Track C report by Patrick Sullivan
The information presented in the Monday morning plenary cut across many thematic areas of the conference. For this session summary for Track C, I will address the topics from the plenary of most relevance to the Track focus of epidemiology, surveillance, and HIV prevention research.
A presentation by Geoff Garnett gave some depth to the topic of how data from surveillance systems and other sources are used to describe HIV prevention successes. Although surveillance data and data on HIV incidence from modeling and research studies are appropriately used to describe trends in the epidemic, Dr. Garnett cautioned that declines in HIV prevalence within a country do not necessarily reflect precedent decreases in risk behavior – rather, epidemics may have a natural course that leads, at some point in time, to declining and then stabilizing HIV prevalence. So, other, correlative data are needed to fully understand how HIV prevalence data over reflect a combination of the epidemic course, and behavioral changes that may have occurred. To illustrate this point, he presented a modeling study which used data from serial HIV prevalence studies in antenatal clinics in Zimbabwe, and concluded that a reduction in risk behavior (measured as partner change rate) of approximately 50% occurred in Zimbabwe in 2001. He also emphasized the importance of using combinations of successful interventions to try to reduce the transmission number (R0) to below 1.0.
Track E report by Stefan Baral
3 by 5 was achieved, but 2 years late. This is representative of the state of the global fight against HIV and AIDS. That is, there have been improvements of translating policy into action, but they are happening slower than initially pledged by countries around the world. Universal access will indeed not happen by 2010, but if countries continue to scale up evidence-based prevention and treatment programs, then this may one day be a reality. The epidemiology of HIV shows an increasing concentration of incidence among the traditionally vulnerable populations of men who have sex with men, sex workers, and IDUs. And it is in these same populations where access to prevention and treatment programs has been, and continues to be, the most limited.
HIV transcends geography and has found its way into some of the most remote populations around the world. Thus, the global fight against HIV and AIDS needs to be equally creative to enact policies that will prevent and treat these same remote peoples. Along the same lines, young people have also been underrepresented in targeted HIV expenditures and generally left out of the decision making process which affect their current needs and future health status. Finally, sexual diversity in young people should be celebrated and HIV programming should integrate this diversity when designed and implemented to ensure higher rates of acceptability and consequently, efficacy.
Jamie Sepulveda: “We cannot treat our way out of the epidemic; we also need to scale up prevention”
Youth report by Annelies Mesman
Thembi Nugubane, a 23 year old from South Africa, referred to digital possibilities for prevention programs. She said that radio is the most important medium to reach communities. Young people can speak to inform peers. She called it “our responsibility to inform other young people.”
Dr. Garnett, Dr. Coutinho and Dr. Sepulveda discussed the heterogeneous nature of the HIV epidemic.
A few returning topics were:
• Lack of data
This includes local data; information on the link between the social, medical, biological, economical and demographic characteristics of HIV; Evaluations and data to understand the efficiency of funding streams.
• Importance of combination intervention and therapy.
Models show the effect of behavioral change, combined with male circumcision. The latter can decrease the transmission rate by 30%.
• Need for earlier knowledge of status and earlier treatment.
Elisabet Fadul , youth advocate from the Dominican Republic described the face of epidemic today:” young, female and marginalized.”
She said that although youth participation has progressed from peer education to decision-making positions, “A big few make decisions for a small many”.
She also called up for celebrate diversity.
Both young speakers responded to a question regarding communication perspectives of advertisements branded by governments. Thembi said that these contain confusing messages, are only targeted at HIV negative people, not to HIV positive people and can be offending.
Elisabet added: “They don’t focus on our diversity” and our not youth-friendly.
At some moments, speakers appealed the audience and decision-making bodies:
Jaime Sepulveda: “All wealthy nations must invest.”
Alex Coutinho: “Allow people to stay in Europe and have access to health services and attribute to scale up treatment.“
“We need new definitions of health systems. Often, HIV infected persons are excluded.”
Elisabet Fadul: Putting “theological, moral beliefs over fact-based evidence” is a violation of our human rights. Please, let sexuality education not be the latest political rhetoric.
“Prevention intervention must focus on young people, by increasing the sexual and reproductive health.”