Progress, Setbacks, Tragedy at International AIDS Conference

The 20th International AIDS Conference (AIDS 2014), held in Melbourne, Australia, from July 20-25, 2014, attracted 12,000 participants, including top researchers, AIDS activists, individuals living with HIV, and famous faces.

HIV/AIDS

Human immunodeficiency virus (HIV) attacks the immune system, leaving individuals with the virus less able to fight off infections and diseases. Without medical treatment, HIV can lead to acquired immunodeficiency syndrome (AIDS). According to the Centers for Disease Control and Prevention (CDC), there were 1.1 million Americans living with AIDS in 2010; approximately 50,000 additional individuals are infected each year. The CDC estimates that 16 percent of individuals with HIV are not aware of their infection. The most effective treatment option to date is antiretroviral therapy (ART), a combination dosage of three or more antiretroviral (ARV) drugs.

Stopping the Spread

HIV is transmitted when certain bodily fluids, including blood, from an infected individual come into contact with a mucous membrane or bloodstream of another individual. The most common transmissions occur from sexual intercourse and sharing intravenous needles. Condoms and other barrier methods that prevent bodily fluid transmission help prevent HIV infection. More recently, a daily medication regimen called pre-exposure prophylaxis (PrEP) has been recommended for individuals at high risk for HIV infection, especially in combination with condom use. The World Health Organization (WHO) recently issued a statement, saying it “strongly recommends men who have sex with men consider taking” PrEP alongside the use of condoms.  AIDS experts estimate that HIV incidence among gay men globally could be reduced by 20 to 25 percent through PrEP, preventing up to 1 million new infections in this group over 10 years. One PrEP, Truvada®, was approved by the FDA in 2012; however, only approximately 4,000 Americans have received prescriptions for the drug.

At AIDS 2014, research was presented showing that in a trial of 1,600 individuals, none who took Truvada at least four times per week became infected with HIV. Studies have also shown that circumcision helps prevent female-to-male HIV transmission by about 60 percent. Fears that circumcised men would use participate in riskier behaviors due to their belief that circumcision protected them were assuaged at AIDS 2014, where research was presented showing that circumcision has no effect on risky sexual behavior. In fact, the research found that some protective measures, such as condom use, increased after circumcision,  which would support a wider implementation of medical circumcision programs. Former President Clinton spoke at AIDS 2014 about the need for prevention and treatment of HIV. Clinton suggested that AIDS could be eradicated, saying “The AIDS-free world that so many of you have worked to build is just over the horizon. We just need to step up the pace. We are on a steady march to rid the world of AIDS.” Some experts agree: despite the lack of a cure, the effectiveness of treatment and prevention options could combine to stop the spread of HIV. If these drugs continue to be made available, each individual with HIV would pass the infection on to less than one person over the course of their lifetime, making the rate of new infections negligible.

Setbacks and Roadblocks

Despite the promise of treatment options, researchers and activists still face many obstacles in eradicating AIDS. The cost of ART and PrEP drugs is prohibitive for many individuals, and there is a lack of funding for research in many areas. Bob Geldof, the musician who founded the charity musical supergroup Band Aid and co-wrote Do They Know It’s Christmas?, said in an AIDS 2014 speech that the lack of funding is “disgraceful.” He said that poverty and AIDS are inextricably linked, and reminded conference attendees of the progress made fighting AIDS over the past 30 years. Recent hopes for a possible HIV cure were destroyed when the “Mississippi baby,” an infant born to an untreated HIV-positive mother, was shown to be infected with the virus. The baby had been given a strong dose of ART drugs at birth and for the following 18 months; then the Mississippi baby left treatment. When she emerged five months later, doctors found no trace of the virus—in general, HIV returns within one month of cessation of treatment. Unfortunately, 27 months after the Mississippi baby stopped treatment, the child tested positive for HIV. Similarly, a new study was published showing that two HIV patients who initially tested negative for HIV following bone marrow transplants now show recurrence of the virus. Prejudice against individuals with HIV, sex workers, and gay men also hinders efforts to stop the spread of the virus. A study released at AIDS 2014 showed that in countries where homosexuality is criminalized, HIV infections increased because gay men stopped seeking medical treatment. Another paper presented at the conference showed that the transmission of HIV among female sex workers would decrease by one-third if prostitution were legal around the world.

Tragedy

AIDS 2014 faced a devastating loss of at least six individuals who died in the Malaysia Airlines Flight 17 crash.on their way to the conference. The individuals are: Pim de Kuijer, lobbyist Aids Fonds/STOP AIDS NOW!; Joep Lange, co-director of the HIV Netherlands Australia Research Collaboration (HIV-NAT); Lucie van Mens, Director of Support at The Female Health Company; Martine de Schutter, Program Manager Aids Fonds/STOP AIDS NOW!; Glenn Thomas, World Health Organisation; and Jacqueline van Tongeren, Amsterdam Institute for Global Health and Development.