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Reflections from AIDS 2014: Next Steps in Ending the Epidemic

By Carole Treston, RN MPH

Chief Nursing Officer

Association of Nurses in AIDS Care

“Targets are the difference between empty rhetoric around ending the epidemic and actually delivering the outcomes to save lives and reverse the epidemic,”
remarked Suzette Moses-Brown, Executive Director GNP+ (Global Network of People Living with HIV) at AIDS2014.

The call for the target of 90-90-90 resonated throughout the Melbourne 2014 International AIDS Conference. This means that globally by 2030, 90% of people living with HIV will know of their infection, 90% will then be on anti-retroviral treatments (ART), and of these, 90% will have an undetectable viral load. This ambitious target was supported by the release of the UNAIDS GAP report , galvanizing a movement for ending the AIDS epidemic by 2030. With success already underway, the report shows the possibility: in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, whereby they are unlikely to transmit the virus to their sexual partners.

“Stepping Up the Pace, Leaving No One Behind.” Michel Sidibe, Executive Director of UNAIDS, led this charge, and it was echoed by many global health leaders. Many talks focused on strategies to achieve 90-90-90. Local, highly focused programs in hot spots where new infections are greatest, aimed at key populations are required. The disparity of HIV for young women, accounting for more than 60% of cases in sub-Saharan Africa, was called out repeatedly. While we were reminded of remarkable progress such as the 60% worldwide reduction in mother to child transmission of HIV since 2001, we must do more to prevent and treat HIV infection in girls and young women in Africa. Sadly, HIV treatment of children lags unacceptably behind in many countries. And new infections and deaths due to HIV continue to climb in adolescents; globally, it is now the second leading cause of death in adolescents.

Targeting key populations with prevention and care strategies that work for them must also be accompanied by technology advances that make the 90-90-90 goal achievable and sustainable. This includes cheap, reliable point of care viral load testing to monitor the viral load goal. The sheer number of repeated HIV tests will require a change in approach to HIV testing and is already being implemented in South Africa, where 6 million HIV+ people or 30% of the global epidemic are estimated to live. Nearly 2.5 million people are on ART in South Africa now, up from 55,000 less than a decade ago - an incredible accomplishment for any country. Many noted that globally, nurses deliver the bulk of ART therapy and the evidence shows that HIV care and ART treatment independently delivered by nurses is effective and sustainable.

While maintaining undetectable viral load is the closest thing we have to a cure right now, scientific talks by Dr. Tony Fauci, Director of the NIAID at the NIH and others focused on developments that will lead to a cure. Some news is disappointing, such as the re-emergence of HIV in the “Mississippi baby," others encouraging, such as a better understanding of HIV reservoirs and latency. But all contribute to the knowledge needed to get us to a cure. The challenge of viral eradication is complex, and includes reactivating hidden or latent HIV back into the bloodstream in order to identify and destroy it. Consequently, this strategy referred to as “Kick and Kill” involves “kicking” the virus out of the latency phase, activating it and then attacking to “kill” it. This is complicated by a growing understanding of how very early the HIV reservoir is populated with virus, possibly within hours of infection. The term remission was used frequently as part of the cure strategy, a drug-free concept familiar to most from cancer treatment. Dr. Fauci noted the strategy of very early anti-retroviral treatment as a means to reduce seeding of HIV reservoirs and to stack the deck in favor of eradication.

We were reminded in large sessions, small discussions and conversations, that none of this will be possible without addressing the human rights issues and stigma that underlie the HIV epidemic. We were called on to sign the Melbourne Declaration in order to affirm that an end to AIDS is only possible if we overcome the barriers of criminalization, stigma and discrimination that remain key drivers of the epidemic. All are invited to support and sign the document, including those who were not able to attend the conference.

Association of Nurses in AIDS Care is a member organization of AIDS United's Public Policy Committee (PPC)

Posted By: Carole Treston, RN MPH, Chief Nursing Officer Association of Nurses in AIDS Care - Tuesday, August 26, 2014

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