Is the global HIV response in crisis?

21 July 2019 (Mexico City, Mexico) – More than 5,000 people from 140 counties have gathered in Mexico City for the opening of the 10th IAS Conference on HIV Science (IAS 2019), where global experts called for urgent action to address the health needs of millions of people affected by humanitarian crises.

Experts grappled with the question, “Is the global HIV response in crisis?” They focused on challenges that threaten the roll out of universal healthcare, including HIV services, to all people. They range from migration to conflict to the difficulties of reaching specific populations, including 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 driving the need for emergency 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) and International Scientific Chair of IAS 2019, said. “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 Central America and Venezuela, political instability has driven mass migration and strained local health systems. Of the 120,000 people living with HIV in Venezuela, only half were accessing antiretroviral treatment and less than 7% had achieved viral suppression in 2017. In Chile, migrants from Venezuela and Haiti accounted for nearly half of 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. “And of course, all eyes are on the crisis in Venezuela, where people with HIV are dying due to a shortage of antiretroviral 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. What’s more, 29 countries require the consent of a husband or partner for women to access sexual and reproductive health services. These inequities are 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 (CAPRISA) Associate Scientific Director, said. “Any successful HIV programme should cover comprehensive care, including family planning and pregnancy prevention.”

Pakistan has 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 programmes in Eastern Europe, access to harm reduction across the region remains low and the epidemic remains concentrated among people who inject drugs.

“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 organizations to take charge and lead the way in the fight against HIV.”

According to Ambassador Deborah L. Birx, U.S. Global AIDS Coordinator and U.S Special Representative for Global Health Diplomacy, “Over the past 16 years, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has saved more than 17 million lives and helped transform the global HIV response. We are proud of the remarkable progress being made by many of the countries we support, and remain committed to accelerating efforts toward achieving epidemic control everywhere that we work -- country by country, community by community.”

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. Women represent half of all abstract presenters, and one-third of the presenters are under 35 years old.

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