Rwandan children orphaned by AIDS in Muhanga village. Credit: Aimable Twahirwa/IPS

By Julia Hotz
WASHINGTON, Aug 9 2014 (IPS)

Though West Africa’s massive Ebola outbreak may be dominating the spotlight within the global health community, HIV/AIDS remains an enormous issue for Africa as a whole – a sentiment that Washington officials made clear this week in their discussions of legislative and technological setbacks plaguing progress in fighting the epidemic.

Despite the World Health Organisation’s announcement Friday that Ebola is now an “international public health emergency,” doctors, academics and policymakers met Thursday at the Washington office of Kaiser Family Foundation (KFF), a health-policy non-profit, to discuss the similarly urgent threat posed by HIV/AIDS, the subject of last month’s 2014 International AIDS Conference in Melbourne, Australia.Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that - with the exception of Angola - has been reversed in surrounding African nations.

Ambassador Deborah Birx, the global AIDS coordinator for the U.S President’s Emergency Plan for AIDS Relief (PEPFAR), echoed the threat’s urgency, explaining that “the AIDS pandemic in southern Africa is the primary cause of death for adolescents, and the primary killer of young women.”

President Barack Obama announced Wednesday at the end of his three-day leaders’ summit with Africa that PEPFAR and the Children’s Investment Fund Foundation (CIFF) will pledge 200 million dollars to work with 10 African countries to help them double the number of children on lifesaving anti-retroviral drugs.

But Ambassador Birx, along with other prominent HIV/AIDS activists in Washington, seemed to suggest that distributing anti-retroviral drugs to children would only address a fraction of the issue.

Fear of HIV/AIDS stigma

While making note of PEPFAR’s unprecedented  progress in moving towards an “AIDS-free generation,” a commitment that President Obama deemed possible in a 2013 national address, Birx suggested that countries with anti-LGBT laws may have disproportionately high rates of new HIV infections.

“People are afraid to be stigmatised,” Birx told IPS, explaining that gay people may refuse to seek diagnosis and treatment for HIV/AIDS if they are legally and culturally persecuted by their homeland.

Identifying nearly 80 countries with such discriminatory environments, Birx’s PEPFAR report highlights Uganda, where the recent passage of anti-LGBT legislation and discriminatory comments of Ugandan President Museveni has attracted substantial condemnation from the international community.

“This is a human rights question,” Birx told IPS, calling specifically on the community of faith- one she describes as “there to wrap its embracing arms in need”- to respond to such LGBT persecution.

Yet beyond humanitarian concerns, PEPFAR’s report notes how Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that – with the exception of Angola – has been reversed in surrounding African nations.

Birx stressed that the majority of HIV infections are transmitted through heterosexual sex, despite the common misperception that homosexual activity is the cause of HIV/AIDS.

It is perhaps this association, Birx reasoned, that incites fear of seeking diagnosis, and explains why approximately half of all people with HIV are still unaware that they are infected, despite the tremendous increase in HIV testing capacity.

“Incredibly powerful” potential of tech innovation

Panelists at Thursday’s conference spoke about the tremendous expansion of testing capacity, an noted how technological innovation is a leading force not only in HIV/AIDS diagnosis, but also in treatment, prevention and education.

“I think there’s actually a lot going on in innovations in technology,” Chris Beyrer, president of the International AIDS Society, told IPS. “And it’s not only internet technology and mobile technology, but it’s also in other domains, like self-testing and home-testing.”

Beyrer added how “getting testing out of the clinics and getting them directly to people” reduces the strain on medical personnel and funding, two areas in which panellists agree there are great shortages.

“Technology is moving to a place where there are much more local kinds of facilities that can actually do staging,” Beyrer explained to IPS.

“You don’t have these kinds of problems with people waiting forever to get a CD4, and then being told to go somewhere else with their CD4 result.”

“One size does not fit all”

Birx, who also participated in Thursday’s panel, added that technology can potentially be used to disseminate information about HIV/AIDS, and can potentially even correct some of the misconceptions about what causes HIV/AIDS.

She referenced the “incredible work” coming out of Cambodia, which utilises different internet strategies to cater not only to people of different ages, but also to people of different sexual practices, in an attempt to distribute key medical information.

The technique, she says, allows everybody to “click on the site and find the voice that resonates with them and gives them different knowledge [about HIV/AIDS] that they need.”

“I found that so incredibly powerful, and if we can figure out how to do that and get broadband throughout sub-Saharan Africa, it would be terrific.”

Beyrer reiterated the need for technology to offer individualised options for the transmission of knowledge about HIV/AIDS, telling IPS that “one size doesn’t fit all in these innovations.”

“It turns out, for example, from looking at interactive supports for treatment, there are very age-dependent differences even among population,” he said.

“Men under 25,” Beyrer explained, “really like SMS interactive messages, and want to be notified at all times, while older men [tend to say] no thank you, leave me alone…it’s very specific so we’re going to have to get that right.”

Yet despite Beyrer’s enthusiasm for more individually-tailored solutions to those seeking knowledge about HIV/AIDS, he also urges that there be more awareness-building for those not expressly seeking knowledge about HIV/AIDS.

“One sector that hasn’t engaged very much in HIV is social media,” he said, calling specifically on Facebook, Google, and others in Silicon Valley to engage more thoroughly.

“We need that, and we would love them to be way more engaged than they are.”

Edited by: Kitty Stapp

The writer can be contacted at hotzj@union.edu

Messages of sympathy adorn a street in Melbourne. Credit: Diana G Mendoza/IPS

By Diana Mendoza
MELBOURNE, Jul 25 2014 (IPS)

The 20^th International AIDS Conference concluded today as the first in its history that remembered not just the 39 million people worldwide who have died of AIDS but also those who lost their lives in the crashed MH17 flight carrying six of its delegates, one of whom was the past president of the International AIDS Society (IAS).

