Despite significant scientific advancements, we continue to encounter structural barriers that impede real world progress. Realizing the promise of scientific achievement requires a greater commitment to removing barriers between discovery and implementation. The 21st International AIDS Conference (AIDS 2016) must bring these pieces together – the key scientific advances needed to end the epidemic and the key structural barriers impeding progress – and secure greater political commitment including financial resources to get the job done.
Focussing on the five key scientific advances
1. Ensure access to antiretroviral therapy for all people living with HIV
The benefits of early and sustained antiretroviral therapy (ART) for the health of people living with HIV and treatment as prevention in the overall population are undeniable and broadly recognized. We must ensure that on diagnosis ART access for all people living with HIV becomes a reality despite resource constraints.
2. Scale up modern combination HIV prevention packages
Pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision are major breakthroughs in HIV prevention science. They should complement the benefits of universal ART and must remain a priority. Long-acting and more convenient prevention methods such as injectable PrEP should be further developed to become an integral part of today’s combination HIV prevention package.
3. Treat and manage co-infections and co-morbidities
Morbidity and mortality in people living with HIV is increasingly driven by co-infections and co-morbidities. A range of new technologies and drug options have been developed which now need to be fully scaled up, notably, for hepatitis C and tuberculosis HIV co-infections. Non-communicable diseases like diabetes and hypertension are another important area of linkage requiring attention.
4. Amplify research efforts for a vaccine and a cure
Preventive vaccine strategies and sustained HIV remission while off ART remain paramount to achieving definitive and economically-sustainable epidemic control. The recent progress in vaccine development and HIV cure research should be accelerated, driven by the necessary resources and motivation to consign AIDS to history.
5. Optimize implementation research
Implementation science should increasingly become the cornerstone for realising access, acceptability, uptake, and sustained adherence across the HIV cascade. This will include leveraging differentiated models of care and other innovative approaches to translate science into long-term, sustainable and equitable progress.
Addressing the five key structural barriers
1. Focus on key populations within and across various HIV epidemic scenarios
Key populations – men who have sex with men, transgender people, sex workers and people who inject drugs – are disproportionately affected by HIV and among these groups there has been a recent resurgence in HIV infections. National responses should create an enabling environment and increase their access to HIV services across the cascade – including for adolescent key populations.
2. Address gender inequality and empower young women and girls
Socially-embedded inequalities render young women and girls – including transgender women - particularly vulnerable to HIV infection. We need a global plan for ending the epidemic among them that includes ensuring multi-sectoral policy and programmatic synergy and embraces sexual and reproductive health and rights.
3. Challenge laws, policies and practices that stigmatize and discriminate against people living with HIV and key populations
It is long past time to amend and remove laws, policies and practices that inappropriately regulate (e.g. violation of sexual and reproductive rights), control (e.g. entry, stay and residence restrictions), punish (e.g. criminalization of HIV non-disclosure, exposure and transmission) and/or fail to protect (e.g. criminalization of homosexuality, sex work and drug use; lack of protection from violence) key populations and people living with HIV in many contexts.
4. Increase investment in civil society and community lead responses
Civil society – as activists, advocates and service providers - has long been the backbone of the AIDS response, ensuring greater accountability and action from political leaders to address the epidemic. In many settings, these groups are under siege by restrictive laws and funding cuts. The global HIV community must stand in solidarity with civil society and reaffirm its place in the HIV response.
5. Enhance capacity of frontline healthcare workers
Ensure that frontline healthcare workers have what they need to provide client-centred care through national roll out of quality pre- and in-service training. This should include addressing stigma and discrimination which is often considered one of the most significant barriers to accessing HIV services.
We, the undersigned, agree that the return of the conference to Durban this year will be a defining moment to establish a clear path toward guaranteeing that no one is left behind in the AIDS response. When we write the history of the epidemic, let it be that in Durban in 2016 we seized the opportunity to alter the course of this epidemic forever.
Now, more than ever we must ensure Access Equity Rights – Now!
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