Conference delegate blog

Each day Genevieve Edwards, THT's Director of Communications, wrote a conference blog from Vienna giving a personal perspective of the people, goings-on and events that took place at the International AIDS Conference.

Friday 23 July

Men who have sex with men (MSM) are disproportionally affected by HIV. Gay men are by far the most at risk group for HIV transmission in the UK. 

In low and middle-income countries, MSM are 19 times more likely to be infected with HIV than the general population.

I wonder why, then, less than 6% of the World AIDS Conference programme focusses on the needs of MSM?

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As a banner in the conference Global Village points out, AIDS is not in recession. Unfortunately, the countries funding the response to the pandemic are, and this is a worry.

As I write, yet another demonstration is progressing noisily through the conference. Their slogans might differ, but the message is broadly the same: 'Don't cut funding for our drugs/services/initiatives.'

The global recession threatens our reponse to HIV in two ways. Firstly, it's restricting countries' abilities to respond to their domestic epidemics in the way they might have done in wealthier times. 

When deciding priorities for limited funds, government departments often swing the axe where there will be least public resistiance. This never bodes well for unpopular issues, and HIV is down there with the best of them. 

So it's our job to make sure vulnerable people with HIV in the UK don't have the services they rely on cut from under their feet as we struggle to balance the books.

Decisions about where to cut are rarely taken in the round either, so one department may cut funding which makes another's job impossible. It's one of the reasons UNAIDS asks every country to have a cross-government HIV Plan.

We don't have one in the UK, nor is there a realistic likelihood of one any time soon. We're too busy tackling the deficit.

So though the UK had a strong start on HIV back in the 80s, we could so easily lose critical ground by cutting vital services or health promotion initiatives. 

Canada is the salutary lesson here - they defunded needle exchanges when they wanted to save money and their epidemic rocketed. Their cost-saving cost them dear.

Secondly, the global recession means donor countries have less money for efforts to tackle the pandemic in lower and middle-income countries. This could also be very bad news.

What will happen to the many thousands of people whose HIV drugs and services rely on fragile economies outside their borders?

We've spent recent years scaling up access to HIV treatment worldwide. Imagine living in a village or town where friends and family had just stopped dying - could we really turn off the supply? 'Sorry, this machine is temporarily out of order,' won't cut it I suspect.

So there are two things we must do to make sure we don't lose ground we've worked so hard to gain:

1. Find cheaper and easier ways of testing and treating people for HIV. This means you, wherever you live in the world. If you're stuck for ideas, ask your local community or voluntary organisation.  I bet they'll tell you how.
2. Find new ways of raising global and local funds to support vital work.  I have heard several very good ones here in Vienna.

It isn't all doom and economic gloom. This week in Vienna has been a dazzling exposition of how far we've come, how much we've learned, what we must do next. 

Money has never been more important.  It's not 'the economy, stupid', it's how we deal with it.

Thursday 22 July

I've just seen research presented which put me strongly in mind of the HSBC adverts you see in airports.

What works in one place might not work in another, or may mean something else entirely to different people.

So when people talk about combination prevention for HIV, they don't mean: 'Do everything you can', they mean: 'Figure out what works locally and concentrate on that.' I think. 

So here are some of the findings of research into risk factors for sexual transmission of HIV presented today. The question is, would it work here?

• Can HIV treatment prevent one heterosexual partner passing it to another?

Several studies have show that if the HIV positive parter in a couple is consistent with their HIV treatment, the risk of transmission to the negative partner may be low. But research in China presented today shows no difference at all in transmission rates between couples on treatment and those who are not. They don't know why, but suggest that sub-optimal treatment could be to blame, or a resistant strain of HIV. But whatever the reason, it will give pause for thought to those who are hoping treatment can stop HIV transmission.

• Do concurrent relationships fuel HIV epidemics?

The theory goes that long-term overlapping relationships are more common in Africa, and are more common than other sexual behaviours, and this, say researchers, explains the much higher rates of HIV in sub-Saharan Africa. But a review of the studies presented today reveals flaws in data or analysis, and guess-work and assumptions about behaviour. Some studies have estimated that concurrence could be responsible for a 1000% increase in HIV transmission in five years. But the model presented today suggests that at worst, we'd see a 26% increase over a century. So how to explain the 10-50 times greater prevalence in sub-Saharan African epidemics?  They didn't say. 

• Can circumcision reduce HIV infection among insertive men who have sex with men in Britain?

Observational studies have shown that male circumcision reduces HIV transmission in heterosexual African men by 60%. So, could the same results apply to men who have sex with men (MSM) in the UK? Researchers studied almost 12,000 white British MSM in 2007-08. Almost 5,000 had unprotected anal intercourse and one third were only or mostly insertive. Well, the short answer to the question is: 'No.' HIV prevalence was 12% for both circumcised and uncircumcised men. And among only or mostly insertive men, prevalence was 6.7% and 6.3% respectively. So circumcision is unlikely to reduce transmission among insertive MSM in the Britain. Sadly, this one won't work here.