The double memorial, however, did not hamper 12,000 scientists, researchers, advocates, lobbyists, and activists from 200 countries, including 800 journalists, from scrutinising a few advances and disturbing setbacks in HIV and AIDS awareness and prevention, treatment to prolong and improve the quality of life of people living with HIV, and compassion and care to those infected and people close to them.

The IAS and the Joint United Nations Programme on HIV/AIDS (UNAIDS) said that globally, there are about 35 million people living with HIV in 2013, but 19 million of them do not know that they have the virus. Also in 2013, around 2.1 million became newly infected, and 1.5 million died of an AIDS-related illness.

"We will not stand idly by when governments, in violation of all human rights principles, are enforcing monstrous laws that only marginalise populations that are already the most vulnerable in society.” -- Francoise Barre-Sinoussi, president of the International AIDS Society (IAS)
But the good news is that HIV transmission has slowed down worldwide, according to Michel Sidibé, executive director of UNAIDS, and that millions of lives are being saved by antiretroviral drugs that suppress and slow down the replication of the virus, but do not eradicate it.

An estimated 13 million people are taking antiretroviral therapy that has resulted in a 20 percent drop in HIV-related deaths between 2009 and 2012. In 2005, there were only 1.3 million who were accessing ART.

Sidibé said at least 28 million people are medically eligible for the drugs. Currently, according to UNAIDS, spending on HIV treatment and prevention is around 19 billion dollars annually, but this needs to be scaled up to at least 22 billion dollars next year.

“We have done more in the last three years than we have done in the previous 25,” said Sidibé, who warned that these advances are disturbed by a few setbacks that are difficult to battle, such as laws against gay people in Africa and the crackdown on intravenous drug users in Russia.

In other countries, new policies have also emerged, criminalising homosexual behaviour and the use of intravenous drugs, and penalising those who engage in sex work.

Activists and experts say these policies help HIV to thrive by driving homosexuals, injecting drug users and male and female sex workers underground, where they have no access to preventative services.

Francoise Barre-Sinoussi, IAS president and chair of the conference who co-won the Nobel Prize for helping discover the virus that causes AIDS, said, “We will not stand idly by when governments, in violation of all human rights principles, are enforcing monstrous laws that only marginalise populations that are already the most vulnerable in society.”

The upsurge of anger was also obvious in the Melbourne Declaration that delegates were urged to sign early on, which demanded tolerance and acceptance of populations under homophobic and prejudiced attack.

The Melbourne Declaration called on governments to repeal repressive laws and end policies that reinforce discriminatory and stigmatising practices that increase the vulnerability to HIV, while also passing laws that actively promote equality.

Organisers believe that over 80 countries enforce unacceptable laws that criminalise people on the basis of sexual orientation and HIV status and recognise that all people are equal members of the human family.

The conference also called on health providers to stop discriminating against people living with HIV or groups at risk of HIV infection or other health threats by violating their ethical obligations to care for and treat people impartially.

Bad news for Asia-Pacific

Another setback is that while HIV infections lessened in number globally, some countries are going the other way. Sharon Lewin, an Australian infectious disease and biomedical research expert who co-chaired the conference with Barre-Sinoussi, said Pakistan, Indonesia and the Philippines are experiencing epidemics in their vulnerable populations with “worryingly high” proportions in 2013.

“While new infections continue to decrease globally, we are unfortunately seeing a very different pattern in Indonesia, Pakistan and the Philippines with increasing numbers of new infections in 2013,” Lewin said during the conference opening.

She cited men who have sex with men (MSM), sex workers, people who inject drugs and transgender persons as the most at-risk populations in the three countries.

This brought the rate of daily new infections in the region to 6,000; 700 are children under 15 while 5,700 were adults. But 33 percent of them were young people aged 15-24.

Aside from Pakistan, Indonesia and the Philippines, she said Thailand and Cambodia are also causes for concern because of their concentrated epidemics in certain populations, while India remains a country with alarmingly high infections, accounting for 51 percent of all AIDS-related deaths in Asia. Indonesia’s new HIV infections, meanwhile, have risen 48 percent since 2005.

Meanwhile, the U.N. predicts that AIDS will no longer exist by 2030. UNAIDS’ Sidibé introduced the “90-90-90 initiative” that aims at reducing new infections by 90 percent, reducing stigma and discrimination by 90 percent, and reducing AIDS-related deaths by 90 percent.

“We aim to bring the epidemic under control so that it no longer poses a public health threat to any population or country. No one must be left behind,” Sidibé stressed.

The conference also saw a few hopeful solutions such as the portable HIV and viral load testing devices presented by pharmaceutical and laboratory companies that joined the exhibitors, and radical approaches to counselling and testing that involve better educated peer counsellors.

The World Health Organisation (WHO) issued consolidated guidelines on HIV prevention, diagnosis, treatment and care designed to assist health providers and policymakers develop HIV programmes that will increase access to HIV testing, treatment and reduce HIV infection in five key populations vulnerable to infection – men who have sex with men (MSM), people who inject drugs, sex workers, transgender people and people in prison and other closed settings – who make up 50 percent of all new infections yearly.

Part of the guidelines recommend that MSM – one of the most at-risk groups for new infections – consider pre-exposure prophylaxis or taking anti-retroviral medication even if they are HIV negative to augment HIV prevention, but they are asked to still used the prescribed prevention measures like condoms and lubricants. The prophylaxis that prevents infection can reduce HIV among MSM by 20 to 25 percent.

(END)