Highlights from AIDS 2012

The number of presentations, posters and information at AIDS 2012 is just overwhelming. With that said, I will highlight five major themes or findings from the conference and related meetings:

1. Treatment as Prevention (TAP) has received a lot of attention here, with the hope that such an intervention could reduce incidence substantially or even end the epidemic. New modeling demonstrates that TAP is very expensive, not as efficacious as previously thought, and maybe most importantly, that other interventions (namely increasing HAART coverage and male circumcision) could be as effective as a TAP regime at a fraction of the cost. More forthcoming.
2. Findings from Robert Bailey and Betrand Auvert re-enforced the efficacy of male circumcision, but it is disappointing that demand creation or behavioral science has not been discussed. Again the key question is why men are not going to be circumcised in the numbers necessary to have a substantial effect on the epidemic. The Bill & Melinda Gates Foundation has announced an effort to study this vital issue. 
3. The question of the treatment mortgage--the seeming endless financial commitment of the United States to millions of people on HAART who are not their citizens--has been discussed. Indeed, the US has plans in 13 countries to move treatment services to the host country governments or NGOs, but the re-assurance that PEPFAR will not cut and run did not curb any of the fears of delegates from recipient countries. One delegate on HAART from Nigeria said that currently 95 percent of all treatment costs are externally funded; how will such a transition occur?
4. There were two sessions on Human Resources for Health (HRH), which was refreshing to see. My takeaway message from Ambassador Goosby was simply that PEPFAR is doing a lot in HRH, but the crisis will not be solved until recipient countries spend more own source resources on health. Not only is this the right message, I wish he actually was more explicit about it. More forthcoming.
5. If South Africa coughs, its neighbors catch TB, or worse, MDR-TB. Coupled with high HIV prevalence, this combination destroys families and communities around the region.  The issue of TB and mines was brought front-and-center, as the Ministers of Health of Lesotho and Swaziland spoke about the urgent need for regional action.  (Brian Brink, chief medical officer for Anglo-American, sat quietly in the audience and left after the Ministers spoke.) More forthcoming.