International AIDS Conference, Mexico, Day 4

The conference has heard a lot about what we have learned in the past in terms of approaches to tackling HIV and AIDS. But a session today made the case that it is important to look to the future of the epidemic to predict what action will be needed.

Looking to the Future – The epidemic in 2031
AIDS is unique because it is a crisis – several 1000 people die every day – but it is also a long wave event. Peter Piot, Executive Director of UNAIDS, suggested some directions in which the epidemic is travelling and how we might need to respond.

Piot pointed to new waves of infections which are incredibly diverse and treatment and prevention efforts that are lagging behind. To respond we need to know where the next 1000 infections are going to happen – not be looking to who is coming for treatment as the pattern of infection may well have changed. For example, in Thailand the highest rate of new infections is amongst married women rather than sex workers, people who inject drugs and men who have sex with men.

He explained that the universal access targets are a means to get to our real goal which is a world where nobody dies of AIDS and people living with HIV have a happy and healthy life. For this to happen far more people need to know their HIV status and we need to stop late diagnosis. We require better second and third line drugs and we need equitable access to them.

For Piot Southern Africa is a special case when it comes to HIV and AIDS. There is no technical fix for the situation there, it will require a society wide shift to tackle it. Leadership and altering social norms will be crucial in this.

Where is HIV prevention headed?
Piot feels that we should aggressively pursue the complete elimination of mother to child transmission as this is a realistic goal. But it will require the integration of SRH and HIV services and much better access to services. Post Exposure Prophylaxis should be better understood and used.

Prevention needs to be innovative using information communication technologies such as mobile phones and web based social networking applications – billboards will not appeal to the young people who need the information. Combination prevention needs to be more tailored to particular communities.

We need to use more business like methods but ground these in community action and knowledge. Bringing in business professionals, for example marketers, is key although it may be expensive. As Piot says, ‘the epidemic is too serious to be left to cottage industry, improvisation and amateurism’.

Funding the response
Piot suggested that international solidarity should continue but developing countries need to make evidence informed policy decisions about the appropriate allocation of domestic resources even when it is politically unpalatable – when it needs to go to the most marginalised.

We need pension funds rather than insurance programmes. Insurance is for the unknown – pensions are for what we know will happen. We know that many more people will need AIDS treatment. If we think it has been tough up until now consider what is to come. We need to act now so that people do not look back in 2031 and wonder what we have done.