AIDS 2018: Finding ways to break barriers and build bridges to improve HIV prevention, care, and treatment

Bill Clinton
SHARE staff

Dinah de Riquet-BonsAttendees’ diverse backgrounds and experiences provided a unique opportunity for the growth of everyone at AIDS 2018. The platform not only gave advocates the resources and evidence-based knowledge necessary to help in the fight for human rights, but also provided researchers and policymakers with more context on the realities faced by the people directly impacted by their important work.  HIV-positive and other marginalized persons need to be included in the dialogue at all levels of the fight against HIV, which was a key component of this year’s conference theme: Breaking Barriers, Building Bridges. Building bridges links one voice to another, making sure the most affected voices are heard, as emphasized by Dinah de Riquet-Bons, an advocate and transgender woman of color speaking at the AIDS 2018 opening ceremony. “To those in positions of power, build bridges to those who are silenced by society,” she urged. 

People infected and affected by HIV face multiple, far-reaching barriers every day – from structural barriers affecting their access to services and care, to societal and scientific barriers keeping them from enjoying healthy, safe, and full lives.

One approach which seems to offer a viable solution to overcoming at least some of these barriers is the application of universal test and treat (UTT). “Two large studies of community-based universal test and treat campaigns to promote HIV diagnosis, treatment and prevention show that the campaigns achieved very high rates of HIV diagnosis and viral suppression, as well as reductions in HIV incidence on some measures,” reported Keith Alcorn for aidsmap, presenting findings from the SEARCH study in Uganda and Kenya and the Ya Tse study in Botswana. In another article which explores the findings from the MaxART study, Alcorn describes how people who started HIV treatment in Swaziland under a universal test and treat policy were seven times more likely to still be in care and to have a fully suppressed viral load six months after starting treatment when compared to management of patients under the existing standard of care.

A significant barrier still to be overcome, and one that garnered an enormous amount of attention at this year’s conference, is that of legal barriers, particularly for key populations such as sex workers. The release of the Expert consensus statement on the science of HIV in the context of criminal law, timed to coincide with the conference, really put a spotlight on the issue. Developed by 20 scientists from regions across the world, the Statement addresses the use of HIV science by the criminal justice system. “The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions,” the Statement says. “The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.”

Bill ClintonReceiving less attention this year as a barrier, but one that is no less critical, is the prevalence of co-infection with tuberculosis (TB) among those living with HIV. This issue was placed firmly on the agenda on the final day of the conference by former US President Bill Clinton in his keynote address. "This conference should remind people that TB is still the largest killer of people with HIV. For all of the progress we’ve made to increase screening, treatment and prevention and deal with other advanced complications with HIV... we’re going to have to keep working to get new TB drugs as well."

Barriers faced by adolescent girls and young women were, rightly, given due attention throughout the five days of the conference. In addition, there was a new emphasis on something not usually addressed in detail - barriers faced by men. On Tuesday, Sir Elton John and the Duke of Sussex announced a ground-breaking new global coalition focused on intensifying HIV services to men – the MenStar Coalition.

It’s difficult to try to summarize all the key discussions, decisions, research findings and connections made at this ground-breaking conference. As we travel back to our homes and workplaces across the globe to continue the fight against HIV, we should consider this conference another milestone where we pause to assess our progress, celebrate our achievements, and renew our commitment. We should also continue to learn from the conference: the AIDS 2018 website includes video recordings of the plenaries, press conferences and special sessions, as well as many of the session presentations. Let’s continue to work together to break barriers and build bridges, ensuring that all those in need of treatment and care receive it and we ultimately end the HIV epidemic globally.  

Images: 22nd International AIDS Conference (AIDS 2018) Amsterdam, Netherlands. Copyright: Matthijs Immink/IAS

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