More science and less inequality: the International AIDS Conference ends with a call for help | future planet

The 24th edition of the International AIDS Conference (AIDS 2022) closed this Tuesday in Montreal (Canada) with optimistic messages about the global fight against this endemic disease, but also with clear signs of concern based on the latest published data, which indicate setbacks from progress made in previous decades. One of lime and one of sand, a party and a complaint. So went the week in which it is considered the world’s largest event for the HIV community, an event held every two years under the auspices of International AIDS Society (IASociety).

The government of Canada, the host country, has refused visas to many participants and delegates, especially those from the Global South.

Even before its inauguration, the outgoing president of the conference, Adeeba Kamarulzaman, expressed loud and clear at a press conference the concern that has been on the minds of many lately: the risk that the world will get off track in the fight against HIV and not because there is no information or resources, but because what should be done is not being done. “We see time and time again that, whether in the context of HIV or COVID-19, too many public health decisions are based on politics and profit, rather than on scientific advances and the input of the most affected,” he said.

Not just because of the novel coronavirus pandemic, but because of the impact of russian invasion of ukrainethe truth is that the most recent data presentados por las Naciones Unidas no son muy esperanzadores: 1.5 million new infections and 650,000 dead in what has happened and año that has registered a slow progress since 2016. Also, we have encountered new cases in this case todas in the regions of the world.

Our goal was to focus minds on people’s needs and new scientific evidence. Policy and policies should be designed around these two pillars and in this order

Jean-Pierre Routy, co-president of AIDS 2022

The conference wanted to be a platform in which the international community renews the vows of its commitment to the global response against the virus, as clearly indicated by the slogan chosen for the event: “Re-engage and Follow the Science”. : get involved and follow the science, in Spanish. During these five days, brushes were given on the future research agenda, new prevention tools, improved treatments and possible steps towards the end of this still incurable immunological disease were presented. “In these highly polarized and politicized times, this message is incredibly important. Our goal this week was to focus minds on people’s needs and new scientific evidence. Politics and policies should be designed around these two pillars and in this order,” said Jean-Pierre Routy, co-chair of the conference, during the closing ceremony.

The visa controversy

It was not just AIDS that was discussed at a meeting that should serve this purpose, since the Government of Canada, the host country, has refused visas to many participants and delegates, particularly those from countries from the South, such as activist Tia Johnson, founder of the African HIV Prevention Alliance.

“I am deeply upset by the high number of visa denials and backlogs that have prevented many registered delegates, including IASocety staff and management, from entering Canada,” Kamarulzaman complained during of the opening ceremony, attributing the difficulties of the participants to a problem of “world inequality” and “systemic racism”.

Winnie Byanyima herself, director of the United Nations HIV Program (UNAIDS) denounced the obstacles she also encountered with a tweet: “I am at Geneva airport, at the departure gate , with boarding pass in hand en route to #unaids2022. I was almost denied boarding, with all the documents reviewed and reviewed, calls made… I boarded the last one. Hundreds of people in the South have been denied visas and will not participate. Unfair, racist! “, he wrote.

A step forward in prevention

The priority is to ensure that new advances quickly reach those who need them most, primarily in low- and middle-income countries, as well as key populations such as sex workers and injecting drug users. For this reason, one of the results that received the most attention was the new way to prevent the spread of HIV through the use of prior exposure prophylaxis (PrEP)).

Oral PrEP was first approved in the United States a decade ago, but its acceptance and uptake has been limited, in part, by the fact that some people have difficulty taking daily pills. In recent years, a pair of studies called HPT083 and HPT084 have shown that long-acting cabotegravir, or CAB-LA, given by injection once every two months, is a safe and effective alternative to oral PrEP. Within the framework of this congress, the conclusions of the two were presented, which analyze the effectiveness of CAB-LA, in cisgender men and in transgender women the first, and in women, the second. In all cases, the injectable version was more effective than the oral version and, in the case of trans women, it was also observed that the drug did not interfere with gender-affirming hormone therapy.

In an effort to generalize CAB-La, two new strategies were also announced at this conference. The first one, OK between ViiV, the pharmaceutical company that makes it, and the United Nations Medicines Patent Fund so that generics can be made and access to the medicine is affordable in 90 low- and middle-income countries around the world where disease burden is the highest. About this deal again there are big questions to answerbecause questions have been left hanging, such as what will happen to a large number of middle-income countries that have not been included, particularly in Latin America, where there are millions of people who could benefit from the drug.

The second announcement, from the WHO, was a CAB-LA recommendation as an additional HIV prevention option for people at high risk of contracting it, who represent 70% of people newly infected each year: building, men who have sex with men, injection drug users, prisoners, transgender people and their sexual partners.

New pathways to a possible cure for AIDS

In the field of advances aimed at curing AIDS, the cases of those known as the Barcelona patient and the London patient were also presented. The first is a woman from the Catalan capital who managed to live more than 15 years without a viral load and without taking antiretroviral treatment. The team that treated her case, led by doctors from the Hospital Clínic de Barcelona, ​​also discovered what cellular mechanisms made possible the functional healing of women.

Equally optimistic is the story of the so-called City of Hope patient, a 66-year-old man who was diagnosed with HIV in 1988. In 2019, he developed acute myeloid leukemia and received a stem cell transplant. from a donor who was naturally resistant to HIV. Thirty-nine months later, the man has no detectable HIV DNA in his body, so he appears to be cured. East This is the fourth known case. of remission in an individual who received a transplant, and its particularity is that the donor and the recipient were not perfectly matched, which indicates that this option could be available for more patients. “Although transplantation is not an option for most people living with HIV, these cases remain interesting and inspiring, and help to inform the search for a cure,” said Sharon Lewin, newly elected president of the IASocety and successor to Kamarulzaman.

Fourth known case of complete HIV remission in bone marrow transplant patient presented at conference

Another of the advances presented is a more effective way of treating HIV and hepatitis B patients, who represent 7% of the world’s population. The success of a new strategy for preventing sexually transmitted infections or STDs through the so-called Doxy PEP, which is short for doxycycline post-exposure prophylaxis. Doxycycline is a safe and widely used antibiotic, and research has shown that taking it within 72 hours of having sex without a condom reduces the risk of contracting three bacterial STDs: gonorrhea, chlamydia and syphilis. However, further research is still needed to better understand the potential impacts on antibiotic resistance.

Among the most positive news is Botswana’s success in complying with the UNAIDS 95-95-95 strategy, namely: that 95% of the population suffering from HIV is diagnosed; that 95% of them are on antiretroviral treatment and that 95% of them have no detectable viral load. Botswana has a very high prevalence – one in five adults are HIV positive – but the country has a number of strategies in place such as Test and Treat which provides immediate antiretroviral treatment to those who are HIV positive.

An alliance against childhood HIV

The Montreal meeting provided a platform to announce new agreements, such as the new Global Alliance to end HIV/AIDS in children by 2030, led by UNAIDS, Unicef ​​and WHO , and the governments of some of the most endemic countries. He is aided by the fact that only 52% of children living with HIV/AIDS receive treatment – ​​among adults, the global average is 76% – and his goal is that by the end of the decade , no minor with HIV/AIDS is deprived of treatment and that all are born without the virus. Among the most urgent action points are preventive, diagnostic and treatment care for pregnant and lactating women and adolescents, as well as ensuring comprehensive care for babies, children and adolescents who are HIV positive or who are exposed there.

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