In July, Melbourne played host to the 20th International AIDS Conference. The event, which is run by the International AIDS Society (IAS) happens every two years in a different host city and it was the first time Australia had ever hosted the conference. Almost 14,000 delegates from around the world were in attendance at AIDS 2014, which was also regarded as the largest conference of its kids to ever grace Australian shores.

As the rest of the world and the HIV and AIDS sector starts to look forward to AIDS 2016 in Durban, South Africa, the Star Observer approached key Australians involved in AIDS 2014 for their reflections on the event.

[Note: The following is a longer version of an article that first appeared in the October issue of the Star Observer.]

Sharon Lewin

AIDS 2014 Co-Chair

Professor and Head, Department of Infectious Diseases,Alfred Hospital and Monash University

Co-head, Centre for Biomedical Research, Burnet Institute

THE AIDS 2014 experience for me on a personal level was exhilarating and exhausting but worth every minute. It was a great privilege to have had this opportunity and to work with so many wonderful dedicated and energised people over the last two years. It was so satisfying to see the results of everyone’s efforts come together in an amazing display of support, inclusiveness and hope, but then to reconcile this with the incredible sadness of having lost colleagues and friends travelling to AIDS 2014 was very difficult. The tragedy of flight MH17 changed the focus of AIDS 2014, but it reinforced to us of the great work this sector does, what really matters, and the resilience of the HIV movement.

AIDS 2014 must be remembered for the stance we took as an international community against stigma and discrimination. To the horror of many, in relation to laws which criminalise homosexual behaviour the situation has actually worsened since the last International AIDS Conference, with countries like Nigeria, Uganda and Russia introducing new discriminatory laws.

Data was presented which confirmed that such laws prevent men from seeking healthcare. In addition, we were reminded that harsh laws against people who inject drugs and sex workers continue to have negative effects on HIV prevention efforts and ART adherence rates are affected by a person’s ability to disclose their status without fear of backlash. These findings clearly indicate we must continue to rally against all forms of HIV-related stigma and discrimination. 

Also of note was the very promising news in relation to the treatment of hepatitis C and tuberculosis, two significant co-infections for people living with HIV. New drug regimes promise significantly shorter and more effective treatment. The challenge, as always, is the scale-up of access to these new regimes and appropriate pricing.

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The “big stores” on HIV cure were both sobering and encouraging. We learnt that finding a cure for HIV is going to be a tough road and that the goal of “remission” is probably more realistic. However, even achieving remission may be tough. The news of viral rebound in the Mississippi infant clearly showed that remission to over two years is possible — but relapse did recur and we currently don’t know why.

Encouraging findings of the “kick and kill” strategy were also presented with an exciting study from Denmark reporting that romedepsin, a drug used to treat a rare form of skin cancer could wake up latent virus. Although this approach is not novel, this drug was able to induce virus release from cells which was a big advance. Now more work needs to be done on the “kill”.

We also learnt about new ways to measure persistent virus in patients on ART. These new assays will greatly assist the design of future clinical trials. We were also reminded of how much more basic science is needed to understand where the virus hides and how to pull it out of hiding.

Australians affected by HIV can take away at least one thing from AIDS 2014: We know what works to end HIV.

We have a wide array of tools at our disposal to reduce transmissions and improve the lives of PLHIV. Our challenge is to apply these tools, and ensure they are available to all that require them. This includes improving access to testing and treatment, targeted activities for key affected populations and the scale-up of new approaches, such as PrEP, rapid or home-based HIV testing, and access to improved treatments for co-infections such as hepatitis C and tuberculosis.

The key to ending HIV is sustaining and increasing resources. Asking for more resources can sometimes be seen as the easy answer, as if everything can be solved by more money, but I think the tipping point we currently face in HIV programming was well articulated by Bob Geldof. We are close, closer than we have ever been, to ending HIV, but this is seen by some as a reason to reduce resources, rather than to increase funding to ensure we reach this goal. Intuitively, this doesn’t make sense to me.

Resources are required to scale-up the interventions we know work, such as increasing access to testing and treatment and prevention tools such as harm reduction services. Increased funding is required to allow scientists to accelerate progress on finding an effective cure and vaccine and to develop the HIV clinical, scientific and community workforce of the future. Political will and commitment is also required to remove legal barriers which increase HIV-related stigma and discrimination.

