July 23, 2010 (Vienna, Austria) — A goal of 0 new infections and 0 AIDS deaths by 2015 was set at an interactive town hall meeting organized by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the International AIDS Society, where speakers and meeting delegates shared ideas to help reshape the response to AIDS to achieve universal access to HIV prevention, treatment, care, and support for all in need. An underlying tenet of the discussion was that any efforts must respect human rights and that all governments must respect the human rights of people with HIV/AIDS.
The town hall meeting, entitled Towards a Paradigm Shift in HIV Treatment and Prevention, was held prior to the AIDS 2010: XVIII International AIDS Conference and enlisted a distinguish panel of speakers.
South Africa Pledges Strong Response to Fighting HIV Epidemic
South African Deputy President Kgalema Motlanthe committed his country to vigorously fight South Africa's HIV epidemic. Efforts have led to a drop in infections among the young for the first time, he said. "Patients started on treatment need to be maintained on treatment, even though we are going through an economic recession, because we believe that investing in HIV is investing in development," he said, "and South Africa has prioritized the AIDS response as an investment in life, hope, health systems, and human development with a view to improve the quality of life."
To "break the trajectory of the AIDS epidemic," South Africa has embarked on a very public campaign of testing and counseling for HIV, as well as for tuberculosis, diabetes, and cholesterol, Mr. Motlanthe said. "It is important for all of our people to know their [HIV] status."
South Africa has made a priority of mother-to-child HIV transmission, and the country is promoting medical male circumcision, which has been shown to reduce the risk for HIV transmission by 60%. "That has to be reintroduced" after being discontinued for more than 200 years in some areas, even if it means going against tradition, Mr. Motlanthe said. Traditional leaders have been brought on board to communicate this message.
Law is another area of reform in the South African response to HIV. "We are putting human rights and law to work for HIV [control] because we believe we cannot achieve a prevention revolution, or effective responses in general, without the protection and promotion of the rights of vulnerable groups, including people living with HIV, sex workers, men who have sex with men, [injection drug users], transgender people, women and girls, and prisoners," Mr. Motlanthe stated.
"Bringing culturally contentious issues, such as circumcision, injection drug use, and men who have sex with men, to the fore of public dialogue provides the impetus to shift social norms in support of more effective responses, because it frees people from being prisoners to prejudice," he said. South African President Jacob Zuma has openly supported these efforts.
Barbara Lee, a United States congresswoman from the 9th District of California, said that "it's important for leaders to get tested publicly" to show support for testing policies and to show that they, too, are willing to do it publicly and without embarrassment.
Mr. Motlanthe warned that programs on health must not be cut back under any circumstances, lest the gains that have been made be lost. "If we fail, we would be failing future generations, since it is our generation that is in the eye of this pandemic," he said.
Key Element in Fight Is Respect for Human Rights
Session moderator James Chau, news anchor for China Central Television and UNAIDS Goodwill Ambassador for China, asked Mphu Ramatlapeng, MD, minister of health and social welfare of Lesotho, her view of human rights. She responded by saying that "it means government has to have programs that protect the voiceless, the weak, the ill; in this particular respect, it means that we should have in place programs that will protect unborn children and women . . . programs that are accessible to all people."
She said she could be accused of "contravening civil rights because, honestly, I will have every pregnant woman tested. I'll have every child who is born tested in Lesotho." She said HIV is a national emergency: "If it means I'm accused of civil rights [violation], so be it. That's what I mean by human rights."
Congresswoman Lee added that "the struggle for human rights means providing equal access to everyone, including as it relates to healthcare, HIV, and AIDS, for the [men who have sex with men] community, for the [lesbian, gay, bisexual, transgender] community, for women who are commercial sex workers, for injection drug users, for women, for children, for everyone who has been shut out, for the most vulnerable."
An animated Mr. Chau asked the audience members to vote on issues and respond to questions by holding up a red or green card indicating their positions. Although low-tech, this audience-response system worked well, and the level of consensus was evident just by looking at the predominant color in the sea of cards.
When he asked whether human rights is the most important issue to be addressed, he estimated that about 80% of the audience held up green cards, indicating a "yes" vote. He then rushed into the audience to probe the reasoning behind people's answers. One "red card" respondent said that although he believes people should have a right to universal access to health services, he disagreed with mandatory testing and said people should have free choice whether to get tested.
Dr. Ramatlapeng emphasized to Medscape Medical News that although her position of universal mandatory testing could be seen as contravening civil rights, she does not see that it would violate human rights. She said she believes her role as minister of health is "to protect the voiceless, unborn children, and women who don't have enough information." Therefore, she said she will offer HIV testing as part of the battery of tests that pregnant women get but not require it if a woman declines. In any case, she said the newborn will be tested. "I have yet to meet a single mother who says 'I'm unhappy that I was tested, and I'm unhappy that my child has been looked after'."
Lesotho has been devastated by HIV and AIDS, Dr. Ramatlapeng explained. The government Web site reports that 31% of the population is HIV-positive. Life expectancy now is 45 years for men and 54.2 years for women, down from more than 60 years just 10 years ago. In a current population of 1.88 million (down from 2.1 million in 2001), there are 120,000 orphans, many of whom are looking after their siblings, she noted.
But she has confidence that Lesotho's program of testing, treatment, and counseling (even for seronegative individuals) is working. She said the incidence of HIV is already decreasing in people 15 to 25 years of age.
Better Access to Treatment Is Needed
Rolake Odetoyinbo, executive director of Positive Action for Treatment Access in Lagos, Nigeria, emphasized that "treatment is nonnegotiable." Adults must have access to treatment so that they can "stay alive to take care of our children," she said. "We do not want to become vehicles for HIV-negative orphans." She urged that infections in women and girls be addressed and that access to testing services for all pregnant women be provided.
Julio Montaner, MD, president of the International AIDS Society and chair of the AIDS 2010 Conference, did not recommend treating all infected individuals, but said that all who need treatment should be able to receive it. He said it would benefit the individuals and have a secondary effect in society by helping to prevent transmission of HIV. "Remember, it's not just preventing HIV. It's also preventing tuberculosis, putting people [back] to work, and consolidating families," he said.
Michel Sidibé, executive director of UNAIDS, stressed that in terms of funding prevention, screening, and treatment efforts, "it's not time to scale down. It's time to scale up." He urged full funding of the Global Fund to Fight AIDS, Tuberculosis, and Malaria by donor nations that pledged resources but have not committed them.
At a news conference at the AIDS meeting, Michel Kazatchkine, MD, executive director of the Global Fund, said that drugs for HIV treatment in Africa can be obtained for $120 per year per patient, and the total cost to treat 1 person is $460 per year.
Mr. Sidibé discussed Treatment 2.0, a simplified treatment platform that can be initiated in AIDS treatment centers and continued in primary care clinics. He and Dr. Kazatchkine linked treatment and prevention, because by treating HIV-infected individuals, new infections can be reduced.
The town hall meeting concluded with an appearance by Annie Lennox, singer, songwriter, long-time AIDS activist, and International UNAIDS Goodwill Ambassador, who concluded the session by asking the leaders and activists on the program and the delegates in the audience to recommit their efforts and to take them further.
AIDS 2010: XVIII International AIDS Conference: XVIII International AIDS Conference. Presented July 18, 2010
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