ODI researcher, Fiona Samuels reports from the 16th international AIDS conference held in Toronto last week (12th-18th August). The theme of this conference was ‘Time to Deliver’. The previous one was held in Bangkok 2 years ago. These conferences are fora for bringing people working in the AIDS world together, including members of the scientific research community, civil society, donors and policy makers. It is a forum for presenting the latest in scientific advances but also for advocacy and networking. Each year attendees grow - there were approximately 26,000 delegates this year - and whilst the venue was large, there were just too many people. As is often the case in these large conferences, when events are occurring simultaneously, there is often a sense that one is missing a key session elsewhere. Distances between the 2 major sites of the venues were also relatively large which prohibited to a certain extent switching between different sessions.

There was a large media presence at the conference; there was daily coverage in the Canadian media as well as international coverage. Key speakers and personalities at the conference included, just to name a few, Bill Clinton who made various appearances and spoke very eloquently on a whole range of issues from prevention through to treatment. Bill and Melinda Gates were also presenting, appearing during the opening ceremony and with the famous ‘2 Bills’ conversation later on in the week. Stephen Lewis, the UN special envoy on AIDS in Africa chaired and spoke at many events and was the key note speaker at the close of the conference. Notably absent from the event was the Canadian Prime Minister and whilst there had been some expectations of pledges or announcements from the Canadian government, none were forthcoming. 

With so many delegates and so much information being presented, it becomes more and more difficult to try and sift out new information. There was also a sense that there was little new being presented and that whilst it was hoped that there would be new people presenting, this was not the case. As usual, the plenary sessions each morning and the rapporteur sessions at the end of the week were key occasions for obtaining an overview of the conference.  

The following provides a very brief overview of some of the key issues presented, focused on my particular areas of interest and research:
 

The importance of prevention in an era of treatment was highlighted by many speakers, according to Kevin de Cock (Director of HIV department, WHO), “You can’t treat your way out of the epidemic”. Prevention technologies included discussions on vaccines. Despite being no breakthroughs, optimism remains around finding a vaccine. Microbicide research is ongoing and initial findings are positive but full results are still not due for another few years. Perhaps most exciting were the results from a circumcision trial in South Africa last year, showing a 60% reduction in transmission in circumcised men; more studies are underway on this and then the whole issue of acceptability and applicability would need to be reviewed. But with people like Stephen Lewis endorsing this by announcing he himself is circumcised one needs to watch this slot!
 

Treatment messages remained strong at the conference, with calls for increasing access to ART. There were also messages around the cost of drugs: “When drugs are free they work better” was a refrain being heard. That adherence in Africa was better than in some Western countries was stated – “Refuting the Afro pessimists”.  Additionally, the prevention value of ART was discussed. There is now not only a call for increasing access to ART but sustaining it, as in some countries treatment partners are planning to move out, so what next?
 

The need for increased numbers of health workers was also a refrain throughout the conference, with the health workers themselves being extremely vocal about their needs, chanting ‘open your purses we need more nurses’ during various sessions. This covers issues such as keeping nurses in their countries of origins and providing them with adequate incentives. This coincided with WHO launching its “Treat, Train and Retain” strategy for nurses.
 

Children and AIDS was once again reiterated as having being a neglected area, with need for more training of health workers to treat children, for more research into paediatric ARV formulations. There was also an emphasis on not just treating the child, but the mother and their family. There was little, however, in the conference on Prevention of Mother-to-Child-Transmission and this remains one of the prevention success stories which has been relatively neglected and has not been scaled up. 
 

Unlike other international AIDS conferences, this one for the first time had many sessions dealing with the issue of HIV/AIDS, nutrition and food security. With people like Stephen Lewis and Paul Farmer putting their voices firmly behind these issues, these events got a lot of coverage. The two ODI BPs Food, Nutrition and HIV and Understanding HIV and Livelihoods went down very well at these events. There was nothing extremely new in the sessions, but the fact that there was wide spread interest in this area at last is key in itself. The following links are press releases by WFP on this topic from the conference

http://www.wfp.org/english/?ModuleID=137&Key=2213   http://news.yahoo.com/s/afp/20060816/hl_afp/healthaidsfoodun_060816210246
http://www.wfp.org/English/?ModuleID=137&Key=2213
 

Also unlike other conferences, there were many presentations on vulnerable, marginalised and silent populations including, for instance, indigenous populations, mobile populations and refugees. Discussions were around how to reach them for both prevention and treatment purposes. This remains a relatively un-researched area and one in which ODI may consider being involved. 
 

There was also a lot on TB and HIV co-infection at this conference with many sessions devoted to it and key speakers such as Kevin de Cock and Bill Clinton highlighting it. There was a call for special coordination between those working on the TB and HIV epidemics, so that TB does not become the Achilles heel of ART scale-up. TB prevention and treatment must become a central component of AIDS care. This bodes well for a study ODI is trying to get funded on the TB and poverty trajectories within an HIV context. 
 

The conference concluded with a statement by the organisers of 17th international AIDS conference, which will be held in Mexico in 2 years time.