Wednesday 21 July

HIV is getting old...

The good news is that thanks to huge improvements in treatments, people with HIV are living into old age. The bad news, as we heard today, is that they're getting older faster, they're likely to be poorer and there are few services geared up to help them.

THT's new research on ageing and HIV, presented in a powerful session here today, is available on this website here and I'd recommend you have a look at it. It should be required reading for anyone providing or commissioning health and social care services or writing policy.

We now know that people with HIV in the UK can live into their 70s with proper treatment and care  But, older people living with HIV are likely to have worse health than their peers, and are less likely to be able to work or have savings or pensions. 

Dr Margaret Hoffman-Terry spoke of a welder in tears because he couldn't work - arthritis, osteoporosis, spinal stenosis and diabetes saw to that.

Lisa Power from THT quoted a survey respondent who said: 'Somehow the category "financial difficulty" doesn't begin to address the unending stress of permanent financial anxiety.'

Older people said - and this is surprising - that disclosing HIV status socially was mostly OK. But they often had problems disclosing their HIV in health and social care settings where you'd imagine people might know better. 

An 80-year-old woman with HIV couldn't get a home help to come into her home, and residential care services are a common anxiety for gay men. She said: 'The thought of ending up in a straight residential nursing home fills me with dread. It would be like going back into the closet and having to deal with HIV on top of it.'

So, we have some way to go.

The research was UK-wide, and was presented with similar research from the US and several African countries. The findings have resonated with delegates from all over the world, and prompted several national HIV organisations to commit to carrying out their own research when they get home. 

It is clear here that for older people with HIV, this focus on issues which are so affecting their quality of life is long overdue. 

One delegate summed up the views of an often-over looked, yet fast-growing group of people with HIV: 'I'm a 54-year-old man living with HIV for 23 years and this was the best session I've been to all week. Most people just don't have a clue. You do, and you know what to do about it. Thank you.'

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Current policies on illicit drug use cause more harm than good, goes the argument here at the conference. HIV epidemics in many countries have been fuelled by the criminalisation of people who use illegal drugs say experts, and by the lack of sterile needles and opiod substitution treatments.

In some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia, HIV prevalence can be as high as 70% among people who inject drugs.

Authors of the Vienna Declaraton point to evidence that drug law enforcement has failed to achieve its objectives in part due to falling drug prices and increasing drug purity. They believe it's time to re-frame drugs policies based on scientific evidence, rather than populist beliefs.

Injecting drug use is a big theme here. The Lancet presented a series of papers on HIV in people who use drugs and called for 'inappropriately aggressive, state-sponsored hostility to drug users [to be] replaced by enlightened, scientifically-driven attitudes and more equitable societal responses'.

The very fact that we're here, in Vienna, is a symbolic bridge between east and western Europe. HIV is rife among drug users in many parts of Eastern Europe, but in the UK the numbers are low and stable thanks to the funding of needle exhanges since the early days of the epidemic.

Yesterday, delegates from Canada trashed the Canadian government's stand in the exhibition hall in protest at the withdrawal of needle exchanges. Canada has had, like the UK, very low numbers of injecting drug users with HIV. Since the needle exchanges went, their HIV epidemic has gone through the roof at a time when they can least afford it.

It's a salutary lesson that saving a few bob now can end up costing a fortune later.  I do hope George Osborne has noticed.

Artist Daniel Goldstein created this work from 800 syringes especially for AIDS 2010

Tuesday 20 July

Microbicide trial offers hope to women

News of a microbicide gel that can reduce HIV infections has caused understandable excitement here in Vienna.  The Caprisa 004 trial showed a 50% reduction in infections among women using the gel for one year, and a 39% reduction over two and a half years.

For the first time in almost 20 years of research, we have a vaginal gel in development that offers some protection from HIV to women, and this will be of particular importance to women in countries with high HIV rates and whose partners refuse to use a condom.

The gel is safe, fairly easy to use and, crucially, low cost.Women used it once in the 12 hours before sex and again in the 12 hours after sex.

So it's an important development, but we need to know more. Why does its efficacy reduce significantly over time?

Researchers here suggest that women taking part in the study became less consistent in how they used the gel as time went on, partly because they didn't know if it was working.

And if it's 50% effective at best, it's going to struggle with repeated exposure to HIV over time.

The results will need to be replicated in a much larger trial before plans to make the gel available can be considered.

In the meantimme, Dr Karim, from the University of KwaZulu-Natal in Durban, summed up the mood here. "Boy, have we been doing the happy dance."

Further information is here: www.aids2010.org

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