Spotlight’s top 8 highlights of AIDS 2016

By Marcus Louw

As the dust settles in Durban and the circus moves on, we reflect on a few of the bigger moments of AIDS 2016. Below are some of the highlights we think may turn out to be significant.

 

  1. Ban Ki-Moon in town to talk medicines

For a few hours on Monday 18 July United Nations Secretary-General Ban Ki-Moon was in Durban. He was there to talk about HIV, but also to talk about access to medicines. Late in 2015 he had appointed a High Level Panel (HLP) to consider problems with access to medicines and the lack of innovation in important disease areas. That he chose to travel to Durban on the eve of receiving the HLP’s report on these issues is significant.

On Monday morning Anele Yawa, General Secretary of the Treatment Action Campaign, presented a memorandum to Ban Ki-Moon urging him to take steps to “never again let people die because they cannot access medicines”. If part of Ban Ki-Moon’s mission in Durban was to take the temperature ahead of receiving the HLP report, he would have found it to be scorching hot. Whether that has any influence on what happens with the HLP report and to what extent the report and its recommendations lives or dies within the United Nations remains to be seen.

  1. Close to 10 000 people in ‘Treatment for All!’ march

In the moment last week most reminiscent of 2000, close to 10 000 people led by the Treatment

Close to 10 000 people led by the Treatment Action Campaign marched to the Durban Convention Centre
Close to 10 000 people led by the Treatment Action Campaign marched to the Durban Convention Centre

Action Campaign marched to the Durban Convention Centre on Monday to hand memorandums to various high-ranking persons in the AIDS world including UNAIDS chief Michel Sidibe, Pepfar head Deborah Birx and deputy president Cyril Ramaphosa. The march was convened under the banner of “treatment for all now!”. Activists emphasised that 20 million people living with HIV need treatment, but do not have access to it. The march showed that large numbers of people can still be mobilised to demand that leaders do better in the AIDS response. (You can read the march memo here)

 

  1. UNAIDS U-turn on “end of AIDS” language

One of the big stories of AIDS 2016 is the shift away from “end of AIDS” rhetoric from UNAIDS. In a move welcomed by activists, UNAIDS Executive Director Michel Sidibe said that we are not currently heading toward an end to AIDS and TB. Along with a number of other speakers at the conference he highlighted the reduced funding available for the AIDS response and the fact that the rate of new HIV infections is not coming down. But, whether the change of course from UNAIDS together with the show of power on the streets of Durban will be enough to push the global AIDS response back on track is unclear.

 

  1. Disappointing results from TasP trial

There was great hope that the TasP (Treatment as Prevention) trial would show that providing more people with treatment earlier will reduce the rate of new infections in a community. Unfortunately, this important trial failed to show a significant reduction in new infections in communities with early treatment. The problem appears to be to get enough people tested and then to get those people to initiate treatment. In better news, new findings from the Partners trial confirmed that people who are stable on treatment with undetectable viral loads do not transmit HIV to their sexual partners. The sobering message from TasP then is that we’ll need to do a lot more to actually get people tested and on treatment, but Partners confirms that getting it right will have a huge impact on new infections.

 

  1. A potential turning point for community healthcare workers

In another notable statement from UNAIDS, Sidibe said that the world needs to train a million more community healthcare workers (CHWs). He said that South Africa should have 200 000. This is significant since the line from the Minister of Health in South Africa has until now been that 40 000 CHWs are enough for South Africa. It is now up to activists around the world to use Sidibe’s comments to push for the training and employment of many more CHWs.

 

  1. Questions about young women and girls

Much lofty rhetoric at this year’s conference focused on the extremely high infection rates in young women and girls. Much of the rhetoric was of course not from young people. When young people did speak out – interrupting South African Minister of Health Dr Aaron Motsoaledi – it was to say they want access to condoms and sanitary towels in schools.

 

  1. Speech of the conference delivered by Justice Edwin Cameron

On Tuesday morning Justice Edwin Cameron delivered the prestigious Jonathan Mann lecture. Apart from being humorous and moving, the speech had a remarkable moral force and clarity. One of the disappointments of AIDS 2016 was that more people did not name and shame countries for discriminatory laws that undermine both the rights of human beings and the AIDS response.

 

  1. Civil society march against crackdown by Indian government

On the morning of 21 July activists marched from the conference to the Indian Consulate in Durban. The activists were protesting the Indian government’s crackdown on civil society groups such as the Lawyers Collective and India’s yielding to pressure from the United States on intellectual property. The activists say that India’s status as the pharmacy of the developing world is under threat and with it the global supply of quality generic AIDS medicines.  The memorandum was endorsed by current, future and past leaders of the International AIDS Society.

 

  1. New evidence supports new models of care

One of the key themes of the 2016 conference was that we need to change the way healthcare systems deliver services to people living with HIV if we want to provide all people living with HIV with treatment. The evidence is in. It is now up to healthcare systems to start implementing more task-shifting, adherence clubs, and care models requiring fewer clinic visits.  There is also new evidence suggesting that offering people treatment on the same day as testing HIV positive leads to more people starting treatment. Not surprisingly, a community healthcare worker-based programme  helped to improve TB detection rates in a study in Malawi.

While it is hard to change the inertia of old ways of delivering care, we now seem to have reached a critical mass of evidence on what we need to do to make healthcare systems much more effective and efficient. Integrating these new ways of doing things must be a top priority for health departments in high HIV and TB burden countries.

