Hopes for AIDS 2014 and beyond

HIV Australia | Vol. 12 No. 2 | July 2014

By Sharon Lewin

It is fitting in many ways, that after three decades of the HIV epidemic, the International AIDS Conference is finally coming to Australia. Fitting because Australia has punched way above its weight on a global level in response to HIV – from the very beginning.

There’s much to admire in Australia’s well documented response to HIV: its bipartisan political approach to the disease has undoubtedly been a major driver in Australia having one of the lowest rates of HIV infection worldwide.

The inclusion of key affected communities – sex workers, gay men, and people who inject drugs – as equal partners in the response from the outset has been fundamental in an effective response. And lastly, the capacity building in science and research around the epidemic has played a pivotal role in driving evidence-based public health policy, innovation and access to the latest treatments and prevention strategies for affected communities.

Australian science

As a scientist I am enormously proud of what Australian science has contributed in the fight against the epidemic and I am thrilled about where it is going, too. For near on two decades now we’ve been guided by the annual surveillance reports provided by the Kirby Institute (formerly known as the National Centre in HIV Epidemiology and Clinical Research), led by Professor David Cooper, previous President of the International AIDS Society.

Professor Cooper has been a giant opinion leader in international forums. The Kirby Institute’s new home on campus at the University of New South Wales will be officially launched the week before AIDS 2014, and is set to further expand its influence beyond HIV into the broader brief of ‘infection and immunity in society’.

The Centre for Social Research in Health and the Australian Research Centre in Sex, Health and Society continue to inform us on how best to address harm in sexual and drug use behaviours – so vital to getting the evidence to develop and implement new prevention and treatment strategies and to deliver the most effective messages as part of broader education campaigns.

The Australian Centre for HIV and Hepatitis Virology Research has diversified from a focus on basic virology to using translational science to find new diagnostics, new antivirals, and to accelerate the path to find effective vaccines for HIV, hepatitis B and hepatitis C.

Innovation

Australian innovations such as a bedside CD4 test could soon transform HIV management in low income countries. And of course the work of Melbourne’s Burnet Institute since the early 80s, whether in or out of the lab, or around harm reduction, malaria or HIV, has without doubt made a huge contribution to global health and, closer to home, played a key role in helping to guide responses to the HIV epidemic in the Asia and Pacific regions.

The launch of the Peter Doherty Institute for Infection and Immunity at the University of Melbourne as a leading infectious diseases research centre is also an exciting development, and one I’ll be very proud to lead over the coming years.

Yes, these are exciting times for Australian HIV science; indeed HIV science is riding a renewed sense of optimism globally.

The response to the HIV epidemic over the past three decades has been a monumental achievement in global health, both scientifically and logistically.

Treatments access

In less than three decades, the discovery of effective antiretroviral therapy (ART) has transformed HIV infection from an inevitable death sentence to a chronically manageable disease. This has been one of the past century’s greatest human achievements in health, and getting 11 million people on ART in low and middle income countries in just over a decade has been a massive task.

Universal access to these life-saving medicines must remain a priority – particularly given we now know that antiretrovirals not only save lives but also reduce transmission of the virus.

Pre-exposure prophylaxis (PrEP) is also now a part of the equation, and the revitalised interest in HIV cure research has gained strong momentum since the first man cured of HIV, Timothy Brown, was reported in 2009.

Recent reports of HIV functional cure following very early initiation of ART – such as the VISCONTI Cohort – have given scientists great hope that a cure is indeed possible.

The discovery that some patients produce very effective antibodies has also recently raised hopes for new directions in vaccine research. It is clear that science will continue to deliver. But as the Australian experience has shown, science alone is not enough to carry an effective response to HIV – it must be accompanied by a combination of community engagement and political leadership, and unfortunately both have been in short supply in too many countries.

In many parts of the world, stigma and discrimination fuelled by unacceptable government policies, cruelly prevent millions of people from accessing treatment, care and prevention, and ultimately prevent us working towards the end of the epidemic.

With 2.3 million new infections and more than 1.5 million deaths reported globally in 2012,¹ we simply cannot say that HIV is under control. Only 34 percent of people eligible for treatment worldwide are receiving antiretrovirals.²

Challenges remain

Progress, as welcome as it is, is still fragile and many challenges remain, the greatest of which is implementing the science that we know works. AIDS 2014 comes at a pivotal time in the epidemic: the Millennium Development Goals come to fruition next year and already there is much discussion on what a post-2015 global health scenario will look like and where HIV/AIDS will sit in that brave new world.

It is my strong belief that besides showcasing some exciting new science around hepatitis and TB co-infection, HIV paediatrics, PrEP and cure research, the AIDS 2014 conference will allow Australia and the rest of the world to reflect on and consider some of the controversial retreats being made in many country responses to the epidemic.

We need to reverse the dwindling political and financial support for proven, cost-effective harm reduction interventions. We need to strongly oppose the introduction of homophobic laws in countries like Russia, Nigeria and Uganda that on past experience are likely to drive those epidemics underground.

And lastly, we need to urgently address the rising rates of infections in many key affected populations – men who have sex with men, people who inject drugs, sex workers and transgender women.

The AIDS 2014 Melbourne Declaration, launched on 17 May 2014, states that non-discrimination is fundamental to an evidence-based response to HIV and effective public health programs, and calls for immediate and unified opposition to these discriminatory and stigmatising practices.

I call on each of you to sign the declaration.

Working together to end stigma and discrimination remains a fundamental part of our work to achieve what we continue to dream for – an end to HIV.

References

1 Joint United Nations Programme on HIV/ AIDS (UNAIDS). (2013). Global Report: UNAIDS report on the global AIDS epidemic 2013. UNAIDS, Geneva, 4.

2 ibid., 47.

Professor Sharon Lewin is currently Director of the Department of Infectious Diseases at The Alfred Hospital and Monash University and Co-Head of the Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.

In September 2014 Professor Lewin will take up her position as the inaugural Director of the Peter Doherty Institute for Infection and Immunity at the University of Melbourne.

She is the local co-chair for the 20th International AIDS Conference (AIDS 2014), which was held in Melbourne July 20–25, 2014.