Community Statement at International AIDS Society 2009 Pathogenesis Conference

Read on behalf of the Community AdvisoryGroup(CAG) by Morolake Odetoyinbo, Positive Action for Treatment Access (PATA) Nigeria 

I am honoured to present the closing Community Statement on behalf of the IAS Community Advisory Group. We are grateful for all the input we have received from community delegates attending the 5th IAS Conference here in Cape Town.

HIV is still an Emergency and we need a sustainable response. Does the world think AIDS is no longer an emergency? The G8 has found one trillion dollars to kick start the global economy but shamefully cannot find 9 billion which the GFATM urgently needs till 2011. Why is the G8 reneging on their promises to fund universal access to HIV treatments? We urge the G8, PEPFAR, the World Bank and other donors not to stall on their commitments and to increase their funding. 

Millions of lives are at risk, I need a bail out too, please help me stay alive!!!

Access to treatments is still being denied to 7 million people who qualify under the current WHO guidelines of 200 CD4 T Cells. As Vuyiseka Dubula-Majola from the Treatment Action Campaign (TAC) in South Africa told us at the Opening,. "HIV is not in recession" and economic recovery must include health.

Without the work of activists in this country many more people would have died. Treatment activism in SA is a classical example of how treatment activism has been instrumental in influencing governments and society. Activists have been busy at this conference, with the TAC protest march on Sunday, which achieved a signed MoU from the Health Minister. They have been working with the media keeping the issues of long waiting lists, ARV "stock-outs" and unavailability of antivirals and other essential medicines, in the forefront of people's minds. They have made people aware that TB is a particularly serious problem in Africa too and that HIV and TB need to be treated hand in hand.

We also appreciate the comments made at this conference by the eminent scientist, a man after my heart, Stephen Lewis from Canada about the importance of doctors and scientists taking action to change policies that are hampering their work in the fight against HIV. Our doctors, health workers and scientists must resist a move which will wipe of all their hard work and laudable achievements of the past 25 years!

More needs to be done. We all need to make stakeholders accountable for failures in treatment supply. This includes drug companies who must share their patents faster, and unsatisfactory government procurement systems that are denying treatments even when funds are available. Why are countries of the South like India, Thailand and Brazil, not working together with African countries and others to reduce the price of second and third line treatments?

Treatment as Prevention was a major topic of discussion with many presentations including Granich's which showed with his modelling that universal testing and immediate ART would lead to a 95% reduced incidence in HIV in 10 years. But this was tempered by Fauci in the session on US Global Policy when he said that more research and data was needed to show how to roll out "test and treat" programmes. The proponents of population health must always take into account and respect individual rights in the roll out of such interventions. But we ask the conference why do we seem to be forgetting the crucial role of behavioural prevention - have we given up on condoms and safe sex messages altogether?
Are we encouraging people to stop taking responsibilities for their own health and lives? Please do not place the burden of prevention on the shoulders of people living with HIV.

We were pleased to see the research presented on mother to child transmissions at this conference. Like a lot of researchers, I personally hate the name Mother to Child Transmission as it once more, places the blame of infection on the woman! Vertical Transmission or parent to child sounds better to me.
There is a greater understanding of how to treat mother and baby as well as the importance of breastfeeding. One thing I heard clearly however is the need to keep women on HAART until they stop breastfeeding and the child on PEP till after weaning. However we wonder why after HAART has shown success in adults, do we not have enough child-friendly formulations of HIV treatments? This is taking way too long and it is heart breaking to watch our babies die needlessly.

Gatell from the University of Barcelona told us that you could only expect normal life expectancy if patients had 500 CD4s for five years or more, which many patients treated under 350 were unable to achieve.

As we are aware, this is a huge problem for people in developing countries who are only treated when they reach 200 T cells. Inspite of the financial arguments, we ask the World Health Organisation to change the guidelines so that developing countries can start treatments at 350. We must set the bar high. WHO must set informed, ambitious target.

We also heard about new understandings on the role of inflammatory responses in HIV and that, if eradication is not possible, there is a need for a functional cure including immune control alongside other interventions. People with HIV also look forward to the day when clinicians can use genomics to predict the likelihood of treatment toxicities for each patient and to use this to develop optimal treatment regimens. My dream is the day when a therapeutic vaccine will be found; a vaccine which will stop my impending AIDS and make me non infectious.

We were delighted to hear that the Obama administration will lift the travel ban to the US by the end of 2009. This we heard last year from the Bush administration but I still needed a visa waiver to enter the US because there were no administrative procedures set. Dear Dr. Fauccii, please tell the wonderful people in Obama-land to hasten these so foreign missions have clear guidelines and the lift of travel restrictions is translated into action.

It is also heartening to hear the US is introducing legislation to lift the ban on needle and syringe programs and will continue to focus significant international aid on HIV, TB and malaria.

Community delegates wish to thank IAS and its secretariat staff for their strong commitment to developing partnerships with community and for their involvement of the Community Advisory Group in decision-making around the conference programme.

We particularly want to thank Craig McClure, the outgoing Executive Director of IAS, for his strong commitment to involving community in IAS and for making all their conferences so inclusive and welcoming to us. We will miss Craig and wish him the best for the future.

Thank you to the people of Cape Town, the conference organisers, the IAS secretariat and the volunteers for making this a very community-friendly conference.

Finally, do you all believe HIV is still an emergency? Do you agree that we need sustainable response from our governments and the international Community? If you believe that AIDS is an emergency, please stand to your feet. Rise up if you agree that the world needs to keep both eyes on the global AIDS epidemic.

Thank you for rising in solidarity and for standing up for what you believe.

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