XVIII International AIDS Conference

Tuesday Plenary TUPL01

Type:
Plenary Back
Location: SR 1
Schedule: 09:00 - 10:30, 20.07.2010
Code: TUPL01
Chairs: Jack Whitescarver, United States
Annie Lennox, United Kingdom
Jacob Gayle, United States
Webcast provided by The Kaiser Family Foundation



Presentations in this session:

08:55
TUPL0101
Slides with audio
Award Presentation: Women, Girls and HIV Investigator Prize; Winner: Naina Rani Mangalore, India


09:00
TUPL0102
Slides with audio
New Concepts in HIV/AIDS Pathogenesis: Implications for Interventions
Anthony Fauci, United States


09:25
TUPL0103
Slides with audio
Violence Against Women and Girls
Everjoice Win, Zimbabwe


09:50
TUPL0104
Slides with audio
Universal Access: Treatment and Prevention Scale-up
Aaron Motsoaledi, South Africa






Rapporteur reports

Track C report by Sabina Bindra BARNES


Tuesday’s plenaries held huge interest for Track D. Anthony Fauci deserves a mention for making the complexities of pathogenesis and the implications of different prevention methods clear for non-scientists. Everjoice Win (ActionAid International)  began with Tracy Chapman, to highlight the intersectionality of gender-based violence and HIV-infection for women . Win argued that women are not intrinsically vulnerable to gender-based violence, but are made vulnerable by the actions of perpetrators and society. Tracy would have approved. Win argued strongly against ‘heteronormativity’, and the exclusion of non-normative groups in HIV prevention. South Africa’s Health Minister Aaron Motsoaledi stated the commitment of his government to treatement and prevention. Amongst HIV+ women and under-5s, mortality has risen sharply, and TB deaths have risen by 338%. The South African National Strategic plan aims by 2011 to reduce by half HIV-infections, and to provide 80% treatment. Motsoaledi described this as ‘like climbing Mount Everest. But we have no choice’. The sound of vuvuzelas accompanied the massive applause. Frankly, we were all just delighted that he never mentioned lemons…

 




Track A report by Takafira MDULUZA


Dr Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases, NIH (USA) described the need to understand the early and complex pathogenic events that take place during early events of sexual exposure to HIV that may inform the development of HIV vaccines, assist in designing prevention intervention, point to early treatment need and aid in the search for cure. His motto for the presentation was: HIV pathogenesis research leads to important interventions. The presentation highlighted early events when the virus crosses the mucosal barrier leading to the spread of virus to lymphoid tissues and establishing viral reservoirs. This stage is essential in initiation and propagation of the HIV diseases and represents a window of opportunity that overlaps with a window of vulnerability of HIV infection for intervention.

A first concept underscored by Fauci was that sexual HIV-1 transmission is a highly inefficient process. Discordant couples illustrate this concept. Second, there is a viral genetic bottleneck: although HIV exists as a quasispecies (i.e. a warm of viruses closely related, but distinct one another) only one virus succeeds in the transmission (founder virus). From the homogeneity of the founder virus, highly sensitive to neutralization, a swarm of quasi species later emerge as consequent of both errors in reverse transcription and of the selective pressure of the immune response. As they diverge, the viruses N-linked glycosilation sites accumulate in V1/V2, at least in clades A and C viruses. This observation implies that HIV-1 transmission success is highly dependent upon these sites and brings into the picture the role of another receptor on the surface of leukocytes: the alpha4/beta7 (a4b7) integrin that retains leukocytes in the gut. A specific binding site for a4b7 was described by Fauci’s groups in the V2 region of gp120 Env. This integrin sticks out higher than CD4 and it is therefore more likely that it represents the first contact molecule with HIV virions. An independent study published in 2001, indeed described a profound depletion of a4b7 following primary HIV-1 infection (PHI). In vitro, CD4+ T cells expressing high levels of a4b7 are highly supportive of CCR5-dependent HIV-1 replication. In the rectal mucosa, there is a high degree of co-expression of CD4, CCR5 and a4b7 in activated/proliferating cells expressing the Ki67 marker.

The transmitting founder virus can bind to a4b7, while later viruses expressing glycans (as published by J. Overbaugh) interfere with this binding (glycan shield), as proven by the observation that removal of the glycosilation sites increases the binding up to 20-fold. Thus, the envelope conformation capable of the initial binding to the α4b7 on the mucosal CD4+ T cells should be considered as a target for HIV vaccine design.

There are multiple opportunities for intervention, Fauci concluded: condoms, microbicides and therapy for sexually transmitted diseases. Microbicides with Tenofovir work! Circumcision reduces the mucosal by cheratinization of the mucosal surface. Pre- and Post-exposure prophylaxis (PREP and PEP) work. New neutralizing antibodies have been recently described and are promising. Early initiation of ART during PHI (undetectable HIV DNA in 4/9 early treated vs. 11% observed in chronic patients) works!. The potential reduction of the viral reservoir, preservation of the immune function, increased possibility to cure is closer now than ever.

            In sum this session provided the overview that early events involved in HIV entry at the mucosal surface are complex and sensitive. Therefore, a better understanding of these events will reform design of vaccines




Track F report by Simona MERKINAITE


Of particular note for Track F in Tuesday’s plenary was the speech of Everjoice Win on violence against women. Win’s talk showed that we need to understand the underlying determinants of violence against women just we need to understand and address the underlying determinants of health.  Gender inequalities and the roles of gender in societies subject of women to vulnerability which prevents them from fighting for their rights. Public discourses still too often separate human rights from women’s rights, as if women are not the subject of rights. Cultural factors often over-ride the rights of women, but these should not and cannot be above universal human rights. And there are serious legal gaps. Many countries have human rights laws and practices, but lack legal protection for women and violence.