Now is not the time to slacken the pace.

 —

Brent Allan

Co-chair of the AIDS 2014 Community Program

Executive Officer, Living Positive Victoria

I WAS thrilled to see the Global Village finally become not just an “add-on” to the conference but actually a space where conference delegates from all professional backgrounds and the local community could gather and experience the diversity of the responses to HIV and AIDS globally. This space exemplifies the unique nature of this conference in that it was not just an “exclusive” event open only to those who could afford or were considered “worthy” enough to attend — but an opportunity to expose the host city and country to the community challenges and community responses to HIV from around the world.

Estimates are that over 6000 people attended the Global Village. Many of them were completely unaware that the conference was offering free and unfettered access to the world’s diversity in response to HIV in a single setting — ranging from over two dozen networking zones from around the world, a dedicated youth pavilion for young people to gather, dialogue and strategise, to market stalls and meet the expert panels. It was almost impossible to describe in advance without sounding like hyperbole.

HIV stigma and discrimination was highlighted in just about every session — from the science to the policy, from community speakers to high level politicians, everyone realises that “stepping up the pace”, “turning back the tide”, and “ensuring that no one gets left behind” are simply slogans and mantras if we do not prioritise and structure real-world responses to HIV stigma and discrimination. It was also heartening to hear the dialogue across numerous at-risk populations about how population-specific stigma (directed at sex workers, people who use drugs, gay men and trans* communities to name a few) links with HIV stigma to create a toxic environment which enables the virus to thrive and consume thousands of lives.

What is needed is clear: (1) policy, legislative and regulatory intervention which inhibits stigma and discrimination across civil society structures (our workplaces, our schools, our places of worship, and so on); and (2) community-led interventions which recalibrate social norms and reconstruct what is “right” and appropriate and what is wrong, unjust, unfair and stigmatising and calls this out for what it is.

Even in wealthy first-world countries like Australia, unless we challenge HIV stigma and discrimination and invest in building the resilience of HIV-positive people, any investment in prevention, testing and treatment will never take us to the goal of virtually eliminating the epidemic.

There has been much talk about the legacy of the conference. From the announcement of the repealing of laws that unjustly and unfairly criminalise people living with HIV in Victoria, to the HIV consensus statement signed by all health minsters across Australia — there’s certainly a legacy. However, one legacy that rises among all others came to me in the form of a young woman who was living a life afraid and scared to tell anyone she was HIV-positive — not knowing anyone else who was HIV-positive, having had awful responses from her family and fearful she was going to lose her boyfriend as well. Her experience at the Global Village, in the positive lounge and at conference sessions filled her with hope, love, laughter and above all an expectation of wellness for her future. She is the embodiment of the legacy that recognises that PLHIV are central and vital to any response.

Australia is demonstrating what can be done when you collaborate and invest in system-wide reform that places key affected populations at the centre of the HIV response. Our partners will always be the scientists and researchers, policy makers and bureaucrats who understand that it is not one discipline alone that will find “the cure” — it is the participation of all of us in a collective and unified response that brings us closer to the goal of ending HIV.

 —

Simon Ruth

Chief Executive Officer, Victorian AIDS Council

AIDS 2014 was amazing. As someone who has arrived in the HIV sector fairly recently, AIDS 2014 was a great opportunity to see how the world comes together to combat the epidemic. Conferences like this remind you why you are in the field and provide a unique opportunity to learn from colleagues from the globe. I learnt how amazing VAC’s staff, volunteers and partners are. My staff pulled out all the stops to ensure visitors to Melbourne had a great time and to ensure our community had access to the conference. VAC staff responded to every request for assistance or site visits with a smile and a helping hand. I’m very proud to say I work here.

The issue of HIV criminalisation was very much at the forefront of my conference experience. If we’re going to have any chance at seeing the end of HIV in Australia, we need to address laws that specifically criminalise HIV transmission. Laws like Victoria’s Section 19A of the Crimes Act 1958 discourage testing and status disclosure, contribute to the stigma experienced by PLHIV and prove counterproductive to HIV prevention efforts.

