New report outlines strategy for HIV/AIDS

The AIDS advocacy group AVAC says 2013 will be a critical year for ending the epidemic. The group has released its annual report that calls for an ambitious pace of funding, implementation and research.

The latest HIV/AIDS figures showed there were 2.5-million new infections in 2011, the lowest number ever. But only 1.4 million people were added to treatment programs.

AVAC Executive Director Mitchell Warren said with the right action, the world could reach a “tipping point” in the epidemic.

“We have over the last 18 months or so seen for the first time consensus-building around the idea that ending the AIDS epidemic is actually possible. We need to see those lines cross, where more people get on treatment than actually get newly infected. That is going to be a tipping point that tells us that we are truly beginning to end the epidemic,” he said.

However, he said that milestone can only be reached if efforts move a lot faster, starting now.

“This idea of ending the epidemic, or of an AIDS-free generation – it’s a tantalizing idea. It’s not going to happen easily though. Ending this epidemic is still a very long-term prospect. And it’s going to require some really hard decisions, and it’s going to require making some really strategic choices,” he said.

The AVAC report – Achieving the End: One Year and Counting -- calls for a three-part agenda for ending AIDS: Deliver, Demonstrate and Develop.

“No one element is going to end this epidemic. We need to deliver all that we have now to reduce infections and increase treatment coverage. And that includes testing, treating, providing voluntary medical male circumcision, certainly always providing access to male and female condoms, and the kinds of behavior-change programs that have helped us bring the infection rate down; but it’s clearly not enough,” he said.

He said there needs to be a better delivery system for pre-exposure prophylaxis – the use of antiretroviral drugs to prevent initial infections – and microbicide gels. The report calls for demonstration projects to show how valuable these would be if delivered on a wide scale.

“But it still won’t be enough,” he said, “So the third prong has got to be a development agenda, which is to develop an AIDS vaccine and to focus increasingly on the scientific pursuit of a cure.”

AVAC lists its top priorities for 2013. The first is ending confusion about combination prevention.

“What are we combining? For whom are we combining it? And how do we deliver this combination? So we need to end the confusion about combination prevention in 2013. Secondly, one of the things you hear a lot about increasingly is the idea of a treatment cascade. And what happens is as we get more and more people tested, that’s a good thing. But we need to link them to care and link them to antiretroviral therapy. And we need to help them adhere to treatment,” he said.

Warren said the problem right now is that people are lost each step of the way.

Other priorities include scaling-up the use of new non-surgical male circumcision devices and safeguarding prevention research funding, especially for the National Institutes of Health or NIH. Warren says “the future of prevention innovation is more precarious than it should be.”

“Everything is on the potential chopping block if the US Congress in the next six weeks does not come to an agreement around what’s called “the fiscal cliff”. And there would be across-the-board cuts, including up to an eight percent cut across NIH. And NIH has really been the lifeblood of HIV prevention and treatment research in the world. NIH provides sometimes up to 75 percent of the research funding,” he said.

He added if quicker action is not taken now, the next generation will ask: Why did you say it was possible to end the epidemic and then fail to act?