HIV Treatment is Prevention: from the IAS Conference no Excuse for Missing the Goal

More than 5,000 AIDS researchers, scientists, clinicians, community leaders and policy experts gathered in Rome for the opening (17th of July) of the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011).

Treatment as prevention has become the leit motif of this conference since the opening: both the IAS 2011 International Chair and International AIDS Society President Elly Katabira and the IAS 2011 Local Co-Chair Stefano Vella, Research Director at the Istituto Superiore di Sanità (ISS) opened their speeches with the concept of antiretroviral treatment as a means of HIV prevention.

And the following day (Mon 18th) prof. Antony Fauci gave an emblematic overview of the  30 years of the HIV/AIDS story, starting from the “dark ages” of the pre-antiretroviral era to antiretroviral development and Global Programmes for HIV. During these 30 years, he said, education, behavioral changes, condom use, clean syringes were the major prevention tools, together with prevention of mother to child transmission and pre exposure prophylaxis. But now we are assisting to the arrival of treatment as prevention with studies – the HIV Prevention Trials Network (HPTN) 052 trial –  showing that ART reduce HIV transmission by 96% in HIV serodiscordant heterosexual couples. And, according to Fauci, serodiscordant heterosexual couples is not something regarding a restrict group of people, since each HIV+ person having sexual intercourse with an HIV – person is forming serodiscordant heterosexual couple. His conclusion is that we can now control and end the AIDS pandemic, but major investment are needed: let science inform policy.

In the afternoon an Oral Abstract Session “Treatment is Prevention: the Proof is Here” went deeper into the HPTN 052 trial. There are many reasons to be optimistic now, but, as somebody from the public noted, we must not forget now about condom.

Financial sustainability is the Achilles’ heel of the ART story

After the emphasis given during the opening and the 1st day to the Treatment as Prevention (TasP), the second day opened with a social perspective on the same issue, given during the plenary session by  Susan Kippax,  Emeritus Professor at the Social Policy Research Centre, University of New South Wales, Sydney. Prof. Kippax, remarked that we should avoid now any unintended consequences of the evidence of TasP – Government abandonment of preventive tools as clean syringes and needles and individual abandonment of condom use.

Serge Eholié, Professor of Tropical and Infectious Diseases at the Medical School of the University of Abidjan, focused on the challenges of sustaining antiretroviral therapy initiatives (and TasP) in developing countries. Evidence claims that there is a need to change the actual paradigm and find asymptomatic patients, but how? With which financial resources?

Financial sustainability – he said – is the Achilles’ heel of the ART story since there are countries where up to 95% of HIV programmes depends  from international donors. At the same time just few countries in the southern part of the world – showed prof. Eholiè -  managed to put on ARV more than 50% of people in need according to 2010 WHO’s guidelines. And with which human resources  (having more people on ART would lead to an increase of staff burden)?

From the time of Vancouver where HAART were declared to be effective, with TasP – added Peter Piot -  we are now in another crucial moment, but we are also in the middle of a dramatic financial crisis with funds for HIV starting to decline while the target of 15 millions of people on ART is still far.

Thus, TasP may became a revolution for the people, concluded the plenary session the Sidaction activist Eric Fleutelot, and TasP should be used to convince Governments,  politicians and leaders to invest more in order to change the actual paradigm (but, I would add, without forgetting about what in the old paradigm was working).

The first government to be convinced is Italy which has not yet paid the 2009 and 2010 pledges to the Global Fund (for a total amount of 260 million of Euro) and for this reason, since the opening of the IAS 2011 Conference, activist from all over the world  are peacefully protesting outside and inside the premises.

No excuse for missing the goal

Low income countries bear over 60% of the HIV disease burden; most of these countries highly depends on international assistance, but total annual resources for HIV went down from 2009 to 2010. The gap between resources available and needed is still high and to close this gap by 2015.

We need to raise $6 billion additional funds annually and there is the need to increase commitments for the period 2011-2020.

IAS Conference, Rome - July 2011 photo credit Forum Italiano della società civile sull’Hiv/Aids

This are the key figures exposed by Robert Greener of UNAIDS during the 3rd day of the IAS Conference. Greene proposed potential sources of funding, included Innovative financing mechanisms, Indirect taxation (airline tickets, mobile phone usage, exchange rate transactions), Front-loading mechanisms (IFF-Im) and Advance market commitments.

But all the estimations he gave are based on “pre–TasP quotations”. Now, the question is “how much would it cost to reach the treatment as prevention target?”. Countries must discuss the best way to make treatment as prevention real and affordable and must give estimations on the costs.

But what is sure now is that TasP will result in a major market extension for the pharmaceutical industry – as stated by Alessandra Cerioli, National President, of LILA  (the Italian League for the Fight against AIDS) reading the Community statement during the Closing Session of the IAS.

Thus, continued passionately Alessandra, we need to negotiate the price tag with pharma……  we urge all of the pharmaceutical companies to enter into negotiations with the Patented Medicines Pool.  It will only be successful if all the companies get on board. 

The geographic scope of these licensing agreements must include both LOW and MIDDLE income countries. We are today more convinced than ever that our generation can end this pandemic. There will be no excuse for missing that goal.

by Marco Simonelli, Health Policy Advisor, ActionAid Italy