New Zealand AIDS Foundation Executive Director Rachael Le Mesurier was part of a New Zealand delegation at the 2010 International AIDS Conference in Vienna. Conference audience -©IAS/Marcus Rose/Workers' Photos The NZAF says the conference is the premier gathering for those working in the field of HIV, as well as policy makers, people living with HIV and other individuals committed to ending the pandemic. "It is a chance to assess where we are, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward." The 2010 conference covered a broad range of topics. Le Mesurier has updated GayNZ.com with her impressions of the gathering. Rachael Le Mesurier What aspects did you find particularly important, from a New Zealand HIV prevention and health care perspective? A very broad range of topics but in brief… · The concern experienced by NGOs from all high income countries attending that ‘prevention as treatment' was so heavily promoted as the answer to reducing worldwide rates of HIV without any reference to the experience of countries that have fully funded ARVs and high testing rates. The experience of those countries has been that rates of HIV have all gone up, not down, after ARVs have been distributed for little or no cost. · That a possible cure is still being worked on and is on par with research into vaccines. These developments made me excited again that rather than pouring research funds into just prevention we can also think about getting HIV out of people's bodies! For more informationclick here Was there a focus more towards MSM? And how important is this for us? · No, there was a focus away from high income countries and MSM in general. It was noted that only about 2% of the whole programme was on MSM. As an example, a great deal of the focus was on male circumcision which research has shown has no preventive impact for anal sex. However, there was shocking data presented to show that MSM in low and middle income who have the highest HIV prevalence – I am shocked/outraged that it has taken 25 years of epidemiological research to show what many of us have known – that gay and bisexual men (as well as lesbian, transgender and other rainbow communities) are part of every society, every culture and every nation of people on this planet. · There was also a lot of talk about human rights – so the pairing of human rights issues and MSM and HIV does give hope that things are changing. ©IAS/Marcus Rose/Workers' Photos In your blog you seem to express a degree of uneasiness about the 'prevention as treatment' mantra at the conference, what are your key concerns? As noted above. The research may well disprove and reassure those of us who are concerned and I have no problem being proved wrong. However, here are some of the concerns shared by many HIV focused, community-based NGOs from high income countries that are focused on the needs of gay and bisexual men: · That microbicides have potential relevance for those who may be unable or are not safe to insist on condoms – for example some heterosexual women, some receptive male partners and sex workers. However they are yet to be proved in ‘real world' trials, and are only 30 – 45% effective compared with condoms (which have an efficacy rate that is at least double that). Microbicides will cost $150million to get just the stage 3 trials completed for the vaginal microbicide trials alone. Microbicides for vaginal membrane protection will also need to work with the very different cell membranes of the anus/rectum to be effective for MSM. · PrEP (Pre-exposure prophylaxis) is also untested and very unclear – if it is proven to work would it mean men who are HIV negative taking pills every day for the rest of their sexually active life? Or if taken only before and after sex how are pills that take so long to suppress person with HIV so effective in blocking HIV after just one or two doses? These are the very same pills on which research was presented showing current and emerging side effects and increasing uncertainty of the impact on a person's health after long term treatment. Also the same pills where research is reporting concerns about increasing drug resistant strains of HIV and the links with poor compliance. · The arguments proposing that the ‘take a pill/use the gel' approach to prevention all say they recognise condoms are the most effective, that they are really targeting those who can't/won't use condoms and asking that group to: plan ahead, have the product at hand, be consistent in their usage and insert a gel or take a pill into their bodies before sex every time. Why would these ‘tools' for prevention be more attractive and consistently used for this group who already find it hard to consistently use condoms? · Of course all of the ‘treatment as prevention' tools do nothing for other STIs or contraception – when of course condoms help a lot to reduce these infections and pregnancies. · At a time when we can't get the cheapest prevention tool - condoms - to many parts of the world I do wonder why we have such a focus on prevention approaches that would mean we would need to get expensive pills/gels to the same remote villages and islands. · Lastly, I would struggle with the morality of the very limited, and presently decreasing, global funding going to helping those who don't want to use condoms when we can't get the precious ARVs to around 5 million people who living with HIV right now and dying without them. ©IAS/Marcus Rose/Workers' Photos From a personal perspective, what was your feeling walking away from the conference? What do you see as the key questions it raised that need to be answered? It was valuable to be able to meet up with other high income countries (New Zealand is grouped as a high-income country) to share concerns issues and experiences such as: · Is the leadership of those countries able to ensure they don't ignore the 14 years what amounts to ‘field trials' of ‘treatment as prevention' in the high income world? · Does the leadership of those countries have the courage and conviction to see how MSM are at the heart of almost all of sexually transmitted HIV epidemics that are occurring worldwide and make sure prevention and treatment reaches them effectively? It was good to get a sense of how the NZAF is doing on a global scale – · Get it On is a cutting edge social marketing initiative when compared with what is happening globally. Many are just beginning to understand the importance of social movements · HIV rapid testing is just beginning to be rolled out (but not for the Aussies and boy are they frustrated!) It was also good to see where we could do better · Accessing a new test that can detect the virus much earlier – getting more people diagnosed with HIV onto treatments and reducing the number who are highly infective and unaware of it. · To monitor nationally, and be ready for emerging issues like early aging, cancers, etc for people who are living with HIV and have been on treatments for more than 15 years. · HPV and anal cancer are huge issues for men living with HIV. We need services to help reduce more illnesses and preventable mortality for men with HIV. Le Mesurier was joined by Director NZAF Positive Health Services Eamonn Smythe, while representatives of Body Postive, Positive Women and INA were also in Vienna for the conference. GayNZ.com - 5th August 2010