During AIDS 2014, the HIV Legal Working Group, led by Paul Kidd, rallied a great campaign to ensure that this issue was ever present. The MSM Global Forum Pre-Conference, the Beyond Blame Forum and the Outrage HIV Justice Film Festival all focussed attention on this issue. “HIV is not a Crime” and “Repeal S19A” banners were everywhere during the mobilisation march. Sean Strub, Nick Rhoades, Edwin Bernard and US State Senator Matt McCoy spoke at multiple events about the harms caused by HIV-specific laws. Our sex worker friends also rallied with “No bad whores, just bad laws”.

The week got off to an unexpected start when Minister David Davis announced that the Coalition Government would amend Section 19A. Several days later, Shadow Minister Gavin Jennings trumped this by stating Labor, if elected, would repeal it altogether. Currently, Section 19A identifies PLHIV as a group that poses a danger to the community. Repealing Section 19A is one of the key actions that VAC and Living Positive Victoria have asked for in our joint election platform. It was great to see that our politicians understand the issue and are prepared to act on this to help end HIV stigma and discrimination in Victoria.

Access to testing and regular testing is key to decreasing the rate of new HIV infections in Victoria and across Australia. Knowing your HIV status better informs the HIV risk reduction strategies you utilise to reduce HIV transmission. With the increased availability of rapid HIV testing, we’ve seen a continued increase in testing among gay men and MSM. During AIDS 2014 there was a great deal of interest in VAC’s Pronto! service. Pronto! had many visitors over the fortnight, including two foreign health ministers. ACON’s a[Test] service also received a lot of attention. It was clear across the conference program that increasing opportunities for rapid testing and home testing will lead to decreases in HIV transmissions. Australian AIDS councils need to increase the availability of testing. This means working with community-based service providers to offer greater options for testing and diagnosis. Mobile facilities and/or testing outposts need to be explored as well as finding ways to encourage men to test more often. Furthermore, we believe there needs to be a commitment to better strategies targeting at-risk women and culturally/linguistically diverse communities where HIV testing rates need to improve in order to close gaps in the time-to-diagnosis. It was encouraging to see all Australian governments supporting this direction.

AIDS 2014 brought many amazing people to Melbourne. Whether it is the researchers looking for a cure, or the activists from ACT UP New York, ACT UP Queensland and The Institute of Many, the world is full of people who care. People who are fighting to end HIV stigma and discrimination, people who are trying to make the world a better place for gay men, sex workers, the trans community and other affected communities. HIV can be lonely and isolating but it doesn’t need to be. Six thousand people marched down Flinders St to remind Melbourne that we need to work together to end HIV.

Michael Kirby

Member of the UNAIDS Reference Group On HIV and Human Rights

Patron of the Kirby Institute

I REGARD the Melbourne AIDS 2014 conference as having been an outstanding success.

Frankly, it was much better than I expected it would be, particularly in the light of the tragic cloud caused by the  downing of MH17 that occurred immediately prior to the opening.

A huge amount of credit must be given to the co-chairs, Francoise Barre-Sinnousi and Sharon Lewin. But also to their team and the support staff. The co-chairs, in particular, bore an enormous burden that was completely unexpected by reason of the tragedy and the involvement in it of delegates to the conference. But their calm, well focused and strong statements made a huge impression, not only in Australia but internationally. In an unexpected and undesired way, the tragedy helped to draw international attention to the ongoing struggle against HIV and AIDS and to our determination to continue in that struggle, and not to be deterred by crazy and selfish acts of warlike people. We have a lot of experience dealing with such people and this was brought over.

If one gesture, taken by our co-chairs, showed the resolute character that they portrayed (but also their personal sympathy and empathy with their audience) it was the gesture of inviting all of the past presidents of IAS to come onto the stage at the opening ceremony to join in a moment of condolence and reflection. But more than this, the act of the organisers in inviting onto the stage the entire delegation of the Netherlands (whose population had suffered the greatest loss in the destruction of MH17) was inspired and appropriately sensitive. I do not believe that anyone who was present at the opening ceremony, and who witnessed the Netherlands delegation, coming on to the stage holding each other’s hands, sobbing and grieving openly, will ever for get that sight. It provided a catharsis for the audience and others beyond who saw it. It helped us to refocus our minds on the tears and suffering that have accompanied the HIV pandemic, and still do so in all parts of the world. It was notable how on following days, the conferenced settled down to address the multiple topics on its agenda. An acknowledgement should be given to those who handled a potentially disastrous interruption to our deliberations, with such care, sincerity and power.

