2012 U.S. Conference on AIDS: Highlights from Pre-Conference Summit to End the HIV/AIDS Epidemic in America
In advance of the annual U.S. Conference on AIDS (USCA), approximately 150 people gathered in Las Vegas over the weekend for the Summit to End the HIV/AIDS Epidemic in America. The two-day event was organized by the National Minority AIDS Council (NMAC), the host of USCA, and attended by executive directors of community-based organizations from across the country along with senior state and local health department staff, and several leaders from community health centers.
The Summit opened with presentations by Dr. Julio Montaner and Dr. Ron Valdiserri. They set the stage for the discussions that followed with important ideas about the implications of game-changing advances in our understanding of the benefits of biomedical prevention and some principles for achieving an AIDS-free generation.
Dr. Montaner, Professor of Medicine at the University of British Columbia and Director of the British Columbia Center for Excellence in HIV/AIDS, made the case that treatment as prevention is the key to an AIDS-free generation. Sharing the science behind the concept with examples from the experience of British Columbia, which has seen significant reductions in new HIV infections as they have scaled up HIV treatment efforts, he noted that the primary benefit of earlier HIV treatment initiation is the reduction of morbidity and mortality among people living with HIV. The well documented secondary benefit—the significant reduction HIV transmission as demonstrated by the HPTN 052 study and others—is not only huge, he argued, but also “free”. Achieving these benefits is not simple, Dr. Montaner acknowledged. The difficult part, he noted, is plugging the leaks in the treatment cascade so that a greater number of people living with HIV are linked to and retained in care, initiate antiretroviral treatment, and achieve a suppressed viral load. He shared the BC version of the cascade and observed candidly that we don’t yet know exactly how plug all of those leaks fully and well. But, he urged the participants to agree that the cascade serves as the best way to measure the success of HIV programs and should be used as the “standard report card for all of our programs.” He recognized important roles for community-based organizations in addressing the leaks in the cascade, noting that there is only so much that health care providers can do. Those roles include addressing HIV-related stigma, discrimination and, in some cases, criminalization that complicate efforts to prevent, diagnose and treat HIV. He also cited the important role of CBO support of patient navigation activities.
Dr. Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services, discussed several principles for achieving an AIDS-free generation. He illustrated each principle with examples from recent HIV research and in so doing highlighted possible approaches for community based organizations and other partners to examine as they work to assess and, possibly, re-tool their roles in helping to end HIV/AIDS in America. Among the principles he shared was “Engage communities in finding solutions to HIV/AIDS.” To illustrate the principle, he discussed highlights from two studies demonstrating the efficacy of community-based, non-clinical approaches to improving HIV care access and treatment adherence. Echoing, in part, Dr. Montaner’s call, another principle articulated by Dr. Valdiserri was “Engineer systems to incorporate emerging research findings.” On this, he quoted NMAC’s Executive Director, Mr. Paul Kawata who has said, “It’s time to adapt…HIV prevention is changing…CBOs must change their service models to adapt.” Dr. Valdiserri noted that it is not only CBOs that must adapt, but all of the systems involved in the response to HIV – federal, state and local governments, clinical care settings, and others – all need to make changes to adapt to significant recent scientific advances in HIV prevention and treatment.
The Summit also featured the release of the “Declaration to END HIV/AIDS in America.” NMAC facilitated development of the Declaration by convening a blue ribbon panel, which included representatives from more than 100 community‐based, public, and private organizations as well as governmental leaders and people living with HIV/AIDS. The Declaration discusses how to translate groundbreaking policy and science developments into an end to HIV/AIDS. Dr. Benny Primm, a founder and Chair Emeritus of NMAC, invited the participants to sign the declaration, rededicating themselves to the mission of ending HIV/AIDS in America and to implement that commitment through all they do when they return to work at their organizations following USCA.
Over the remainder of the two-day Summit, the participants heard from a number of other thought leaders on key topics: HIV testing and diagnosis; linkage and access to care; retention in care; and treatment. The HIV leaders from across the country participating in the Summit held several rounds of intensive, in-depth small group conversations to unpack what the thought leaders were sharing and discus their own experiences and concerns as they reflected on how they and their organizations will move forward in revitalized ways to better serve their communities and help bring us closer to ending HIV/AIDS in America