The 2019 International AIDS Society Conference on HIV Science has opened in Mexico City and will this year have a special focus on the role that humanitarian disasters play in the epidemic in the developing world.
 
Experts grappled with the question, “Is the global HIV response in crisis?” as they focused on challenges that threaten the roll out of universal healthcare to all people.

Discussion topics ranged from migration, to conflict, to the difficulties of reaching specific populations such as women and girls and people who inject drugs. 
 
More than 135 million people around the world are in need of humanitarian assistance, mostly due to conflict, with natural disasters also driving the need for assistance.
 
“From Syria to Venezuela, the challenge of providing HIV services in humanitarian crises threatens global progress in confronting the epidemic,” Anton Pozniak, President of the International AIDS Society (IAS) said at the conference.

“People in emergency settings are especially vulnerable to new infections. We must work to ensure that HIV prevention and treatment are an integral part of global relief efforts.”
 
In parts of South and Central America, political instability has driven mass migration and strained local health systems.

The conference heard that of the 120,000 people living with HIV in Venezuela, only half are accessing anti-retroviral treatment, and less than seven percent had achieved viral suppression in 2017.

In Chile, migrants from Venezuela and Haiti accounted for nearly half of all new diagnoses in 2018.
 
“Latin America is one of the most unequal regions of the world. Efforts to control the HIV epidemic will only succeed when the enormous differences in income distribution and well-being are addressed,” Brenda Crabtree Ramirez, IAS 2019 Local Scientific Chair, said.

“All eyes are on the crisis in Venezuela, where people with HIV are dying due to a shortage of anti-retroviral treatment. These needless deaths will end only with a comprehensive regional strategy.”
 
Globally, women and girls face structural and societal barriers to accessing healthcare, including stigma and discrimination and health providers’ lack of specific knowledge around women’s healthcare.

29 countries still require the consent of a husband or partner for women to access sexual and reproductive health services. This is further exacerbated during humanitarian crises and natural disasters.
 
UNAIDS estimates that in sub-Saharan Africa, three in five new HIV infections among 15–19-year-olds are among girls.
 
“Crises and emergency settings put women and girls at increased risk of violence and heightened risk of both HIV and unintended pregnancy,” Quarraisha Abdool Karim, Columbia University Professor and Centre for the AIDS Programme of Research in South Africa Associate Scientific Director, said.

“Any successful HIV program should cover comprehensive care, including family planning and pregnancy prevention.”
 
Pakistan has also witnessed a recent paediatric outbreak of HIV, with nearly 500 diagnoses of children in a single city.
 
“Strengthening weak health systems must be at the core of a global humanitarian response,” Fatima Mir, Assistant Professor, Paediatrics, at The Aga Khan University Karachi, said.

“In Pakistan, we are experiencing a devastating outbreak of HIV among very young children infected from reused syringes and a compromised blood supply. The solutions are clear and simple; we need to invest in basic training and resources for rural health centres providing primary- and secondary-level care to women and children.”
 
Despite some successful needle exchange programs in Eastern Europe, access to harm reduction across the region remains low and the epidemic remains concentrated among people who inject drugs, the conference heard.
 
“We have the science and technology we need to address the epidemic, and it’s time to eliminate stigma and discrimination to reach all people,” Momchil Baev, Sexual Health Program Manager at SingleStep said.

“Eastern Europe and Central Asia is the only region where rates of new HIV infections are on the rise, with Russia alone contributing 100,000 new infections every year.”

“To reverse this trend, we need interventions that address the needs of those most vulnerable to HIV. And with the Global Fund withdrawing from some East European countries, it is critical to have community organisations to take charge and lead the way in the fight against HIV.”
 
IAS 2019 will feature the latest science on innovations in treatment, cure and prevention and the latest on-the-ground strategies to address inequities in the HIV response.

More than 1,000 abstract presentations were selected from more than 3,000 submissions from researchers around the world.

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