I am somewhat biased, I suppose, in judging the conference and pre-conference program. I was involved in about 20 events, both pre-conference and in the conference proper, or associated with the conference. This cut into participation from the floor. However, there was more such involvement than at previous AIDS conferences that I have attended and discipline by the chairpersons is essential and should be emphasised for the future.

I have to say that so far as Australian cities are concerned, Melbourne is a standout in the serious attention it typically gives to serious issues. Melbourne 2014 took HIV and AIDS very seriously. Even the demonstration in the opening session was serious and courteous. So much so that I thought it was part of the program with people coming quietly to the front of the stage and holding up protest banners, joined in their protests by the Executive Director of UNAIDS. While this lost some of the passion and vigour that I have seen at previous, early, AIDS conferences, it was entirely in tune with the serious character of the meeting, in part consequential on the grieving that was surrounding MH17. Even the super cold weather during the conference contributed. It meant that delegates stayed together, attended the sessions and were not tempted into as many touristic activities as is often the case. Of its character, the International AIDS Conference is a serious event. Certainly, the Melbourne conference was serious and well-focused.

Please make allowance for the fact that my encounters with the conference were not typical. However, from my vantage point, the conference was very well organised. It was also well focused on the Melbourne Declaration, which had been drafted before we met and was available for consideration during the sessions.

I express thanks and praise for the co-chairs and the organising committee and their supporters.

Rob Lake

Executive Director, Australian Federation of AIDS Organisations

AIDS 2014 was a powerful, inspiring experience, perhaps made sharper by the tragedy of the delegates aboard flight MH17. It was humbling to glimpse the impact of criminal laws, discrimination and neglected health systems on communities. It was great to see strong, confident activists and representatives, many with HIV or from gay, trans*, sex worker, migrant and injecting drug user communities. We heard unambiguous messages about the need to acknowledge the impact of HIV on young people, including adolescent boys and girls. Great scientists, researchers and activists talked and listened together. There was agreement about the value and necessity to use community based responses, new tools and new evidence for prevention and to increase testing, treatment uptake, legal protections and to pull down the barriers that discrimination and attitudes create. There was good news about what is possible. Making it happen is our challenge.

Global action has brought us to this significant point in the HIV epidemic. This was clear at AIDS 2014. There was recognition of progress, the impact of global community activism and of scientific discovery. Leadership by affected communities, researchers and the UN has been essential in creating and maintaining energy and resources for the global fight against HIV.

In Australia, bipartisan government leadership began with an acknowledgement in the 1980s that an effective response was needed to work with all parts: doctors, researchers, state and federal governments, PLHIV, gay men, sex workers, people who inject drugs. Globally, responses like this were rare. At AIDS 2014, Australia launched its Seventh National HIV strategy. These national plans have guided the response in Australia since 1989. The strategy is how we can plan for the best use of new tools that we know are effective in HIV prevention. Finding the most effective ways to use them in Australia is the work that is now underway.

One of the benefits of an AIDS conference in this region is a chance for focus. HIV in Asia, whether prevention, testing, treatment or human rights protections, is a cause of concern and needs focus and action. In this region, the impact of HIV falls heaviest on gay men, trans women, sex workers, and people who inject drugs. In too many countries, laws and governments still pretend this is not the case. Prosecution imprisonment and harassment are often the response, rather than prevention and care. HIV prevention cannot succeed where people are scared to step forward to test for HIV, to get and use condoms, or to begin and maintain HIV treatments. Rates of HIV in cities across Asia are high and growing. Funders must ensure that the resources get to those who need them. Without a recognition of this and the use of diplomatic, advocacy and funding influences to support this, we will not see change. In large cities across Asia, community activists carry out this work themselves, offering HIV and STI testing, providing clean needles and condoms to sex workers and supporting people with HIV to begin and maintain treatments. These communities need support from their governments, but also from governments like Australia where this does not happen. DFAT and the Australian government have acknowledged this and committed to support the work of these community organisations and with them, to increase access to testing, prevention and HIV treatments.

