Fourteen years ago, tiny, emaciated 11-year-old Nkosi Johnson addressed the international AIDS conference in Durban and appealed to President Thabo Mbeki to give pregnant HIV positive women antiretroviral (ARV) medicine to protect their babies from HIV.

Last week, the International AIDS Society (IAS) announced in Melbourne that the biennial conference would return to Durban in 2016. But this time, the circumstances in the country are significantly different.

Last year, only around 7 600 babies were infected with HIV by their mothers, in comparison to 56 000 babies in 2003.

In the past 14 years, South Africa has made impressive progress against HIV, particularly in preventing mothers from infecting their babies, as Johnson was. The transmission rate from mothers to babies is now less than 3 percent (down from approximately 12 percent).

“The rollout of antiretroviral therapy, surely one of the greatest human achievements in recent memory, has saved an estimated nine million life years in sub-Saharan Africa,” Professor Olive Shisana, who will co-host the 2016 conference, said at the close of the Melbourne conference.

“Some 56 percent of eligible people on the continent were receiving ART in 2011, higher than the global average of 54 percent,” added Shisana, who hoped that bringing the AIDS conference back to Durban would “reinvigorate the HIV/AIDS response in Africa”.

Key populations remain focus of international HIV response 

[quote float=”right”]“We should all be deeply concerned about the anti-gay laws and policies being enacted in Russia, India, Nigeria, Uganda…”

Melbourne was not a great choice for this year’s AIDS conference, as the HIV rate is negligible in Australia and it was very costly for delegates to travel all that way. But what did emerge from Melbourne was that a “once-size-fits-all” approach to HIV does not work. Instead, there was widespread consensus that unless HIV in “key populations” is addressed, “a sustainable response to HIV will not be achieved”.

These “key populations” were identified by the World Health Organisation (WHO) as “men who have sex with men (MSM), people who inject drugs, people in prisons and other closed settings, sex workers and transgender people”.

Discrimination against these groups means that many don’t get healthcare, which enables HIV to flourish – and pose a danger to the wider community.

Addressing men who have sex with men is particularly challenging in Africa, where same-sex relationships are illegal in 37 countries. The criminalisation of homosexuality was a huge concern in Melbourne.

Ifeanyi Orazulike of the International Center for Advocacy on Rights to Health (ICARH) told the conference that the criminalisation of homosexuality in Nigeria this year had resulted in a dramatic drop in MSM seeking health services.

Meanwhile, a Thai study of MSM showed that 45 percent of young Bangkok men who used condoms intermittently were at risk of getting HIV within five years.

The WHO recommends that “countries work towards implementing and enforcing anti-discrimination and protective laws and health services are available, accessible and acceptable to men who have sex with men”.

The new IAS president, Dr Chris Beyrer from Johns Hopkins University in the US, said he was dedicated to ensuring that all “key populations” had access to health services.

“We should all be deeply concerned about the anti-gay laws and policies being enacted in Russia, India, Nigeria, Uganda, and now being actively debated in many more countries. Not only because they so restrict basic human rights and freedoms, but because these laws threaten the entire AIDS response,” said Beyrer.

“I am the first openly gay person to lead the IAS, and as a man who buried too many friends and lovers before we had effective treatment, let me pledge that inclusion for all who need and want HIV services will be a fundamental focus of my leadership,” said Beyrer.

On Friday, Uganda’s Constitutional Court overturned a Ugandan law that called for a 14-year jail term or life sentence for those convicted of  ‘aggravated homosexuality’. Challenged by 10 petitioners including civil society, parliamentarians and academics, the law was annulled by the court over a lack of quorum when the bill was passed.

Meanwhile, Shisana – who will be the first African woman to chair the international AIDS conference – stressed that “the past three decades of HIV/AIDS has taught us that the disease doesn’t discriminate but that people and governments do”.

“A renewed engagement with decision makers across the continent on the issue of human rights will be unavoidable if we are to move towards ending AIDS in sub-Saharan Africa and build on the huge gains that we’ve made over the past 15 years,” she added.

New “90/90/90 target” set for 2020

[quote float=”right”]“The past three decades of HIV/AIDS has taught us that the disease doesn’t discriminate but that people and governments do”

Determined to accelerate the pace of progress against HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) released a discussion paper on the eve of the conference proposing a “90/90/90 target” by 2020. This target aims to ensure that 90% of all people living with HIV will know their status; 90 percent of those who need it, will be on treatment and 90 percent of these will have undetectable viral loads (a measure of HIV in their system, which proves that the ARVs are working).

Although less than four out of 10 people worldwide who need ARVs are getting them at present, UNAIDS believes this target is possible and necessary to eradicate HIV.

Cuba has already tested 90 percent of its population, while Brazil and Rwanda have tested 80 percent, and over two-thirds of those in Ethiopia and Malawi know their HIV status, according to UNAIDS.

But testing is far easier than effective treatment. In sub-Saharan Africa, less than a third of those who need ARVs have access to them. Plus the high cost of viral load testing means that in many places, there is no way of testing whether ARVS are working on those lucky to get them.

To achieve such ambitious targets will take money – yet financial aid for HIV is dwindling precisely when a last big push is needed. Musician Bob Geldof condemned the “preposterous reluctance” of governments to fund HIV programs in developing countries as “disgraceful,” particularly as the fight against the HIV epidemic was “in the last mile”.

As the Durban 2000 conference ended with a strongly worded declaration critical of governments (such as ours back then, under President Thabo Mbeki) that failed to provide ARV treatment, so the Melbourne conference ended with a declaration that condemned all barriers preventing people from getting access to HIV treatment and care.

The declaration’s ambassadors included Geldof, Richard Branson, Archbishop Desmond Tutu and Aung Sang Suu Ki.

Meanwhile, in another boost for South Africa, University of Cape Town’s Professor Linda-Gail Bekker was announced as the president-elect of the IAS. – Health-e News Service.