Global AIDS Policy Watch (GAPW), with focus on countries in the Global South, expresses its position within the global epidemic response in regards to the Vancouver Consensus announcement, released at the 8th International Conference on Pathogenesis, Treatment and Prevention of HIV (IAS, 2015), held from 19-22 July 2015 in Vancouver, Canada – as well as in regards to the recent article on the Strategic Timing of Antiretroviral Therapy study, also known as the START study published by the National Institute of Health of the United States (NHI) in May. (Read Spanish version)
We consider both documents with caution:
- We recognize the important achievement of studies, such START, which show evidence that starting treatment at the moment of HIV diagnosis more than doubles the survival chances of those living with HIV. Despite the scientific evidence, and the impact of these results on ending the epidemic, we caution that in the present global situation, there is little chance of this goal being met, especially, if we consider what resources are currently available. Regrettably, there is a tendency to oversimplify both global financing and the commitment of international leadership in order to create responses to the epidemic on a global scale. If we have, in fact, arrived at this clear scientific advancement, and are close to the end of the global epidemic, who will front the bill for all of this? In addition to enthusiastic declarations, the world needs concrete political proposals that show the steps necessary to realize the promises of these new scientific facts in practice.
- We recognize the significance of the Vancouver Consensus in emphasizing that “barriers to access in law, policy, and bias must be confronted and dismantled”. We regret, however, that the document does not specify how these barriers should be addressed in order to establish true progress in the global response to the epidemic. In several countries, the legal status of homosexuality is a threat to HIV prevention policies. In addition to this, there are regions in the world where the criminalization of both prostitution and drug-use constitutes a real obstacle in confronting HIV and AIDS. Another troubling factor is the criminalization of HIV transmission in some nations, which irrationally limits the efforts of public health. We reiterate that the Vancouver Consensus would have created a more effective contribution if it had chosen to be more precise in addressing these specific barriers.
- We agree with the Vancouver Consensus’s declaration that “all people, regardless of social or legal status, race, gender or geography must have access to effective treatment and prevention”. Despite this declaration, the document makes no explicit mention of sexual orientation, nor any demand at all for LGBT inclusion, which is one of the groups most affected by the epidemic. We underscore the necessity of civil society’s mobilization, full participation, and leadership in the fight for access to both treatment and prevention.
- We call special attention to the high price of medication. We remember that it was the reduction of costs that allowed for the nearly 15 million individuals globally to be on treatment, but there remain nearly 20 million on the planet without access. We reiterate that patents are still the principal agents responsible for these barriers in access to medication, especially in the Global South. We observe that is critical to adopt successful universal access to medication models, as well as demand patents be broken in order to garnish access to strategic medications and ensure that, particularly, the Global South may have access to effective first-line treatments.
- Ultimately, we underscore that it is imperative that all nations immediately and aggressively address the persistent political, social, economic, cultural, and any other structural barriers to both diagnosis and treatment as well as to prevention. It is equally imperative for governments to strengthen partnerships with civil society and with communities, especially those most affected by HIV – in order to guarantee the benefits so clearly documented in the scientific presentations in Vancouver are able to reach all individuals in the world who live with HIV, or who are vulnerable to and suffer the consequences of HIV. We stress that is also especially necessary to strengthen and reinforce existing national public health systems for the effective intake and retention of those diagnosed with HIV so that they may have sustained access to treatment and care.
- We also stress that it is imperative that those international institutions responsible for commitments to fund the Global Fund (one of the principle mechanisms financing the global AIDS response) reaffirm their agreements to allocate the resources necessary to allow the nearly 20 million HIV- positive people in the world to have access to treatment. It is essential that concrete policies and actions be created for immediate implementation in order to guarantee the access to treatment, care, and prevention for all.
Rio de Janeiro, 28 July 2015.