We can take pride at having been part of making AIDS 2014 the success it was. The response to the conference and to delegates by Melbourne was welcoming and warm. We were reminded of how the Australian community, medical and government response to HIV, from the beginning in the 80s, set us up for today. We must remember that this success requires vigilance to maintain an effective prevention, care and anti-discrimination response.

James Ward

Associate Professor, Baker IDI

Deputy Program Head, Aboriginal and Torres Strait Islander Health

GLOBALLY, Indigenous peoples comprise 4.5 per cent of the total population and are custodians and knowledge holders of some of the worlds’ most precious and bio-diverse ecosystems, cultures, languages and customs — possessions we should all strive to retain. The health status, including that of HIV for Indigenous peoples, is generally poorer than that of the dominant population they live among. At all points across the globe, Indigenous peoples are either over-represented in HIV data, or are recognised as a priority or vulnerable population for the prevention of HIV.

The convening of AIDS 2014 in Melbourne and the International Indigenous Peoples Pre-Conference on HIV (IPCHIV) held in Sydney has provided significant opportunities for Indigenous peoples. Not only have the conferences enabled us to highlight the issues for Indigenous peoples globally, but they have allowed us to lay the foundations for a responsive and responsible global strategy that will ensure Indigenous groups comprising often <100 to a few 1000 are not wiped out by HIV.

The invisibility of Indigenous peoples in key HIV international agency strategies has to change. During AIDS 2014 a plea was sought for the recognition of Indigenous peoples as a key population at risk of HIV, in the same way men who have sex with men, injecting drug users or sex workers are.

In Australia, the HIV response toward its first peoples has been good, however in recent years we have seen worrying increases in HIV diagnosis, highlighting that more is required. The conferences have set the platform for a number of activities for us to work on into the future. The first is implementing the Eora Call to Action on HIV that was launched at the IPCHIV. The Eora Call to Action urges governments and community organisations to step up and commit to: reducing the number of new Indigenous HIV infections by 50 per cent by 2017; reduce rates by 50 per cent of other STIs in Indigenous communities; reduce all mother-to-child transmissions; and reduce rates of sharing between people who inject drugs by 80 per cent.

The second legacy of the conferences and in line with our call to action is involving a group of Aboriginal and Torres Strait Islander elders from across the nation who attended the IPCHIV and demanded they be involved in the future in guiding our work.

Thirdly, a group of young Aboriginal and Torres Strait Islander leaders now known as ANTHYM was launched at IPCHIV. ANTHYM will guide work into the future, that needs to be done with young people in the areas of sexual health and HIV. Finally, over the next four years around World AIDS Day each year we will be rolling out a campaign to increase HIV awareness in Aboriginal and Torres Strait Islander communities nationally. 

The legacy of these conferences will be long standing and will place Australia in good stead to control HIV in our first peoples communities and separate us out as outstanding international Indigenous leaders into the future. Something we should all be proud of.

Details: anthym.org

Nicolas Parkhill

Chief Executive Officer, ACON

ONE of the most exciting topics discussed at AIDS 2014 was pre-exposure prophylaxis (PrEP). Just before the conference began the World Health Organisation updated its guidelines on oral PrEP to include all gay men, other men who have sex with men and trans women who are at high risk of contracting HIV.

This does not mean that they recommend all gay men should be taking PrEP. Rather those at especially high risk, such as the negative partner in a serodiscordant relationship or people who use condoms inconsistently with casual partners, should have PrEP available to them as part of a comprehensive prevention package that includes condoms and other risk-reduction strategies.

While clinical PrEP trials are underway in Victoria and about to commence in NSW, it is likely that it will be a few years until it is approved for use here. Nevertheless, it was a hot topic at AIDS 2014 among researchers and practitioners globally.

While PrEP is set to become a part of the HIV prevention package available to us here in Australia, there are places around the world where people living with HIV do not have basic access to antiretroviral treatments. Significant criticism was levelled at major pharmaceutical companies for failing to provide these treatments in a way that was accessible.

