21 July 2016

Africa: What I Have Been Hearing....

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There has been a lot of buzz about this 21st International AIDS Conference, AIDS 2016, which the beautiful city of Durban has been hosting. Many people, whether at the conference or following the proceedings from afar, have been excited, especially as talk about the "End of AIDS" continues to pick up pace. I spent some time listening to conference delegates about the conversations they are hearing; and also those they would like to hear but which haven't received the deserved attention. Below are their thoughts:

At the 21st International AIDS Conference in Durban, what have you heard the most in conversations?

"Fighting new infections," said Peter Piot, 67, former Executive Director of UNAIDS.

"This is the first conference in a long time at which prevention has been central to conversations in the different meeting rooms. Treatment is important, but we have to give prevention as much attention," Mr Piot added.

"Decentralization of treatment to the community structures," said Luthando Qobo, 39, of the Department of Health in Kwa Zulu Natal, South Africa.

"New infections are happening in communities. The people who urgently need treatment live in communities. So, being here at the conference and hearing several speakers talk about taking treatment to the communities is refreshing for me," Mr Qobo added.

"I've heard a lot about male condoms, but nothing at all about the female condoms. I don't even remember when I last saw a female condom. Where are the options for young women?" asked Nomtika Mjwana, a 20-something year old woman, South Africa.

"HIV prevention approaches - for example, pre-exposure prophylaxis or PrEP have dominated the conversations at AIDS 2016. That's great, because prevention needs attention. Young women especially between 15 to 24 years are getting infected with HIV at alarming rates. So hearing that we now have options that are discreet is a breath of fresh air for me," said Jonas Langa, 40, of Right to Care here in South Africa.

"I'm excited to hear lots of conversations about PrEP, including injectable PrEP that in future may be available for people to get a single injection that could offer prevention of HIV for several months," observed Dr. Edith Nakku-Joloba, 47, a clinical epidemiologist at Makerere University and the Infections Diseases Institute in Uganda.

"This conference has also been about human rights and activism. Activists have been everywhere, leading conversations and directing the agenda. We need to reinvigorate activism if we're to end AIDS," Dr. Nakku-Joloba added.

And what would you like to hear more of as the conference progresses?

"I would like to hear more about the reality of achieving the goals we're setting of fewer HIV infections. How practically are we going to see more prevention at the community level?" asked Mr. Piot.

"Viral load monitoring for people living with HIV hasn't received enough attention at AIDS 2016. Even where it's been talked about, it's not clear exactly what it means to be "virally suppressed". I hope that we'll hear more about this as the conference progresses," said Mr. Qobo.

"As excited as I am about PrEP, I'm not hearing enough about how the adolescent girls and young women whom I work with will access PrEP. They need it. They want it. Now, tell me how they'll get it," remarked Ms. Langa.

"Are sexually transmitted diseases/infections on the AIDS 2016 agenda?" asked Dr. Nakku-Joloba. "I've personally not heard much about STDs and STIs. HIV/AIDS and STDs and STIs go hand in hand. We would be lying to ourselves if we took our sight off of one as we focus on the other," she added.

On my part, I've heard a lot of talk about focusing on young people, but I've not seen as many young people leading, talking and representing themselves as I would have loved to. Also, I've heard a lot about nice-sounding targets such as the new UNAIDS target of reducing new infections to 500,000 annually (currently at 2 million) by 2020; the new UNAIDS and WHO target of circumcising an additional 27 million boys in men in priority countries (where male circumcision is low but HIV prevalence and new infections are high) among others. I believe in ambitious targets and also know that they are critical if we're to make the "End of AIDS" a reality, but, like Dr. Piot, I would like to hear more about real practical ways to deliver prevention.

In addition to this, global funding for HIV/AIDS is reducing. I would like hear more funding commitments from current major funders such as the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, the Bill and Melinda Gates Foundation, European donors, and most importantly, governments of the countries that bear the biggest burden of HIV/AIDS.

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