Episode 8 - 2007-2008: Good research drives good policy
In 2007 the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007) was held in Sydney, Australia. The conference, which was organized by the IAS together with the local host, the Australasian Society for HIV Medicine (ASHM), attracted more than 6,000 participants from 140 countries. By the time of IAS 2007, billions of dollars in new financing for AIDS were being allocated to low- and middle-income countries through multilateral, bilateral and private foundation programmes; treatment coverage alone had risen from 400,000 in 2003 to more than 2 million by the end of 2006, or 28% of those in need. With scale-up came new challenges, including concerns that HIV programmes were not well coordinated, either with each other or with the planning and budgeting process of national health authorities. Also that the disease-specific programmes, such as those delivering HIV interventions, needed to intensify integration with other health care areas such as primary care, sexual and reproductive health, TB and hepatitis prevention, and treatment and maternal care. New questions were emerging about how to best implement the public health approach to delivering a range of HIV treatment, care and prevention interventions using the standardized population-based approach recommended by WHO for maximizing treatment coverage.
This was the background against which ‘The Sydney Declaration’ was issued by the organizers of IAS 2007 in The Lancet. The Sydney Declaration drew attention to the need for operations research to guide scale-up efforts, calling for donors to allocate 10% of all HIV resources to research. Although some activists were initially concerned that the text could be interpreted to draw resources away from treatment and prevention programmes, the intent was to call attention to the urgent need for research to answer pressing questions about what works and what does not in what has been described as the greatest public health experiment in the world – the rapid scale up of ART therapy throughout the world. The declaration noted that “good research drives good policy”, and was quickly endorsed by the World Bank and other global players. The IAS, the WHO, the World Bank and the Global Fund co-hosted a meeting in March 2008 to obtain the input of a range of stakeholders to help identify research priorities and allocate roles and responsibilities in implementing The Sydney Declaration recommendations.
In 2008, the XVII International AIDS Conference (AIDS 2008) in Mexico City demonstrated both the enormous progress and outstanding challenges in the global response to HIV and AIDS. As the first International AIDS Conference to be held in Latin America, it was particularly encouraging to hear the number of commitments made by political leaders across the region, both immediately prior to and during the conference. These commitments included the principled stand of Mexican President Felipe Calderon to fight homophobia and other barriers to meeting universal access targets within Mexico, the regional agreement of health and education ministers across Latin America and the Caribbean to address sexual health education reform targeting young people and the commitment of the Coalition of First Ladies and Women Leaders in Latin America to eliminate mother to child transmission (MTCT). Because of all these declarations AIDS 2008 had an impact well beyond the five days of the conference itself.
The most important takeaway message from the conference was that a combination of inadequate resources, unmet commitments and structural barriers were thwarting the implementation of evidence-based prevention, treatment and care interventions. AIDS 2008, perhaps more than any previous International AIDS Conference, brought a renewed focus on the legal and human rights issues faced by vulnerable and most at risk populations both in generalized, concentrated or low-level epidemics. The evidence and experiences from the conference were unequivocal in their message: until leaders in both government and civil society are able to separate personal morality and political expediency from the evidence-based interventions required to halt and begin to reverse this epidemic, agreed global targets would not be met.