Save the Children Voices from the Field

Recapping The 19th International AIDS Conference

Carl Henn, Senior Director of Child Protection and HIV & AIDS

July 28, 2012

Washington, DC

The 19^th International AIDS Conference (or “IAC”) ended on Friday, after a closing speech by President Bill Clinton. That brought to a close a week in which almost 25,000 participants attended daily “plenary” speeches in a huge hall, plus hundreds of smaller talks and presentations, and saw thousands of posters on aspects of HIV prevention, care, and treatment, from almost every angle imaginable.

The participants at IAC included people most Americans might expect would work on this issue, such as doctors, nurses, and scientists, as well as politicians, program planners, donor agencies, and celebrities, who visited thousands of AIDS displays by all types, and even enjoyed musical and dance performances. People came from 90 countries around the world, and from all aspects of American society as well.

The participants also involveda very large number of AIDS activists, including “LGTB”, or Lesbian, Gay, Bisexual, and Transgender people, who play a prominent part in HIV/AIDS meetings and activities. Also present were commercial sex workers and intravenous drug users, who are at high risk for HIV/AIDS. In the exhibition halls were drug companies who are often the targets of protests by many AIDS activists.

For me, personally, I met a large number of colleagues who work on HIV/AIDS, as well as some of their kids, who came to volunteer, and even a former US Ambassador and his wife who volunteered at IAC. I also met workers at the convention center, African Americans from Washington, DC, where there is a mini-AIDS epidemic. We talked about the need for HIV testing, to learn their status and to be HIV-free.

So it was a very diverse cross-section of people, and also an amazing learning environment for a week. How can we convey to you even a brief sense of what the meeting was about, and what we learned? Let’s take a look at some of the headlines and the people that made them (or at least presented them).

MEANING

What does HIV/AIDS mean to America, Americans, and people from other parts of the world? It’s hard to summarize. What do most of us know about HIV/AIDS? That there is a virus (HIV) that destroys the immune system, leading to AIDS. There is still no vaccine, and no cure. For now, we prevent, provide care for, and treat it. There are 8 million people on treatment, called “ART,” and 7 million who need it.

MONEY

Money is a big part of every discussion about HIV/AIDS. The cost of 8 million people on treatment, and everything else that is being done, is a huge figure, about $17 billion per year. But estimates of the total needed range another $7 billion per year, for a total of $24 billion, in order to “turn the tide” on AIDS.

MEDICINE

What do “we” (meaning, Americans, the world, people infected with HIV (or PLHIV), and also children orphaned by AIDS) get for $17 billion a year? We get a range of drugs that PLHIV, including babies born with HIV, have to take every day for the rest of their life, in order to protect their immune systems. We get a vast array of programs to prevent HIV infection, and to care for and support those affected by it.

MORALITY

There are always discussions about morality when we talk about HIV/AIDS, including everything from the most conservative faith-based groups that oppose condom promotion, and condemn homosexual behavior, to the churches and congregants who visit PLHIV in their homes and provide hospice care. Sometimes the same churches operate on “both sides” of HIV/AIDS, showing compassion for PLHIV.

MORTALITY

Death is always a main topic at AIDS meetings. Without access to life-prolonging treatment, PLHIV will eventually progress from asymptomatic, to symptomatic, to “full-blown” AIDS. We’ve all seen images of what AIDS does to its victims – the weak, gaunt figures, who in the past were often cast out of societies. The good news at this IAC is that far more PLHIV receive ART, so far fewer people are dying now of AIDS. Stigma (discrimination against PLHIV) is decreasing in Africa, but still persists in some parts of the world.

MOMS – AND KIDS

Women and kids were a big topic at the IAC, and they should be. HIV prevention and ART for moms protects them and their babies from infection with HIV. There is huge progress on getting adults on ART, but less in getting babies and kids onto ART early enough to save their lives. So, more needs to be done. Along with ART for moms and babies, the world needs to care for and support millions of AIDS orphans. Imagine the sheer numbers of AIDS orphans – estimatedat17 million – and imagine what their life would be like without our support. Imagine what life would be for your kids if they became orphans.

XIX International AIDS Conference - Day 2

Scott McGill, Senior Advisor, HIV/AIDS

Washington, DC

July 24, 2012

Every two years experts, governments, activists, and affected community representatives meet to take stock of the global AIDS response – these conferences are often known for particular breakthroughs or for global commitments and other landmarks.  The 2012 International AIDS Conference will be known as the meeting that ambitiously committed to ‘The Beginning of the End of AIDS!’

