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AIDS 2014: International AIDS Conference Open with Tributes and Determination

The 20th International AIDS Conference (AIDS 2014) kicked off Sunday in Melbourne, Australia. With the theme of "Stepping Up the Pace" in the response to HIV/AIDS, delegates will focus on expanded access to HIV and hepatitis C treatment, the promise of biomedical prevention, ending criminalization of people with HIV, and reaching key populations including gay men, transgender people, sex workers, prisoners, and people who use drugs.

The conference opened on a somber note, as attendees remembered several colleagues killed on Malaysian Airlines flight MH17, which crashed Thursday after being hit by a missile near the Russia-Ukraine border; initial reports that more than 100 delegates were aboard were unsubstantiated. At a press briefing Saturday afternoon, International AIDS Society (IAS) president Francoise Barré-Sinoussi and president-elect Chris Beyrer expressed their condolences and said 6 delegates were confirmed to have been on the flight, including renowned Dutch AIDS researcher and former IAS president Joep Lange.

This year's conference drew approximately 10,000 participants -- a substantial drop from the 24,000 who attended the last International AIDS Conference in Washington, DC, in 2012. Despite its smaller size, the meeting features a broad and diverse program that spans all aspects of HIV/AIDS from basic scientific research to human rights advocacy.

UNAIDS Executive Direct Michel Sidibé gave a keynote speech at the conference opening plenary on Sunday evening. The global response to HIV/AIDS has made some remarkable progress since 2012, he said, emphasizing that "more has been done in last 3 years than in the last 25 years."

Nevertheless, more remains to be done to ensure that no one is left behind. UNAIDS has set a goal that 90% of people with HIV be tested, 90% of those start treatment, and 90% on treatment achieve fully suppressed viral load by 2020. In particular, resources must be focused where they are most needed to address the 15 countries that account for 75% of new HIV infections and related deaths.

Treatment and prevention advocates interrupted Sidibé's speech both at the plenary and at an earlier dedicated session on the UNAIDS new target. Holding signs reading "We Demand Undetectable -- Action Is Unacceptable," the activists called for an evenmore ambitious goal, calling for every person with HIV to achieve undetectable viral load by 2020.

"Today most people living with HIV outside wealthy countries don’t even know their viral load because they’ve never had access to the test, and too many do not have the treatment they need to control the virus," said Bactrin Killingo of the International Treatment Preparedness Coalition. "This is a violation of basic human rights -- all people deserve the information, medicine, and support needed to control and suppress the virus."

Former Australian high court judge the Hon. Michael Kirby gave the annual Jonathan Mann lecture at the plenary, speaking about how reforming laws that criminalize and discriminate against people with HIV and key affected populations is a necessary part of the response to the epidemic. 

Pre-conference Events

The days leading up to the official opening on Sunday included a full slate of satellite session and pre-conferences including the IAS "Towards an HIV Cure" symposium and the International HIV/Viral Hepatitis Co-infection Satellite Meeting.

According to Gregory Dore from the University of New South Wales, the major highlight of the coinfection meeting was the final session on Public Health Advocacy and Access to HCV Therapy, which featured a presentation by Kirby on Human Rights and Access to Antiviral Therapy. "He provided an incredibly informative address aimed at reconciling issues of intellectual property with the human right of access to quality health care," said Dore.

This was followed by a panel discussion with representatives from the World Health Organization, Médecins sans Frontières, Open Society Foundation, the Clinton Foundation, community organizations, and representatives from Gilead Sciences and Janssen, which market the 2 next-generation HCV drugs approved so far, sofosbuvir (Sovaldi) and simeprevir (Olysio).

"The key issue addressed at the coinfection meeting was how the highly successful global response to HIV could facilitate responses to hepatitis B and C, in particular strategies to enable access to highly effective antiviral therapies," Dore addeed.

The annual Global Forum on MSM & HIV pre-conferencefeatured discussion of new prevention technologies, including treatment-as-prevention (TasP) and pre-exposure prophylaxis (PrEP), and how they fit into the broader picture of health and wellness for gay, bisexual, and other men who have sex with men.

"This was not a PrEP session -- it was about the variety of prevention methods for gay men, MSM, and transgender women around the world," said community PrEP expert Gus Cairns of NAM. "There's an extraordinary cultural shift ongoing in the gay community, especially in the U.S. An extraordinary and very rich and respectful discussion arose, and what we ended up agreeing on is that the PrEP debate has enabled people to start talking about things that have been a bit taboo or frozen in the HIV conversation. The PrEP debate has thrown a hand grenade into discourse about prevention in the gay community, and that can only be a good thing."

With regard to TasP, the concern is about the potential for "compulsory test-and-treat," where people will be expected or coerced into taking antiretrovirals before they are ready, Cairns added, saying that, "People are worried they won't have ownership over whether they take antiretrovirals anymore." EATG and NAM have produced a succinct community consensus statement of principles and are asking others to sign on.

The potential for coercion around TasP and PrEP also came up at a sex worker pre-conference sponsored by the Scarlet Alliance. Biomedical HIV prevention was one of 5 key themes discussed, along with funding for community-led programs, migration and mobility, legal and human rights, and stigma and discrimination.

Human rights, criminalization, and stigma and discrimination are a running theme throughout AIDS 2014.

Another pre-conference satellite -- Beyond Blame: Challenging HIV Criminalization -- focused in more depth on these issues. David Davis, the Victorian Minister for Heath opened the meeting with a surprise announcement that his government would amend the only HIV-specific criminal law in Australia (Section 19A of the Crime Act), according to organizer Edwin Bernard of the HIV Justice Network. The meeting also heard about the continued challenge of new HIV criminalization laws in Uganda as well as some recent successes in the U.S.

The International AIDS Conference will continue through Friday, July 25. The full AIDS 2014 programis available online. Follow conference news on Twitter using hashtag #AIDS2014. HIVandHepatitis.com and content partner Aidsmap.com will provide comprehensive on-site coverage all week. Find the latest news on our AIDS 2014 conference page (coming soon), our Facebook page, or on Twitter @HIVandHepatitis. 

7/21/14