AIDS 2014 also deepened my appreciation of how privileged we are to live in a country where access to healthcare and sexual health education for young people is comparatively good (although not ideal), allowing us to sustain the near-elimination of AIDS-related deaths in Australia.

Internationally, AIDS continues to be a leading cause of death for adolescents, with a 50 per cent increase occurring among 10-19 year olds between 2005 and 2012. Young people are at heightened risk of contracting HIV, representing over 40 per cent of new infections worldwide.

Young men who have sex with men and trans* people face higher prevalence rates due to complex social factors, and were at the forefront during conference talks. When discussing the biomedical, structural and social interventions that work, one common theme emerged: that knowledge and self-empowerment is essential.

In a session about enabling environments for young people, Australian Global Poverty Project director Shobaz Kandola described a global citizen as someone who “thinks globally but acts locally”, urging youth to take action together. Simply put, we will not end HIV and eliminate stigma and discrimination unless we position youth ambassadors at the very centre of our HIV response.

Craig Cooper

Chief Executive Officer, Positive Life NSW

AIDS 2014 provided a rare opportunity to hear from international delegates about what is happening to people with HIV and those who are at risk of HIV in other farts of the world. It also provided a poignant reminder that although we still have may issues in Australia that require attention in relation to HIV, in comparison, our problems are quite minor when compared to some other parts of the world.

Australia is a pluralistic and multicultural society, where people who are outside the mainstream are generally tolerated and able to get on with their lives, with a reasonable level of acceptance and protections. But if you happen to live in a country where traditions are actively opposed to anything other than the mainstream family orientation and religious norms, you’re in for some real problems. This is particularly so when it comes to stigma and discrimination and access to care of people with HIV, LGBTI people, people who inject drugs and for sex workers.

During the conference numerous international delegates described how gay men, lesbians, trans* and intersex people are vilified and serially abused, and in some countries such as Iran and Uganda, killed. We heard how sex workers in the Ukraine and other parts of Russia are denied access to life-saving treatment and care. We heard how prisoners with HIV in some countries are left to die without access to any medical care or treatment. We heard about the causal links between the war on drugs and the spread of HIV and AIDS and drug market violence and how repressive drug control policies and under-funding of evidence-based approaches are the main drivers of the HIV epidemic in many regions of the world. We heard how pharmaceutical companies who manufacture HIV antiretrovirals are buying up the Indian companies who manufacture and supply generic HIV drugs, so they can control access and prices and maintain profits at the expense of the health of people with HIV who desperately need those cheap drugs. And, we heard how the criminalisation of HIV transmission in many places in the world continues to marginalise people living with HIV, LGBTI people, sex works and people who inject drugs and to drive stigma and discrimination.

Many countries still have specific laws criminalising HIV transmission or exposure – including Australia. The fact that the criminalisation of HIV transmission or exposure continues to misrepresent HIV as a death sentence, to increase people’s fear of getting tested and to prevent access to life saving antiretroviral therapy, would appear to even the most unsophisticated observer, a folly. Yet prejudice and foolishness continue to prevail and in the meantime people’s lives are ruined. It surely is a very strange and unfair world in which we live.

Mark Stoové

Associate Professor

Head of HIV Research, Head of Justice Health Research, Burnet Institute

THE theme of AIDS 2014 was Stepping Up the Pace. A sentiment very much focused on ramping up strategies to meet the challenges and opportunities of combination prevention — combining strategies to reduce risk behaviours, enhance access to biomedical prevention interventions, and support social, political and structural environments that facilitate HIV prevention. At AIDS 2014 there was an overriding sense of optimism — that through such strategies we have the tools to effectively end the transmission of HIV.

However, HIV prevention optimism was also tempered by frustration. First, while we have made great advances in prevention science, these have coincided with diminishing levels of global funding. With many countries pulling back from their Global Fund commitments, evidence-based and effective strategies that would prevent potentially millions of people becoming infected with HIV will not reach many of the most at risk. Second, countries around the world continue to support political and legislative environments that foster intolerance, violence and discrimination against high-risk and often marginalised communities such as gay men, people who inject drugs and sex workers.

Ultimately, the global protection of human rights has the capacity to prevent as many, if not more, HIV cases than the broad implementation of best practice behavioural and bio-medical prevention strategies.

