Just a few short years ago, HIV conferences taking place in Africa and internationally were about shaming political leaders, donors, and drug companies, all with the intent of getting more people on treatment, and fast. Note the 2000 International Aids Conference in Durban, in which thousands of activists took to the streets calling for reduced prices of drugs. In a press release they claimed "denying people with HIV and Aids access to affordable medicines in order to protect profits or intellectual property rights is tantamount to genocide". Winnie Madikizela-Mandela publicly shamed Thabo Mbeki's notion that HIV doesn't cause Aids, calling the government's policies a "social holocaust".
Confrontation was the name of the game.
The mood of participants and topics of conversations at the the 17th International Conference on Aids and STIs in Africa (Icasa) taking place in Cape Town this week is notably different. Save for a few short protests Icasa has been tame, in part reflective of massive progress made in the past decade. Today, UN agency UNAids estimates that nearly 10 million people are receiving anti-retroviral therapy in developing countries, nearly 2,4-million of whom live in South Africa, according to the department of health. With millions of people on chronic treatment, discussions at Icasa centered more around long-term sustainability, with a focus on how to manage patients already on care, easing burdened health systems, reaching populations that are traditionally underserved, trying out new technologies, and figuring out how to pay for a long-term epidemic.
Long way to go
But while significant progress has been made, there's still a long way to go. UNAids estimates that 18-million people are currently eligible for treatment but not getting it. In 2012, UNAids estimates that there were 2,3-million new HIV infections, 70% of them in Africa, where Aids remains a leading cause of death. And financing is tight. UNAids says that annually another $3-$5 billion is needed in order to continue to make significant strides against HIV.
But now that millions of people have received care, a key focus is how to reach traditionally under-served populations such as men, children, adolescents, and sex workers. According to UNAids, only 39% of children in low- and middle-income countries receive an HIV test within the first two months of life. On Tuesday, a panel hosted by Sonke Gender Justice noted that across Africa, men are less likely to test for HIV, less likely to receive HIV treatment, and more likely to die of Aids than women. In a press release issued Tuesday, the Sex Worker Education and Advocacy Taskforce (Sweat) called for the decriminalisation of sex work, noting that limited access to services "is largely due to criminalisation of sex work, and the resulting stigma and discrimination sex workers experience from society".
While traditionally big international donors have been targeted for increased financing, African activists are increasingly looking towards home. In one of the few public actions seen at the conference activists called on African leaders to respect human rights, increase domestic financing for HIV, and amend their patent laws so as to increase access to affordable medicines. An overriding theme among academics at the conference is helping HIV patients adhere to lifelong treatment, which is good for individual health, reduces new infections, and eases the burden on healthcare workers.
Rather than acting in crisis mode, the HIV community seems to now view the epidemic as one that's here for the foreseeable future, and one that requires increasingly targeted interventions. Now that HIV is part of our world, it's about figuring out how to get used to it.