Participants at the 21st
International AIDS Conference (AIDS 2016), taking place this week in Durban,
South Africa, reviewed the remarkable gains that have been made in
access to HIV treatment and new prevention tools since the conference was last
held here 16 years ago. But researchers, activists and government
officials agreed that this progress could be reversed if stakeholders do not commit
to increased funding and respect for the human rights of key populations at
risk.
Effective combination antiretroviral
therapy (ART) debuted in the mid-1990s, but it was not until the Durban
conference in 2000 that widespread access to effective treatment for people in low-
and middle-income countries was put forward as a global priority. This year's
theme – Access, Equity, Rights Now – recognises that barriers must still be
overcome to achieve universal access to prompt
diagnosis, effective treatment and biomedical prevention methods such as
pre-exposure prophylaxis (PrEP).
"We
call for AIDS 2016 to finish what we started in 2000," United Nations Secretary-General Ban Ki-moon said at
an opening press conference on Monday. "We must close the gaps that keep
people from accessing services and living with dignity. We can end stigma and
discrimination, prevent the spread of HIV and save lives."
"The
2000 conference was a catalyst for historical change and launched a global
movement to bring lifesaving treatment to people around the world," AIDS
2016 co-chair Olive Shisana of the South African Human Sciences Research Council said in her
opening remarks. But "progress is precarious," and "we
must bring about structural changes in laws and policies" that determine
who has access to the latest HIV prevention and treatment advances.
UNAIDS recently announced
that an estimated 17 million people with HIV were receiving antiretroviral therapy (ART) at the end of 2015.
South Africa – which has the world's largest treatment programme – now has about
3.4 million people on therapy. But both globally and locally, over half of
those who need antiretrovirals to preserve their own health and prevent HIV
transmission to others are not yet receiving it.
"Despite tremendous progress, there are still people being left
behind," said
AIDS 2016 co-chair Chris Beyrer of Johns Hopkins Bloomberg School of Public Health. "New infections among adults have stalled and not fallen in five
years, new tools like PrEP are out of reach, and the human rights of key
populations are persistently violated."
Speaker
after speaker highlighted the importance of reaching vulnerable populations
including women and girls, youth, gay and other
men who have sex with men, transgender people, sex workers, prisoners and
people who inject drugs. While past conferences often focused on scientific
advances in the areas of effective treatment and biomedical prevention, many sessions
at AIDS 2016 look at how to translate these breakthroughs into widespread
practice – a challenge that will require social, cultural, political and legal
changes.
In advance of the conference the International AIDS Society (IAS)
released the Second Durban Declaration, highlighting five key scientific
advances made to date and five key structural barriers yet to be overcome.
Supporters are encouraged to sign on to the statement.
Preceding the AIDS 2016 opening
ceremony on Monday, several thousand AIDS activists from around the world held
a march to demand universal access to treatment and prevention services for all
who need them.
At
the end of the march, which wound from Durban City Hall to the convention
centre, activists presented memoranda to leaders including UNAIDS executive
director Michel Sidibé (on behalf of Mr Ban), US
Ambassador Patrick Gaspard and Global AIDS Ambassador Deborah Birx, and South
African deputy president Cyril Ramaphosa and minster of health Aaron Motsoaledi.
"Our political leaders want to
talk about the millions who are on treatment – which is a far cry from the last
Durban AIDS conference," said Anele Yawa of the Treatment Action Campaign.
"But we know that instead we have to tell the truth about the majority who
still lack access."
UNAIDS has set a goal that 90% of people with HIV be tested, 90% of those will start treatment and
90% of those on treatment will achieve viral suppression by 2030. But large
international donors are pulling back on their commitment, and while low- and
middle-income countries are stepping up, they may not be able to manage on
their own.
Mr Sidibé, who gave the keynote speech at the AIDS 2016 opening plenary Monday
evening, said he was "fired up" about
the challenges ahead, but also scared about the consequences if we stop
focusing on HIV and devoting enough resources to stop the epidemic.
"Our progress is incredibly
fragile," he said. "If we do not act now we risk resurgence and
resistance."