 2.3%. Among those under the age of 30 the
infection rate was an alarming 6%! The
later strongly suggests that if the trend continues by the time they
are in their 40’s most urban black MSM will have the virus.
Longtime AIDS activists such as the Rev. Franklin
Hobbs of Boston’s Healing Our Land feel immediate action is needed to stem this
tidal wave of new infections.
"We have an unprecedented and small window of opportunity to respond to the
national black HIV/AIDS state of emergency," declared Rev. Hobbs.
Dr. Greg Millett of the CDC told AIDS 2012 attendees
that the reason for all the black MSM infections are not because these men are
having more at risk sex than their white counterparts. He said
studies show that generally these men are more sexually cautious. In
fact, on Tuesday, the CDC presented data showing that risky behavior among all
black teens has declined significantly over the past 20 years. Instead, sexual
ecology is driving the black MSM epidemic according to Dr. Millet. The new
infections are resulting from repeat partnering within a highly infected
community. The takeaway is to be aware of the risk of exposure within these
high prevalence "pools" and not just minimize risk during sex.
Women’s issues were also on the program at AIDS 2012. Around
the world women still bear much of the HIV/AIDS burden. Among
those 34 million adults worldwide living with HIV and AIDS, half
are women. Women are also at greater risk of HIV heterosexual infection
through unsafe sex, less likely to be able to negotiate condom use, and
more likely to be subjected to non-consensual sex.
"We cannot even begin to talk about ending AIDS when so much of the impact of
the HIV/AIDS epidemic continues to be so heavily skewered towards women," said
Dr. Diane Havlir, AIDS 2012 U.S. Co-Chair
and Professor at UCSF.
On Monday researchers discussed two new published studies on gender-based
violence and how it increases transmission of the virus. Co-author
of both studies, Edward Machtinger, MD, directs
the Women’s HIV Program at UCSF.
"For a long time we have been looking for clues as to why so many
women are becoming infected with HIV and why so many are doing poorly despite the
availability of effective treatment," Dr. Machtinger
said. "This work clearly shows that trauma is a major factor in the HIV
epidemic among women."
The studies showed how childhood or adult physical and sexual abuse fuel the
women's HIV epidemic. They demonstrated that American women with HIV are more than
five times more likely to have PTSD and twice as likely to have been the victim
of partner violence. HIV infected women who experience trauma are also more likely to
fail their HIV treatment and engage in risky sexual behavior.
Although the planet is economically exhausted it still must garner the needed
resources to fulfill the extraordinary promise of AIDS 2012. Cities
like the conference host, Washington D.C. are trying to do their part. Washington
is now a hotbed of the epidemic with HIV prevalence in some parts of the city
as high as in Africa.
At a press conference, the Washington D.C. Department
of Public Health showcased its efforts in HIV testing and treatment including
regular screening at the cities DMV, supermarkets, schools, houses
of worship, city welfare agencies, even
barbershops. For those who test positive, nine
out of ten see a doctor within three days.
"The goal is to provide HIV testing in unprecedented settings."said
Mahlon Isaacs of D.C. Public Health. "A lot of people do want to
know their status and from there, once
you have received your results you can be directed to care if you have been
identified as being positive"
D.C. even set up a condom drop off service. However, after a
week of endless AIDS 2012 meetings this reporter was too exhausted to find a reason for
giving them a call. Perhaps in Melbourne at AIDS 2014.
To view many of the conference sessions, go tohttp://pag.aids2012.org/