ODI at 16th international AIDS conference, Toronto
Thursday, August 24, 2006 5:15 PM by Laura Jarque
With so many delegates and so much information being presented, it becomes more and more difficult to try and sift out new information. There was also a sense that there was little new being presented and that whilst it was hoped that there would be new people presenting, this was not the case. As usual, the plenary sessions each morning and the rapporteur sessions at the end of the week were key occasions for obtaining an overview of the conference.
The following provides a very brief overview of some of the key issues presented, focused on my particular areas of interest and research:
The importance of prevention in an era of treatment was highlighted by many speakers, according to Kevin de Cock (Director of HIV department, WHO), “You can’t treat your way out of the epidemic”. Prevention technologies included discussions on vaccines. Despite being no breakthroughs, optimism remains around finding a vaccine. Microbicide research is ongoing and initial findings are positive but full results are still not due for another few years. Perhaps most exciting were the results from a circumcision trial in South Africa last year, showing a 60% reduction in transmission in circumcised men; more studies are underway on this and then the whole issue of acceptability and applicability would need to be reviewed. But with people like Stephen Lewis endorsing this by announcing he himself is circumcised one needs to watch this slot!
Treatment messages remained strong at the conference, with calls for increasing access to ART. There were also messages around the cost of drugs: “When drugs are free they work better” was a refrain being heard. That adherence in Africa was better than in some Western countries was stated – “Refuting the Afro pessimists”. Additionally, the prevention value of ART was discussed. There is now not only a call for increasing access to ART but sustaining it, as in some countries treatment partners are planning to move out, so what next?
The need for increased numbers of health workers was also a refrain throughout the conference, with the health workers themselves being extremely vocal about their needs, chanting ‘open your purses we need more nurses’ during various sessions. This covers issues such as keeping nurses in their countries of origins and providing them with adequate incentives. This coincided with WHO launching its “Treat, Train and Retain” strategy for nurses.
Children and AIDS was once again reiterated as having being a neglected area, with need for more training of health workers to treat children, for more research into paediatric ARV formulations. There was also an emphasis on not just treating the child, but the mother and their family. There was little, however, in the conference on Prevention of Mother-to-Child-Transmission and this remains one of the prevention success stories which has been relatively neglected and has not been scaled up.
http://www.wfp.org/english/?ModuleID=137&Key=2213 http://news.yahoo.com/s/afp/20060816/hl_afp/healthaidsfoodun_060816210246
http://www.wfp.org/English/?ModuleID=137&Key=2213
Also unlike other conferences, there were many presentations on vulnerable, marginalised and silent populations including, for instance, indigenous populations, mobile populations and refugees. Discussions were around how to reach them for both prevention and treatment purposes. This remains a relatively un-researched area and one in which ODI may consider being involved.
There was also a lot on TB and HIV co-infection at this conference with many sessions devoted to it and key speakers such as Kevin de Cock and Bill Clinton highlighting it. There was a call for special coordination between those working on the TB and HIV epidemics, so that TB does not become the Achilles heel of ART scale-up. TB prevention and treatment must become a central component of AIDS care. This bodes well for a study ODI is trying to get funded on the TB and poverty trajectories within an HIV context.
# re: ODI at 16th international AIDS conference, Toronto @ Tuesday, August 29, 2006 6:43 AM
The theme 'Time to Deliver' was addressed essentially by scientists, academics and CSOs. But a robust response partners these groups with government which alone can be held accountable for delivery. There was virtually no space for consideration of the responsibility of national governments to deliver in terms of policy, legislation (addressing vulnerability), enabling institutional frameworks of CSO collaboration and, most importantly, resource allocation through government budgets. Only one of the 5 tracks was Policy and only one of the themes within the track was national resource allocation. And this in the context of moves towards universal access and the need both practically and ethically for sustainable predictable financing. The Conference was in consequence not grounded in the real world of implentation, resource constraint and institutional challenge. Where is the platform for this kind of dialogue?anne austen
# re: ODI at 16th international AIDS conference, Toronto @ Wednesday, August 30, 2006 1:54 PM
On nutrition and biological vulnerability to HIV infectionI have read with enormous interest the briefing paper on Food, Nutrition and HIV: What next? in particular the paragraph on page 2 column 2, about malnutrition, the immune system and susceptibility to infections including HIV.
Many health activists including a few staff in international health agencies have struggled to have this perspective considered for more than a decade.
Specifically, the element that has been ignored, neglected, even rejected - is biological vulnerability to primary HIV infection due to poorly functioning, weakened, overworked and disrupted immune systems. This, as we know from 100 years of classic public health lessons, is the condition of immune systems among populations living in miserable conditions, with inadequate nutrition and chronic co-infections. It is the major cause of avoidable disease and death. HIV/AIDS is the quintessential disease of poverty but it has not been addressed as such.
I think it is critical for the long struggle towards a rational, scientific, effective approach to AIDS to understand why this perspective has been met with such obstruction from the international health establishment.
1. This perspective is threatening because it implies that structural causes of poverty must be addressed. Quite simply basic needs for health (therefore forming human rights) must be met through a new international economic order as WHO and UNICEF set out in the 1978 Declaration of Alma Ata at the Conference on Primary Health Care. By 1980 already, in a savage backlash by the establishment, the principles of Alma Ata were abandoned.
2. Since the advent of AIDS, WHO and UNAIDS, heavily influenced by neoliberal propaganda and policies, have ignored this perspective. It would not please donors nor the international financial institutions. Victim blaming in terms of individual behaviour is much more acceptable because it allows inaction on poverty. So when you ask in the last section "Why no action?" I think this is part of the answer.
3. Although you state boldly that mal- and under-nutrition play a role in susceptibilty of HIV-negative people, this point is not in fact translated into one of the essential actions at the end of your excellent briefing paper. If ever there is a reprint, I urge you to do so. Nutrition is primary prevention and far more primary than condoms. Furthermore, malnutrition as we know, contributes to chronic coinfections which disturb or weaken immune function, thereby increasing population transmission rates of both HIV and the myriad co-infections with which it interacts so catastrophically.
4. There is plenty of scientific evidence on the biology of vulnerability with enormous implications for strategy and policy. For example, universal treatment of parasitic infections which are endemic in poor communities and responsible for seriously disturbing immune function, would be a priority strategy. It is cheap and highly effective, important in its own right and could be implemented immediately everywhere.
5. WHO and UNAIDS' own research on sexual behaviour seems to be inconsistent with their policies and strategies which focus almost exclusively on individual behaviour. They found that sexual behaviour differs little between regions, nations and communities (except that men everywhere tend to have more sexual partners than women everywhere) and bears little relation to the pattern and extent of the epidemic.
6. Eileen Stillwaggon has enormously advanced the gathering of the scientific evidence on biological susceptibility to infection especially in her book AIDS and the Ecology of Poverty, Oxford University Press 2006 - an absolute must for anyone working in AIDS and public health. Alison Katz presented this perspective in AIDS, individual behaviour and the remaining unexplained variation. African Journal of AIDS Research, 2002, 1: 125-142.
Thank you again for this important briefing paper and advocacy work.
Rosamund Russell, People's Health Movement
Rosamund Russell