Speaker: Gus Cairns
Rapporteur: Babs Evans, NAT
The first international conference about AIDS was a meeting in Atlanta in 1985 and only three Africans attended. The International AIDS Society (IAS) was founded at a conference in Stockholm in 1988 and organised annual conferences until 1994. After this they were held every two years. The number of people attending has increased in size to 19,000 in Bangkok and the conference cost $17m. IAS started organising scientific conferences in alternate years in 2001.
IV drug users are the one group in whom HIV did not decline in the 1990s. In Thailand half are living with HIV and 90% of these are co-infected with HCV. In Russia 90% of IV drug users are living with HIV. A temple sign in Thailand reads:
Whatever you die from is fine
but don’t come to us to be cremated
if you die from methamphetamines
There are increasing rates of transmission in the West. In Sydney rates increased by more than 50% from 1998 to 2002. 70% of men living with HIV in the US are gay and 50% are under 24. A survey from India showed that 24% of Indian gay men had never heard of condoms, 87% had unprotected sex and 50% had unprotected sex with a woman in the last three months.
The use of the word ‘gay’ was discussed at the conference. There are cultural differences and some countries use ‘MSM’ (men who have sex with men) as men do not always define themselves as ‘gay’ in all cultures. Some gay men are very isolated. In Beijing for example, a study showed that gay men are only ‘out’ to an average of two people.
WHO target for treating people living with HIV is 3 million by the end of 2005, about half of those who actually need treatment. 440,000 are now on treatment but the WHO target was 500,000 by June 2004. Treatment alone is unsustainable and 8m more people will be infected by the end of 2005. TreatAsia found 13 generic HIV medication manufacturers in India alone but there was only one specialist doctor per 9,000 patients living with HIV. There are serious gender issues too. Men are reluctant to get tested but once they are, they are more likely to receive treatment.
There weren’t very many important results at this conference. A study in Thailand of structured treatment interruption (one week taking it, one week not) showed that it didn’t work, however treatment interruptions which are guided by CD4 counts do. Trizivir has been very successful and is a simple drug regime, as is Kaletra (although it has yet to be shown whether it is as good as HAART). Boosted saquinavir has had the best ever HAART result.
Superinfection does happen but less often between steady partners (3 in 78 in the San Diego study). Testing has doubled in Botswana every year since 2002. There are huge variations across Europe in the use of PEP, which is often used for very small risks. PREP is about 80% effective. Microbicides are in development but it will be at least two years to phase III results. The first generation of vaccines will be in phase III next year until at least 2008. The third ‘wave’ of vaccines are just starting and may be due by 2019.
Bill Gates has given $50m to the Global Fund
The EU has given $50m more
US allocates $2.8bn but threatens not to pay unless other countries contribute twice as much again
"Everyone must help, not just Governments but private companies and individuals. Allow me to enjoy my retirement by showing you can rise to the challenge of defeating HIV"
Nelson Mandela, 86 on 18 July 2004, whose son died of AIDS in January 2005 but was still alive at the time of the conference in September 2004
HIV infection has not declined in IV drug users and is as high as 90% in some countries.
There are increasing rates of transmission in gay men in the West
In resource poor countries men living with HIV are more likely to receive treatment than women
56,000 people died of AIDS in between the closing date for Changing Tomorrow and the conference itself
Move on to Treatment Information Needs of People Living in London