HIV/AIDS In 2016: Reflections From Durban

Three decades ago, “AIDS” was a word shrouded in stigma, shame, and silence. Those afflicted with the virus too often suffered alone, as few medical leaders, politicians, or other people in power were willing to get involved in the growing epidemic. Today, HIV/AIDS is no longer the death sentence it once was. Antiretroviral therapies (ART) make it possible for HIV-infected people to live long, healthy lives and pre-exposure prophylaxis (PrEP) has been proven to greatly reduce an individual’s chances of becoming infected.

But, in spite of these incredible strides, we cannot afford to rest on our laurels. According to the World Health Organization, there are approximately 37 million people living with HIV/AIDS worldwide, with 2 million more becoming infected every year. When thousands of researchers, advocates, and medical professionals convened weeks ago in Durban, South Africa for the 2016 International AIDS Conference, they celebrated the advancements made and recommitted to moving ever forward in the battle against HIV/AIDS.

Kenneth Mayer, MD, Co-Chair and Medical Research Director at The Fenway Institute, and Sean Cahill, Ph.D., The Fenway Institute’s Director of Health Policy Research, led a team of Fenway Health scientists and researchers who presented on the intersections of HIV/AIDS and LGBTQ health. Dr. Mayer also served as Scientific Co-Chair of the conference. They returned to Boston with a wealth of new information to contribute to HIV/AIDS research in the U.S. The following is an overview of the Durban conference’s key takeaways.

The number of people on ART has risen to an unprecedented 17 million globally. However, that number is only 63 percent of the estimated 27 million needed to reach the goals of the ambitious UNAIDS “90-90-90” treatment plan.

Global AIDS-related deaths have declined 45 percent since peaking in 2005, and the past decade has seen a 35 percent decline in new infections. In the coming years, flat funding for HIV/AIDS research and treatment threatens to slow or even reverse these trends.

Stigma and discrimination against HIV-positive people remains high, especially in areas where structural homophobia and transphobia is the norm.

In Sub-Saharan Africa, there has been a large increase in the number of youth - those from ages 5 to 19 - who are on ART. However, the rate of viral suppression for this group generally remains much lower than desired.

According to Dr. Mayer, “the next decade of AIDS looks like the first, with gay men, transgender women, injection drug users, and young heterosexuals in Africa most at risk.” Internationally, men who have sex with men (MSM), especially young men of color, face the highest rates of new infections.

Exciting new PrEP options are emerging for women. Several clinical studies have found some success with oral tenofovir disoproxil, which can be used as part of a treatment regimen for infected people, but also works well as PrEP. Another prevention option that shows promise is a monthly dapivirine vaginal ring. In all studies of female PrEP, high adherence proved essential.

MSM and transgender women often bear the dual burdens of having both high rates of HIV/AIDS infection and experiencing hardships in accessing health care. “Structural barriers to HIV care and suboptimal provider engagement are significantly associated with negative health outcomes,” explained Dr. Mayer.

Transgender people in particular often delay or avoid seeking medical care due to fear of discrimination. In fact, 59 percent of HIV-infected transgender people name gender-affirming care as their number one health concern. As Dr. Cahill pointed out, “pronouns matter,” as does training staff in sensitive and trauma-informed care.

Criminalization of homosexuality has had devastating effects globally. “In Africa, anti-gay prejudice, criminalization of homosexuality prevent many MSM from accessing HIV prevention and treatment,” said Dr. Cahill. Today, 78 countries criminalize homosexuality, including 38 in sub- Saharan Africa, where fear is stopping countless HIV-positive LGBTQ people from seeking lifesaving care.

In prisons around the world, HIV care and prevention is severely lacking, if present at all. Viral suppression is nearly impossible to achieve with the health care available behind bars, and prisons, where populations are disproportionately HIV-positive, are important sites for engaging people living with HIV and treating them with antiretroviral medications.

As we look back at this year’s International AIDS Conference, it is clear that there is still much work to be done to end the global epidemic once and for all. New treatment and prevention methods give us hope for an AIDS-free generation, but the true test will undoubtedly prove to be the eradication of discrimination and health care disparities for all the citizens of the world.