Dr Laura Waters, Consultant GU/HIV Medicine, HIV & hepatitis lead CNWL, Mortimer Market Centre, reports on the 22nd International AIDS Conference, which was held in Amsterdam from 23 to 27 July 2018.
Conference and protests: The AIDS conference is held every two years, this year in swelteringly sunny Amsterdam. It’s a BIG conference: over 15,000 delegates attending over 500 talks, workshops and activities. At the heart is a noisy and colourful ‘global village’ where numerous non-governmental and community organisations share their work and messages. The neighbouring exhibition hall, housing hundreds of scientific posters and large pharmaceutical company stands, attracted frequent sparkly protests as a singing procession scattered glitter-filled capsules with abandon while calling/singing for cheaper HIV drugs.
Another big protest issue is the decision to hold the 2020 conference in San Francisco. Many feel the issues, including punitive legislation, stigma and deportation, faced by men who have sex with men, people of colour, people who inject drugs, trans communities, sex workers and migrant populations, make the USA an unsuitable host for a conference on a condition that particularly affects people from these groups. More here: https://hivpowershift.wordpress.com/the-ias-values/
The celebrities: Big conferences attract big names. HRH Prince Harry and Sir Elton John, both vocal and generous supporters of HIV causes, launched a new initiative, The MenStar Coalition. The Elton John AIDS Foundation and several other organisations (including large pharma companies) have pledged $1.2 billion to focus HIV testing and care efforts in men, starting with an HIV self-testing project in Kenya and efforts to improve the number of men on HIV treatment in the US. Charlize Theron (above), who runs a project in Africa, gave a moving overview of stigma and discrimination. Bill Clinton gave a storming speech but faced louder, longer protests than any other speaker – activists were rightly asking for the US to improve their poor track record on rights for the communities mentioned above. Eventually, even the supportive audience asked them to move on and give him the chance to speak. To be fair to Bill, the Clinton Foundation does LOTS of good work and I doubt he had much to do with the 2020 decision.
A person with HIV, on treatment, with undetectable virus, CANNOT TRANSMIT TO OTHERS! One of the most discussed studies was PARTNER2. The original PARTNER study, published in 2016, showed that amongst almost 900 couples (including over 300 gay male couples) where one partner was HIV-negative and the other HIV-positive but with an undetectable viral load on treatment, there were ZERO HIV TRANSMISSIONS after 48,000 episodes of condomless sex! Based on a need for more data, PARTNER2 was set up to recruit only men who have sex with men, and almost 800 couples (again, one HIV-negative and one HIV-positive but on treatment with an undetectable viral load) were included. After an average time in the study of 1.6 years per couple and more than 75,000 condomless anal sex acts there were ZERO HIV TRANSMISSIONS. Hopefully this will now reassure any doubters that undetectable=untransmittable or U=U! U=U is a message, spearheaded by the ‘Prevention Access campaign’ since 2016, that has gained huge momentum over the last 12 months: https://www.preventionaccess.org/about. Despite this, many people, including health professionals, do not know U=U, so tell them! Tell your friends, your family, your colleagues and anyone you talk to, that U=U!
New HIV treatments: There wasn’t a huge amount but there are two things worth mentioning. Most people on HIV treatment take 3 drugs, some studies show you can switch to 2 drugs if you are undetectable, but for the first time we saw really excellent results for 2 drugs as first-line treatment in a trial called GEMINI. However, just 1 drug is, in most cases, taking it too far. Several researchers have looked at using a new-ish drug called dolutegravir on its own. It’s not good enough because too many people develop a detectable viral load and resistance to the drug and we saw two more studies of this strategy. There was some heated discussion about how ethical this is and I sincerely hope these were the last studies to look at a treatment that is not good enough.
Prevention: There was a lot of discussion on pre-exposure prophylaxis (PrEP). Essentially, it works, we need to improve access and we need to be better at targeting people who need it, particularly trans communities, women at high risk and migrants. During the conference it was announced the European Court has decided that we should be able to get cheaper unbranded (generic) drug for PrEP in England (there has been a drawn out legal battle between the branded manufacturer and four generic companies). This now needs to be confirmed in an English court and then there’s the even greater hurdle to overcome… convincing NHS England to provide it! Right now buying generic PrEP online (or through a special service at 56 Dean Street) or enrolling in the IMPACT trial are the only ways to get PrEP, and you can read more here: https://www.iwantprepnow.co.uk/
Final words: There was a really interesting session on anal health and anal sex. I’ve written about anal douching before for Boyz but didn’t know about this website https://howtocleanyourass.wordpress.com/ which was recommended as a good resource for people wanting to know how to douche safely.
As I write this I’m in the closing talks where people summarise all the different sessions. There is so much I haven’t covered including sexual violence, hepatitis C, HIV cure (mostly disappointing or very, very early) but here’s one last message: general health is important for us all – stop smoking, go for a run, eat well and sleep more!