On World AIDS Day on Monday, at the final event of our HIV and AIDS season hosted at the Frontline Club, an expert panel of policy makers, scientists, journalists and community activists were asked “have we seen the worst?” The perhaps unsurprising answer was; “it’s more complicated than that”. Representing very different sectors in the global fight against AIDS, the panel were all careful to emphasise both what has been achieved in the 20 years since the first World AIDS Day and how much there is left to do. In short, the past two decades have witnessed almost unprecedented progress in disease response, yet there remains much, much more to be done.
The statistics are sobering; 3 million people on anti-retroviral drugs (ARVs), another 7 million needing them, 2.7 million people infected in 2007 and worldwide, over 33 million people living with HIV. Robin Shattock, Professor of Cellular and Molecular Infection at St George’s, University of London was clearest in his statement that without investment there is no possibility of keeping up with demand: “we cannot halt the epidemic without reducing rates of infection which will only come with medical advances – and ultimately a vaccine.”
In the chair, Sarah Boseley – a Guardian journalist and well-known writer on HIV and AIDS – expressed disappointment at a sense of “stalemate” and resistance towards reporting the issue from many in the media world. She posed questions to panel members covering key current issues such as microbicides (described as “the most important innovation in reproductive health since the Pill” and, it is hoped, a developing world solution), vaccination, prevention methods, behaviour change and male circumcision, before opening it up to the floor.
So, can science solve the problem? How viable is behaviour change? How can we combat the stigma and discrimination that persists in many parts of the world? What is the influence of the media in maintaining the political and financial will required to halt the epidemic? And when are historic injustices in ARV drug provision to be addressed?
Many of the questions from the audience were directed towards Michael Bartos of UNAIDS. He was at pains to stress the progress that has been made in areas such as mother-to-child transmission (MTCT) and specific instances of behaviour change – like an increase in condom use amongst young men in Mexico (from 20 to 80%).
And in a very different view from that of Elizabeth Pisani – who I wrote about last week – he identified problems of gender-based violence (GBV), stigma and discrimination as the biggest barriers to HIV prevention.
He called for a combination approach to messaging on behaviour change (partner number reduction, increased condom use, and increasing age at first sex) saying that from a policy perspective, the difficulty was in keeping “all the balls in the air” without focussing too much on one issue. However, the AIDS movement itself needs to maintain a sense of “righteous indignation” in order to keep up the momentum, he said – adding that the answers in terms of funding and support may well come from the work being done outside of the health sector: “the clinical setting is not the paradigmatic setting”.
This touched upon a question of particular interest for the work of the BBC World Service Trust posed by an audience member; namely, how to maintain interest and generate coverage of the AIDS story. Here, in some ways unusually, the same rules apply for HIV and AIDS as for anything else. Headline is king, results are key, and everyone wants a cure.
Thandi Haruperi, an HIV and AIDS activist and founder of restorEgo warned that editors’ disinterest in HIV was in large part due to the geographical location of the majority of those affected. Put simply, that if the epidemic in the west was as severe as that in southern Africa, then AIDS would scarcely be out of the headlines.
Advocate Anton Kerr argued that political will in the north has a direct impact at a grassroots level, underlining the importance of media representation and the need for political lobbying. He praised the UK government’s (through DFID) progressive role since the G8 summit at Gleneagles in 2005 on pushing for universal access, but warned that changes in political leadership and domestic political pressures – such as a shrinking civil service in the UK – could also have an adverse impact.
Robin Shattock concluded by emphasising the unique medical nature of HIV. “Conventional vaccines do not work on this virus”, he said. It is a great challenge for the biomedical community, but it is essential that the momentum is maintained. There were encouraging signs, though – he identified a “sea change” in the last three years from big pharmaceutical companies committing to licence-free microbicide development in treatment and prevention field that won’t repeat the same mistakes of inequalities in drug availability. This coupled with the idea of “patent pools” (borrowed from the technology world) gave hope to those looking for a true development focus on the search for an AIDS vaccine.
The legacy of the Bush administration’s ABC approach and focus on abstinence (through PEPFAR) in which much of the $15 billion pledged to fighting AIDS has been ringfenced made an inevitable appearance. The panel saw PEPFAR as a “double-edged sword”, in that the amount of funding is commendable, but the earmarking approach unhelpful.
Differences in approaches to delivering health funding in the developing world between the US and Europe are rooted in differing domestic healthcare systems. How health will be delivered in a developing country context under an Obama administration that is committed to building and providing universal healthcare at home is certainly an area to watch over the coming years.
