The last World AIDS Conference to be held on American soil was in San Francisco in 1990. Soon after, the USA applied a travel ban preventing anyone who was HIV-positive from entering the country, thus preventing any further conferences from being held there. President Obama lifted this ban in 2009, and the conference returned to the US in July after 22 years.
This change in policy was much appreciated by the large home crowd among all the delegates, particularly because the generosity of the American people has been key in the global fight against HIV/AIDS, especially in the badly affected areas of Central and Southern Africa. They not only fund the US President's Emergency Fund for AIDS Relief (PEPFAR) but also make the largest contribution of any country to the Global Fund to Fight AIDS, TB and Malaria (The Global Fund).
The high level political engagement at the conference was impressive. Both US President Obama and French President François Hollande gave personal video-linked addresses; and there were key note plenary lectures from US Secretary of State Hillary Clinton, former US President Bill Clinton and top-ranking officials from the US administration. The presidents and directors of all the top institutions involved in the fight against HIV/AIDS -- WHO, UNAIDS, UNICEF, the World Bank and the Global Fund -- were at the conference and spoke at various sessions and symposia.
The key message was that the strategic use of antiretroviral therapy for treatment --as well as prevention -- can enable us to get on top of the epidemic. In the context of global economic problems, the challenge will be to make the business case for this approach, to secure the upfront funding and to work out how to deliver decentralised treatment to the large numbers of people living with HIV who will become eligible for therapy under the new criteria.
The UNAIDS/WHO new flagship paradigm "Treatment 2.0" is the platform for providing this therapy, but each country needs to work out the details of implementation. There were strong calls from many quarters for good data systems, better strategic information and operational research.
Another positive sign was that tuberculosis had a good profile at the meeting, with important recognition that 25% of deaths in people living with HIV globally are due to this infection. It was clear that attention needs to be paid to TB if UNAIDS and WHO's "Three Zeros" – 0 new HIV infections, 0 stigma and discrimination and 0 AIDS-related deaths -- are to be attained by 2015.
A good Chinese proverb shown by Bernhard Schwartlander of UNAIDS summed it up well: "Those who don't believe should stand aside for those who are doing it!"
Prof Anthony D Harries