XVI International AIDS Conference, Toronto, Canada. 13-18 August 2006
The XVI International AIDS Conference is the largest meeting of its kind. This year around 24,000 people traveled to Toronto to choose from over 4000 studies covering all aspects of HIV including basic science, clinical science, epidemiology, prevention, behavioural and policy-related research. It is organised every two years by the International AIDS Society (IAS) and since 2000 has alternated between northern and southern countries.
The meeting also now reflects the urgency and inequalities of the global epidemic, and treatment access takes an increasingly high profile.
In this issue we report on durability of treatment in several access programmes and highlight several other aspects of treatment important in developing countries, especially paediatric treatment.
Much of the scientifically data was compressed into an extended Track B late-breaker session. This session included studies with several drugs with potential to treatment drug-resistant HIV including MK-010518 (an integrase inhibitor), maraviroc (a CCR5 inhibitor), TNX-355 (a monoclonal antibody), together with several lopinavir/r monotherapy studies and the head-to-head study between fosamprenavir and lopinavir/r. This generated an optimisim for pipeline drugs, supported by studies on darunavir (TMC-114) and etravirine (TMC-125), presented in the main meeting.
While it is unlikely that the title for the conference Time to Deliver – as with earlier meeting titles such as Bridging the Gap, Breaking the Silence and Access for All – will change the reality for most people living with HIV, the intention to focus on access issues is at the centre of the meeting.
Key lectures at the opening and closing ceremonies, together with many of the oral sessions, focused on treatment access. Stephen Lewis was one of the speakers to close the conference, giving his last speech as UN Ambassador for AIDS in Africa. He received a standing ovation, largely for broadening his talk to clear political and social concerns: the disproportionate of HIV on women, their own abysmal track record of equitable inclusion of women within the UN system, and political leadership most particularly from South Africa (see below).
However, while over 1.5 million people are now on treatment – half of the WHO target for the end of 2005 – most concerns about the goal of universal access by 2010, are linked to financial scale-up and sustainability. Repeated calls at the meeting were made for individual country to make clear national targets for their HIV programmes for 2010 due to be set by December 2006, but not so far released by any government.
Other speakers at the meeting highlighted again and again, that we have everything we need to stop HIV and to treat people already living with the virus; what we lack is political will for change, and in this we are all responsible for positions taken by our own governments.
Three community delegates were also given unprogrammed one minute slots to address the final closing ceremony. In perfect balance to the official positions driving towards access, Loon Gangte, from the Delhi Network of People Living with HIV was able to articulate a first-person demand that the audience would otherwise never have heard so clearly: we demand universal free access to all essential medicines.
Given that first line therapy has only been possible because of generic manufacturers, and that newer drugs for second-line therapy are barely available and linked to new restrictions on patent use, he continued when you sign free trade agreements, you sign away our lives.
Some of the excellent general sessions, debates and press conferences are also available online as;
Webcasts, podcasts and transcriptions by Kaisernetwork.org.
The conference website includes abstracts for all presentations, and powerpoint slides from many studies. These are available by viewing the online conference programme, and following the link to the session in which the study was presented.
Abstracts for all presentations
Our own reports relating to clinical studies from the conference covered in this issue of HTB.