October 18, 2013

BRUSSELS — All of the keynote speeches delivered at the EACS 2013 opening session shared a similar narrative: Significant progress has been made globally in the treatment, prevention and diagnosis of HIV/AIDS in the past 25 years, but there remain considerable challenges to ridding humankind of the epidemic, specifically in Eastern Europe, Central Asia and Africa.

Michel D. Kazatchkine, MD, PhD, the United Nations secretary-general’s special envoy on HIV in Eastern Europe and Central Asia, spoke out regarding the alarming rise in HIV transmissions in those regions.

In particular, Kazatchkine drew attention to HIV infections described as “exposure group unknown,” which includes elevated transmission numbers among highly stigmatized groups, including sex workers, homosexuals and injection drug users.

“Coverage, availability, access and the scope of interventions are shaped by the policy and the social environment — stigma in the region is very high,” Kazatchkine said. “Very few intervention services are actually tailored to the particular needs of the vulnerable populations, in large because of the widespread political and moral opposition to drug use, sex work and homosexuality. The system cannot reach those in need of services who are excluded from the system.”

In addition, Kazatchkine highlighted the likelihood of a “quadruple epidemic” in Eastern Europe, as coinfections such as HIV, tuberculosis and hepatitis C continue to be spread through injection drug use. With regional governments unable to take action due to social resistance, Kazatchkine asked that the European Union survey the situation immediately.

“If the epidemic in Eastern Europe is not brought under control, it will be the governments of the region who will bear responsibility for the human tragedy that is unfolding in their countries,” Kazatchkine said.

Success in Africa

Peter Reiss, MD, PhD, professor of medicine at the University of Amsterdam, delivered a keynote speech on behalf of Kevin De Cock, MD, who was prevented from attending due to the recent US government shutdown.

De Cock, who is director of the CDC’s Center for Global Health, said HIV incidence has declined in many African countries during the past decade, with more patients receiving ART than are becoming infected. Overall, the incidence of HIV in Africa peaked in the 1990s — as it did globally — and the prevalence of the disease leveled off at the turn of the century.

“The AIDS response in Africa over the past decade represents the largest public health program in history, and, without question, success,” De Cock said.

However, efforts to completely reduce the incidence of HIV on the continent face significant challenges, including high treatment dropout rates and the need for increased treatment coverage, especially among children. De Cock called for a similar approach to that of TB, which is monitored through cohort analysis and for which standard outcomes for every patient are reported. In addition, a randomized trial of when to initiate ART may determine whether universal treatment is the right course.

“While I hesitate to speak of an end to AIDS, defined correctly, we can achieve an AIDS-free generation. We can ensure that few children are born with HIV, that adult HIV incidence drastically reduces and that those living with HIV do not progress to die of AIDS,” he said.

New initiatives

After the launch of its first national strategic plan on HIV, Elio Di Rupo, prime minister of Belgium, discussed the framework of the government initiative that has prioritized care for highly affected populations, such as migrant workers and men who have sex with men.

The strategic plan focuses on reducing the transmission risk of HIV by combining available preventive strategies and tools, encouraging routine HIV testing and early-stage HIV-status notification, and reducing stigma and discrimination based on gender, sexual orientation and identity.

“The HIV plan the Belgian federal government recently adopted is without precedent,” Di Rupo said. “It demonstrates that we can focus our efforts on one single goal; reversing the spread of AIDS. Belgium is a country particularly affected by this disease — 20,000 Belgians currently carry the virus with between 1,000 to 1,200 new cases diagnosed every year.”

However, ignorance of the disease remains a considerable challenge to the initiative, particularly among Belgian youth.

“AIDS is no longer top priority as far as the media and general public are concerned,” Di Rupo said. “As a result, young people tend to think that AIDS is no longer an issue — and failure to provide necessary information to young people is a failure to offer help to someone in danger.”

Laurette Onkelinx, vice prime minister of Belgium and the minister of social affairs and public health, said despite the progress reflected in the AIDS initiative, racism and homophobia continue to have a negative impact on patients’ access to and quality of care. The international cooperation needed to combat the global HIV epidemic must also be directed at this issue, she added.

“I would like to make a wish, that this cooperation will also offer the opportunity to support the fight against discrimination, because you know as well as I do that public health and the struggle against discrimination go together,” Onkelinx said.