Putting AIDS 2018 Into Perspective: Policy, Advocacy Implications

“Ok, so now what?” asked J. Stephen Morrison, PhD, senior vice president and director, Global Health Policy Center, Center for Strategic & International Studies. “On the one hand, we know we need to continue down the paths we’re taking, but the question is: what do we do differently today and [in] the next couple of years beyond all of the great things that are underway right now.”

Following the 2018 International AIDS Conference in Amsterdam, the Netherlands, Morrison and other experts in the HIV space convened in Washington, DC, to recap the meeting’s findings and discuss what they mean and what’s next.

Contrasting the excitement and optimism coming out of clinical research presented at the conference, there was a sobering takeaway in the political and advocacy sphere. “If you go back to the accounts of the conference and listen…there’s a certain consensus emerging, and it’s a new realism, a new consensus that is not an abandonment of hope and commitment, but it’s a recalibration of expectations,” said Morrison.

To read more on clinical news coming out of AIDS 2018, click here.

According to Morrison, there was a common acknowledgement that targets are not being met, there’s a widening deficit of political will and financial capacity, and there are daunting challenges in prevention. He also highlighted the 17 million people living with HIV who need to be reached and the stagnant new incidence rates stuck at 1.8 million.

While there has been remarkable progress in gaining hold of the epidemic and the threat of HIV has diminished significantly, this progress has formed a certain complacency that puts the globe at risk of a resurgent epidemic that is not understood at the level of political leadership, he warned.

Among the general consensus that we are in a fragile moment in time, there were several policies and advocacy efforts that made it to the forefront of the conference.

Mexico City Policy

The Mexico City Policy has a policy that took center stage at the AIDS conference. The US policy denies nongovernmental organizations from receiving US global assistance for the provision, counselling or referral for abortion, advocating to decriminalize abortion, or expand abortion services. In the last year, the policy has been expanded to include a majority of health assistance, including funding for HIV, under the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

This has implications for dalutregravir, which has been linked to neural tube defects affecting babies born to women with HIV who were taking the treatment at the time of conception or early in the pregnancy, explained Greg Millett, MPH, vice president and director, public policy, amfAR. However, he noted, it’s still too early to realize the policy's impact.

Community and Government Collaboration

One of the biggest takeaways from the conference was evidence of remarkable progress made in countries that implemented community and government collaboration. Ambassador Deborah L. Birx, the US Global AIDS Coordinator, highlighted data from Namibia. Two years ago, northern Namibia had a significant pandemic, with a 35% prevalence of HIV among women. In response, the government, the prime minister of health, and the community came together and came up with a plan.

“Yes, we had resources,” said Birx. “But, the magic secret sauce was the community and the government working together in a new way, where the government drove policy changes based on the community’s input to make these programs work.”

The result? The region went from a 40% viral suppression (VS) rate up to 70%, and the country as a whole now has a 77% VS rate. “You can’t do that in 2 years without those groups coming together,” said Birx.

MenStar

In communities around the globe, 50% of men age 20 to 35 do not know their HIV status, according to Birx. And because the first 5 to 10 years of HIV are asymptomatic, these men perceive themselves as healthy and don’t have a reason to interact with the health system.

Taking on the challenge, Sir Elton John and Price Harry, Duke of Sussex, launched the MenStar coalition, setting a focus on understanding what it takes to get men into the clinic before they’re sick. The coalition is leveraging over $1.2 billion in initial funding from its partners, including PEPFAR, the Elton John AIDS Foundation, the Global Fund to Fight AIDS, Johnson & Johnson, and Gilead.

Lancet Commission

Also at the forefront of the conference, the International AIDS Society (IAS) Lancet Commission released a report that painted a grim picture for the future of HIV response and outcomes.

“We wanted to take a big picture look at where we were in the response and thinking about reaching the next 17 million people living with the virus who are not being treated and thinking about these issues around key populations that we’re not reaching,” said, cochair of the Commission Chris Beyrer, MD, John Hopkins Bloomberg School of Public Health, and past president of the International AIDS Society.

He highlighted key takeaways from the report, which mirrored warnings from Morrison, including that we are not done with HIV/AIDS, it’s too early to call victory, and the risk of a resurgent epidemic are real. Beyrer added that there are a potential number of wins if we can do better with engaging in an evidence-based, step-wise fashion with other areas of health, most notably HIV and tuberculosis. He referenced progress made in South Africa and Kenya as a result of integration with noncommunicable diseases, such as hypertension and diabetes.