Vienna: Success or Not?
July 28, 2010
Deputy Director and Senior Advisor, Global Health Policy Center
The 18th International AIDS Conference concluded in Vienna on Friday. For as many delegates as attended --there were roughly 20,000 --- there are probably an equal number of opinions as to whether the meeting was a success. For me, the jury is still out.
For sure, there were moments of real elation. For example, the ground breaking news that at last there might be hope for an effective vaginal microbicide gel that women could use to protect themselves from HIV infection That announcement elicited multiple standing ovations from an audience of almost a thousand. After many years of research, the study conducted in South Africa and largely supported by USAID, found that new HIV infections could be reduced by as much as 39% with proper and consistent microbicide use. There is still more research that needs to be undertaken and multiple serious operational challenges that will need to be addressed before a microbicide (this one named Caprisa) can be widely and effectively introduced. However, the energy and optimism that the Caprisa results injected into the Vienna 2010 discussions cannot be overstated. (See my colleague Phil Nieburg’s more detailed analysis, An Important Success in HIV Prevention Research – and the Need for a Lot More Work, on the further research and introduction challenges for a microbicide gel).
But there were also moments of real anger and frustration. No where was this more apparent than in the voices of Eastern European civil society. This was supposed to be the International AIDS Conference that put a clear focus on the oft-neglected challenges of HIV and AIDS in that region and helped propel the response there forward, but the conference seems to have failed on that score. Eastern Europe, in particular Russia and Ukraine, have the fastest growing epidemics in the world. While the absolute number of existing and new HIV infections may be smaller than in sub-Saharan Africa, it is the Eastern European epidemic that is most concentrated in high risk populations and where the potential for the epidemic to move into the general population remains significant. Yet, with the exception of the Moldovan Health Minister, there were no senior-level East European government officials present. Instead, it fell to civil society alone to represent the region. Their pain and anger were palpable. During the conference’s opening ceremony, the hall of several thousand was still when Sasha Volgina from Russia and Vladimir Zhovtiak from Ukraine spoke of the chronic neglect and paralyzing stigma that characterizes the life of an HIV-positive person in the region. By the end of the week, it was questionable whether, despite the best intentions of the conference organizers and the many Russian-English brochures and posters scattered about the conference venue, that the meeting had been at all effective in galvanizing greater political leadership and resources.
And, between these moments of great optimism and deep pessimism there were many thoughtful, often sobering discussions, on the big challenges ahead:
Is Universal Access really achievable and how can it best be linked to the Millenium Development Goals (MDGs)?
The Universal Access movement was born of a political process that was largely aspirational. Yet, it has now evolved into concrete goals and high expectations in many countries. Many advocates argue that the health MDGs cannot be achieved without meaningful progress on HIV/AIDS. How can there be greater accountability around existing universal access targets? Where those targets fall short – for example in assuring access to prevention and treatment for high risk groups -- how can they be revised and made more meaningful?
How do we fill both the financial and the leadership gaps?
Given the continuing financial crisis, there was much discussion and activism in Vienna around the potential for innovative finance to help fill the dollar gap and for greater program efficiencies to help save money. Surely, both those processes can contribute, but there still will be a dollar gap that the U.S. alone can’t and shouldn’t have to fill. Where is the rest of the world’s political and financial leadership –both public sector and private sector?
Finding the right balance across prevention approaches --
With the possibility of “test and treat” as a new form of HIV prevention (i.e., “test and treat” refers to a newly-described approach in which HIV-positive persons would be placed on antiretroviral treatment as soon as possible after diagnosis in order to reduce their ability to further transmit HIV), there is also a risk that existing, effective HIV prevention intervention approaches might be neglected. We need to guard against a rush to embrace the “new” that could result in less commitment, funding and attention to existing, proven prevention approaches. One of the Conference’s most interesting sessions was a discussion on combination prevention (i.e. use of all available proven prevention interventions within a given population ). While there was some variability across the presented studies, a number of them showed that combination prevention, in some settings, does seem to have an impact in reducing HIV incidence. Now, as many countries are beginning to act on the mantra of “Know Your Epidemic” and as the U.S. government is revising and expanding its prevention approaches including for injecting drug users, it is particularly important that combination prevention stay at the forefront of the response.
Most importantly, how do we continue to maintain an effective global coalition in the fight against AIDS?
In the face of the continuing international financial crisis, there is not only growing competition for resources for HIV/AIDS, but also growing competition across approaches and among international partners. Here in the U.S. the important bipartisan consensus that has sustained U.S. support has started to fray. Similar fissures in the international community, between treatment and prevention advocates, or across key entities such as the Global Fund, PEPFAR, UNAIDS, and the World Bank, could prove destructive and could put an abrupt end to the progress of the last decade. This is a time when unity of effort and support for a common vision is more important than ever.
Was AIDS 2010 a successful meeting? I don’t feel any one person can make that judgment, but what I do know is that I left Vienna not only with a renewed appreciation for the challenges, capacities and commitment of the global HIV community, but also with a very real sense that time is short. AIDS 2012, which will be held here in Washington, DC, is right around the corner. We all have a lot of work to do before then to ensure that real progress is made on the issues noted above among many others that dominated the Conference’s discussions.
What’s your perspective? From where you sit, did AIDS 2010 make a difference?