Pride, pessimism and two firsts have marked this evening's closing ceremonies of the World AIDS Conference in Melbourne. The two firsts were evident when Chris Beyrer, the first openly gay president of the International Aids Society - which organises the biannual gatherings – welcomed Olive Shisana who will be the first African woman to co-host a World AIDs Conference, in Durban in 2016. Beyrer said he wished he could feel optimistic about the years ahead but this is not possible unless progress is made on three important fronts. He called for action against the rise in hate against most-at-risk minorities, which include gay men in regions such as Africa and eastern Europe. He said action is needed to reduce the current treatment gap and improve access for underprivileged populations, given that 28 million HIV-positive people around the world are would benefit from HIV medications yet only half of them have access to treatments. And Beyrer called for an increase in solidarity and commitment, as HIV risks falling off the global agenda right at the point where an end to AIDS may be in sight. HIV prevention and support agencies must, he emphasized, use the two years before the next conference to set a road map and actually deliver on it. The IAS Presidential Award was presented to Professor Eric Goosby who has been working with HIV patients at San Francisco General Hospital since 1981. In those days HIV was almost exclusively confined to urban gay communities and San Francisco was amongst the hardest hit with thousands of gay and bi men dying every year in terrifying circumstances. Goosby said that clinicians and researchers now know the mechanisms by which HIV spreads, but now they need to identify the “determinants of performance” among successful responses internationally and locally. Earlier in the week-long conference it was noted by a UNAIDS official that it is only among men who have sex with men that the epidemic is rising internationally and that HIV prevalence is universally higher in these communities by an order of magnitude. He pointed out the paradox whereby it was gay and bi men who initiated the first global responses to HIV but who now faced the prospect of “reverse development” with rising epidemics again. In a Thursday plenary session Filipino HIV activist Laurindo Garcia warned that prevention and treatment for men who have sex with men would not reach full potential unless social prejudice was addressed, even in western countries. He put forward his own research agenda: an “intolerance vaccine” an “anti-violence condom”, and “hate PEP." (PEP stands for Post-Exposure Prophylaxis, a treatment whereby a person just exposed to HIV infection is immediately dosed with high levels of anti-HIV medications in an attempt to stop the virus taking hold.) As the conference winds down NZ AIDS Foundation boss Shaun Robinson says he found a special session on the expanding world-wide epidemic amongst men who have sex with men "disappointing." "It felt more like a bunch of scientists doing experiments on lab rats and pointing out the blindingly obvious such as the correlation between gay and bi male communities and the incidence of HIV," Robinson says. But he took heart from a report by delegates from Brazil, which has 700,000 people living with HIV, who reported high levels of condom use and a "comparatively stable" HIV rate of HIV infection. Like New Zealand they have kept new infections stable "but now the task for both of us is to drive it down." Robinson repeated the NZAF's long-held view that this can best be done by continuing commitment to condoms for safe sex and ramping up testing and access to treatments. On the much-debated possible role of relying more on treatments to drive down the infectivity of people with HIV, something the NZAF has been extremely wary of publicising as a frontline prevention strategy, Robinson says it is "indisputable that undetectable viral loads reduce infectivity" but he feels there are definite limitations on treatment as a technique for prevention from an epidemiological point of view, so the art to placing any reliance on it is "to do that without losing our condom culture." Preparing to return to New Zealand, Robinson says the conference has been a great opportunity to meet not only with those working in the HIV fields overseas but also to spend time with people from the clinical and prevention areas from throughout New Zealand. Robinson says he was pleased to see a number of delegates from the Pacific islands, although he has concerns based on their reliance on funding from world bodies and the trend for HIV funding pools to decrease in recent years. "They are lucky that so far HIV hasn't taken off in their nations but that means in tight financial times they are considered low priority in funding rounds." From the perspective of people living with HIV, Body Positive's Bruce Kilmister also says it was good to see many kiwis at the conference. "Most of the Auckland Infectious Diseases team were here and I've seen clinicians from other regions as well," he says. But the most gratifying aspect of the overall conference has been "a strong gay content which has been strangely lacking in previous conferences." As a gay man he has also been gladdened to see the "absolute condemnation" against regressive countries like Russia and Uganda who are forcing gay men to go underground. "One result, of course, is that they have clearly rising rates of HIV infection." Coming from a nation with strong human rights protections, a liberal social climate and comparatively low incidence of HIV compared to most other countries "makes us proud to be New Zealanders."
Credit: GayNZ.com Daily News staff
First published: Friday, 25th July 2014 - 9:32pm