Win discussed the need to transform unequal power relations between men and women, and introducing the concept that HIV and violence reinforce each other. But less money is available for programs dealing with violence against women in the framework of HIV funding and there is a lack of consistent policy guidelines on behalf of key international HIV/AIDS agencies and donor organisations.

Health care providers must understand how the HIV/AIDS machinery itself can lead to violence against women due to lack of anonymity. Moreover, the specificities of risks facing women was highlighted by the fact that safe sex is often not the decision made by women themselves, which calls for new approaches in HIV prevention.

Yogan Pillay closed the session by emphasising that reaching universal access in South Africa required building more open, democratic and human rights based societies, including building more independent responses from international donors as sustainable health care system development.

 



Youth report by Onikepe Oluwadamilola OWOLABI


The first speaker started off talking about the science of the HIV virus, specifically its pathogenesis. He broke down the usually very technical details explaining the early stages of an infection and thus how effective the current preventive interventions are and the possibilities for new mechanisms such as circumcision, microbicides and a possible vaccine/cure.
Everjoice Win a South African female activist for violence against women, established that violence against women is a cause of HIV which in turn causes more violence against women. Quoting statistical figures and policy evaluations, she called on governments and policy makers to invest more research, policies and programs which acknowledge the human rights of women and girls and fight gender inequality in order to achieve our common goal of eliminating the scourge of HIV.
South Africa’s Minister of Health gave the last talk, speaking on their tremendous success in scaling up access to ARV’s and emphasizing Bill Clinton’s words that the fight against HIV is one which if won will help Africa achieve an overall improvement in their health systems and in the battle for other public health problems. He spoke out passionately against corruption in resource allocation concluding that Africa must become less dependent on international donors while we fight and refuse to submit to the ravages of HIV/AIDS.
 

Onikepe Oluwadamilola OWOLABI

 



Track D report by Lorraine SHERR


Tuesday’s plenaries held huge interest for Track D. Anthony Fauci deserves a mention for making the complexities of pathogenesis and the implications of different prevention methods clear for non-scientists. Everjoice Win (ActionAid International)  began with Tracy Chapman, to highlight the intersectionality of gender-based violence and HIV-infection for women . Win argued that women are not intrinsically vulnerable to gender-based violence, but are made vulnerable by the actions of perpetrators and society. Tracy would have approved. Win argued strongly against ‘heteronormativity’, and the exclusion of non-normative groups in HIV prevention. South Africa’s Health Minister Aaron Motsoaledi stated the commitment of his government to treatement and prevention. Amongst HIV+ women and under-5s, mortality has risen sharply, and TB deaths have risen by 338%. The South African National Strategic plan aims by 2011 to reduce by half HIV-infections, and to provide 80% treatment. Motsoaledi described this as ‘like climbing Mount Everest. But we have no choice’. The sound of vuvuzelas accompanied the massive applause. Frankly, we were all just delighted that he never mentioned lemons…
 




LAPC report by Nathan FORD


Everjoice Win, head of Women’s rights at ActionAIDS in Zimbabwe gave a powerful summary that highlighted the ways in which violence against women fuels HIV/AIDS. She reminded us of the statistics –more than one woman a week in Kenya is killed by her male partner, over a third of women in Egypt report being beaten by their husband at some point – before stressing that each of us has the power to change and reverse those statistics.

 
Violence against women, she made clear, is “endemic, systemic, and systematic…in all societies the root cause of violence against women is unequal power relations between women and men.”
 
Win made it clear that women are not a homogenous group; experiences of violence differ depending on: race, class, geography, caste, HIV status, sexual orientation, gender identity, and made a plea for the need to stop seeing women through a narrow lens: “Women are people, they are human, they are not just mothers, they are not just wives.” 
 
The only way the situation will improve, said Win, was if governments enact and implement stronger anti violence-against-women laws and uphold international human rights standards.  “Let no government claim ignorance that they have adopted all of these declarations in the last 15 years.” This, she said, requires much more financial support. To this end, she directed participants to the recent research done by the Women Wont Wait campaign released this week (www.womenwontwait.org)
The Honorable Minister of Health, Dr Aaron Matsolaedi from South Africa began by underscoring the importance of civil society in holding governments to account. ”I want to assure my colleagues in government from across the world that…Democracy and human rights are not a threat to government; they are the prerequisite for good governance.”
 
He spoke about the importance of political leaders own actions in encouraging efforts in country. “Leaders, starting with the President of the country, the Deputy President, myself and other ministers…took HIV tests to encourage testing and destigmatize testing. This has caught the imagination of South Africans with large numbers of people coming forward to be tested.” He went on to express confidence in that the massive effort to scale up testing in South Africa will lead to more people accessing treatment and prevention.
 
Dr Matsolaedi also underscored the importance of national governments’ own contribution to the HIV/AIDS response. “We recognize that South Africa is a middle-income country with developing country health performance and so we have committed to funding the majority of our health programme from within our own fiscus.”  Domestic resources fund some 83% of South Africa’s HIV programme. 
 
However, he stressed that the global effort to scale up HIV/AIDS prevention and treatment is under threat if funding dries up. “Our government believes that there needs to be greater donor investment in HIV if we are to ensure that millions of lives continue to be saved.” He went on to caution recipient governments to not squander or misuse the resources provided to them. “Corrupt officials must be prosecuted and in the long run Africa must become less dependent on international donors,” he said, concluding that “More resources are needed, and existing resources must be used more efficiently. Developed countries have a responsibility to mobilize resources for this effort and we call on them to embrace this responsibility.” 
 
Such funding must be a long-term commitment. “We cannot urge countries to make universal access a priority and then provide assistance for just one or two years!”
 



   

    The organizers reserve the right to amend the programme.


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