Over the past two years, a consensus has developed that anti-retroviral treatment (known as “ART”) is also a prevention strategy. New technologies show promising results. These include using HIV treatment drugs with higher risk individuals to prevent the spread of HIV infection. While these are exciting innovations, we also need to scale up other prevention strategies, and combine those with other medical approaches to achieve the greatest impact on slowing and ultimately reversing this epidemic.

Even if a vaccine or cure for HIV infections is found tomorrow, there is still the need for prevention as well as strengthening of healthcare systems.

Save the Children has prioritized prevention of HIV transmission among youth, especially those who are vulnerable or most-at-risk for HIV transmission. 

At the conference workshop “Leading the Way in Asia – Mapping, Mobilizing and Building Capacity in Young Key Affected Populations” we took part in discussions led by youth with many stakeholders and partners which resulted in a consensus on a number of important issues:

• More information is needed to identify the youth most affected by HIV & AIDS
• Policies and laws need to support HIV programming and not block them
• Services need to be youth friendly
• The meaningful engagement of young people is critical in developing the next generation of young leaders for the AIDS response and beyond.

Two young delegates from the Philippines, Jeffry and Philip, said, “young people also need to be seen as more than HIV risks – they need other support and services that would help them avoid being in situations which make them more vulnerable including safe housing, education, other health and support services, legal protection and opportunities to make a living and contribute to their communities’.

Over the last two days Save the Children has been involved in many activities – including presentations on the challenges and legal barriers in providing prevention services to those selling sex in Bangladesh, Vietnam and Papua New Guinea, and school based programs for children and youth in Georgia.

There are a number of questions and challenges posed to us as a child-focused agency – how do new technologies and innovations fit in our approaches? How do we address the multiple needs of younger key affected populations beyond solely their HIV risks and address the factors that make them more vulnerable?  How do we not lose focus on the behavioral and social issues? How can we better understand and access those youth who are hidden, ignored, and misunderstood?

XIX International AIDS Conference - Day 1

Ronnie Lovich (Senior Advisor HIV/AIDS) and Alice Fay

Washington DC

July 23, 2012

We come together at the 2012 International AIDS Conference with 20,000 colleagues, implementers, activists, ready to listen, and share our experiences of what works. As we gather for this week of meetings, we eagerly await news of scientific advances, global successes, and evidence of best practice and effective response. We also need to keep the fire that moves so many to respond to the HIV and AIDS pandemic burning. On this first day, we have not been disappointed.

After 30 years of responding, we can now look at ‘hyper-endemic’ countries such as Zambia and for the first time say that we have more people being treated than being diagnosed with new infections. And it is possible to say that adhering to treatment could possibly mean living a long life. But we have a new conviction and a new way of looking at treatment – treatment must be viewed as prevention.

Nowhere is this truer than in the case of ending parent to child transmission. The faster we can get a mother on treatment, the sooner we can reduce the risk of ransmission to her baby.

Some compelling facts:

• In 2011, 330,000 children were born with HIV; a decade ago that number was 600,000. Now to prevent mother to child transmission there is “Option B+” which provides full treatment during pregnancy and continues for life. We have an unprecedented opportunity with the new B+ therapy, which is simple and can be started in the antenatal clinic setting, and demonstrates that the best treatment is prevention.
• Under the Global Plan to end pediatric AIDS, a goal has been set for reducing transmission to , and treatment rates of 90% to keep mothers alive. However, as a number of our colleagues have illustrated, preventing mother to child transmission is a cascade of services….but the cascade can be imperfect. We may start off with good antenatal coverage but few receive the continued support they need. At each step ofintervention, we lose more women and their infants, and too few infants are tested soon enough. 

There is another missing piece that requires our attention. The majority of youth who are living with HIV do not yet know their HIV status. There has been a lot said about adolescent sexual and reproductive health, and the need to take into account the needs of younger people, who are so often excluded from adult programs including preventing mother to child transmission. We met a young Ugandan woman living with HIV; she gets her Anti RetroviralTreatment and other HIV related services from a clinic for people over 15. She said that since the clinic has opened, people her age feel much more comfortable accessing services. She also expressed her frustration that there is little
representation of the voices of young people living with HIV.

Which is why sharing our exhibition space with our young colleagues from YouthLead is so special. These inspiring individuals will be able to share their experiences living with HIV, their strategies for
addressing the stigma and helping others as peer educators.

More to come tomorrow…