In a show of solidarity with breast cancer patients across the world, activists covered the Roche stand at the conference with hundreds of bras
In a show of solidarity with breast cancer patients across the world, activists covered the Roche stand at the conference with hundreds of bras

 

  1. Breast cancer protest at an AIDS conference

In a show of solidarity with breast cancer patients across the world, activists covered the Roche

stand at the conference with hundreds of bras. The activists were protesting the high prices that Roche is charging for the breast cancer drug trastuzumab in South Africa and other countries.  In South Africa a course of the drug costs a half a million Rand. One of the protestors was a breast cancer patient from South Africa who has not been able to access trastuzumab. Her cancer has recently spread – something taking trastuzumab could potentially have prevented.

 

 

 

Our house is still burning: We need your help

By – Anele Yawa

What is the state of play as the world returns to Durban 16 years after the historic 2000 AIDS conference? It is simple: less than half of people who need HIV treatment have access to it.

Around 17 million people living with HIV are receiving antiretroviral therapy, 20 million are not. We now know that 20 million people are at increased risk of developing tuberculosis and cancers – even if some of them still have high CD4 counts. We also know that providing those 20 million people with treatment will help prevent many new HIV infections.

It is clear what we need to do – we need to make sure an additional 20 million people have access to treatment. On this score most of the researchers, doctors, diplomats, policy-makers and activists gathering in Durban will agree. We have all the slogans and all the right rhetoric. We all agree that 90-90-90 is the way to go.

But 20 million? Twenty million when all we’ve achieved so far is 17 million – and that 17 million only through years of struggle, sweat and tears, with years of donor assistance, and unprecedented political will. Is it not madness to think we can get another 20 million on treatment? Is a reality check overdue?

If we are ever to get near an additional 20 million, then Durban has to be a turning point. It has to be the moment where we once again get serious about the HIV epidemic.

What should we be getting serious about? Firstly, we must get serious about where we will find the healthcare workers to support an extra 20 million people on treatment. Secondly, we have to stop pretending we can end AIDS without dealing with the widespread dysfunction in our healthcare systems. Thirdly, we have to get serious about how we are going to produce and pay for the medicines needed to treat an extra 20 million people. Lastly, we need detailed, fully funded plans that will make treatment for all a reality.

Getting serious also means an unwavering commitment to the evidence in all aspects of our AIDS response. It means being guided by the scientific evidence rather than by what sounds good or by what “sells on the hill”. It means never again wasting money in the way money was wasted on, for example, abstinence-only programmes. It means standing up to the moral Mother Grundys and providing young people with proper sex education and access to condoms. It means asking “Why are we so quick to stigmatise ‘sugar daddies’? but so slow to ensure young people have easy access to condoms?”

Getting serious means addressing the political obstacles to fixing our healthcare systems. It means dealing with corruption, mismanagement and patronage in our healthcare systems. It means not turning a blind eye when healthcare systems are wrecked by people who are politically well-connected – as is happening in the Free State province here in South Africa. It also means acknowledging that while PEPFAR giveth, the United States Trade Representative taketh away – the latter by bullying poor countries into trade deals that compromise access to medicines.

Getting serious also means not tiptoeing around cruel and inhumane legislation such as the anti-gay laws in place in many countries. At a conference like the International AIDS Conference IAC, we must say loudly and clearly that what countries like Nigeria and Uganda are doing is unacceptable and an affront to our common humanity.

Getting serious means an end to empty rhetoric and spin. It means that UNAIDS must stop talking about an end to AIDS while there are 20 million people who still need treatment. We cannot spread complacency just because we want to tell a positive story. Our lives are not an advertising campaign.

At this point in the AIDS response, complacency is our greatest enemy.

Even though a staggering 20 million people still need treatment, we have allowed the spotlight to shift. We have allowed the world to think AIDS is no longer a crisis. To the extent that we have allowed this to happen, we have betrayed the 20 million people needing treatment today. We have no choice. We are morally obliged to change this in Durban.

Getting an extra 20 million people on treatment will not be easy. If we are serious about things like 90-90-90 then we are going to have to rock the boat. I know that most of us want to be polite and not offend anyone. But our moral obligation is not to ourselves, or our own comfort, but to the 20 million people who still need treatment. We have to say to the governments of high burden countries: “You have to invest more. You have to do better.” We have to say to rich countries that they have a moral responsibility to the people still dying of AIDS and their families. And if governments don’t do their part we must name and shame them and stop the quiet diplomacy.

We don’t have to go hat-in-hand to Geneva or New York. We don’t have to accept ‘no’ for an answer. If a house is burning with people inside, then we help. That is what it means to be human.

If we are truly serious about things like 90-90-90, then we have to once again turn our crisis into a crisis for our political leaders. Together we must demand that HIV and TB is on the top of the agenda when the G7 or G20 meet. We must demand that more money is invested in TB research. We must say ‘no’ to a world where the United States government spends US$600-billion a year on its military, but the entire world can only find US$700-million per year for TB research.

We have the moral authority to demand a second wave in the AIDS response. We have no choice but to use it.

Welcome to Durban 2016, let’s roll up our sleeves and get serious. We have 20 million more people to treat.   

 

Anele Yawa is the General Secretary of the Treatment Action Campaign.