Michael Costello-Czok

Executive Officer, Anwernekenhe National HIV Alliance

AIDS 2014 was preceded with the Sydney International Indigenous Pre-Conference (IIPC) — Our Story, Our Time, Our Future, which was developed to ensure greater participation of Indigenous people, not only for AIDS 2014, but also in the global response to HIV.

The pre-conference was convened as an independent affiliated event of AIDS 2014, a first for both the IIPC and the International AIDS Conference. Deliberations and discussions ensured Indigenous AIDS 2014 delegates, including our elders and youth were prepared for active involvement and participation.

Some of the highlights included: Neville Fazulla, who addressed the UNAIDS Parliamentary Meeting at Victorian State Parliament during AIDS 2014, providing a presentation on the lived experience, barriers and future responses for Indigenous people living with HIV; Associate Professor James Ward became the first Indigenous person to address an International AIDS Conference plenary on Indigenous issues; a strong presence from the gay, sistergirl and trans* community, advocating for increased cultural considerations and research about testing behaviour and treatment, employing effective Treatment as Prevention responses, and combatting discrimination, racism and HIV stigma-related issues; and finally, the Indigenous Peoples Networking Zone (IPNZ) at the Global village, which provided a colourful and vibrant networking and cultural space.

The pre-conference, AIDS 2014, Global Village and associated event outcomes have certainly set a benchmark.

John de Wit

Professor and Director, Centre for Social Research in Health, University of NSW

THE large-scale iPrEx trial among gay men has shown that taking one pill daily of Truvada, a combination of two HIV medications, significantly reduces the chances that HIV-negative men become infected. Use of this oral Pre-exposure Prophylaxis (PrEP) is controversial, and AIDS 2014 provided a global platform for sharing new evidence and debating this “hop topic”.

The burning question discussed in the main conference program and at community forums in Melbourne was what role PrEP will play in HIV prevention for gay men. Whereas advocates highlight the potential for PrEP to offer protection to men who have condomless sex, critics are concerned that the availability of PrEP will further erode the condom use culture, and raise concerns about adherence, unknown long-term side-effects, cost and inequitable access.

New data shows that men on PrEP do not seem to be having more condomless sex. It was also found that Truvada offers good protection if daily pills are taken at least four times per week, addressing some concerns regarding adherence. Disappointingly though, only one third of follow-up visits had participants achieved sufficient adherence.

PrEP has potential as an HIV prevention tool for gay men, but questions remain after the conference. In the meantime, we need to be thinking about how PrEP can be made available and affordable for those who would benefit from it in Australia.

On a personal note, I commend the organisers for providing ample opportunity for mourning for the MH17 victims, enabling AIDS 2014 to become an inspiring meeting. I’m particularly pleased with the conference focus on human rights and the attention for gay men, sex workers, trans* people and people who inject drugs. I’m proud of my colleagues, who presented our work in many sessions and forums.

David Ridell

Chief Executive Officer, Bobby Goldsmith Foundation

THE AIDS 2014 experience for me was overwhelming, inspiring, sad, joyful. It was a privilege to be part of such an incredible coming together of so many cultures, ideas and experiences.

Cure is a big idea. I personally struggle with the idea that a cure is the be all and end all. A cure may alleviate immediate health concerns. Many people have had lives so severely impacted by living long term with HIV that a cure will not repair their social isolation, their skills deficits or their poverty. I’d like to think that a cure is around the corner but we have heard that for a great many years.

Treatment has become very sophisticated but not available globally. To hear figures of 3600 children and 25000 adults dying very week from HIV says as a global community we need to do more. The sense of anger that I felt in response to these figures reminds me that we have a long way to go. For a few dollars per head per week we can change and save lives.

When Bob Geldof commented on Australia’s reduction of the foreign aid budget, after promising more, being akin to abusing a child, I silently cheered. We are rich. We can and should do more.

This is one war we can win.

—-

**A shorter version of this article first appeared in the October issue of the Star Observer. The November issue will hit the streets on Thursday, October 16. Click here to find out where you can grab your free copy in Melbourne, Sydney, Brisbane, Adelaide, Canberra and select regional areas. 

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