I’m just back from AIDS 2014 in Melbourne, Australia and hoping it won’t be another conference relegated to the past, but a building block for forward momentum.
I’m just back from AIDS 2014 in Melbourne, Australia and hoping it won’t be another conference relegated to the past, but a building block for forward momentum.
One of the big issues discussed was stigma and the barrier it presents to people in getting the treatment and care that are their human right. Although stigma should be history by now, many key populations in the HIV epidemic are still not being reached because of prejudice they face again and again. Challenges that sex workers, men who have sex with men, people who inject drugs, transgender people and incarcerated populations face in accessing care, stem from social, cultural and political attitudes, including discrimination and punitive laws.
Also a big part of the conversation last week, at the world’s largest conference on AIDS, was the good news regarding available treatments for HIV and possible dreams about eradication of the virus by 2030. But despite these advances there is still a long and hard road to travel, particularly to provide services for key populations.
Scientific breakthroughs
Antiretroviral medication is now being provided to more people than ever before. In 2013 an additional 2.3 million people gained access to these life-saving medicines, according to the new UNAIDS report, bringing the total to almost 14 million people living with HIV who are now receiving antiretroviral therapy.
This scale up of HIV programmes has shown effective at turning the tide, reversing the spread of the virus as globally the numbers of new infections are going down. But, there’s always a but, this is far from being enough, and in certain key populations – such as young people the numbers are still rising.
HIV and HCV co-infection
HIV wasn’t the only disease taking center stage during the conference – hepatitis and tuberculosis also had their moment in the spotlight. Truly ground-breaking advances in new treatments for hepatitis C and tuberculosis, two of the main killers affecting people living with HIV worldwide, were presented.
I was excited to hear about the scientific breakthrough in hepatitis C, these new drugs, called DAA (direct acting antivirals), can definitely turn the tide of this killing disease, but sadly currently prices are absolutely unaffordable, even for rich countries.
I couldn’t help thinking of Mario, a loving husband and father of four children who works in a green grocery in Argentina. He has been living with HIV and hepatitis C (HCV) since 1990. He is still alive thanks to effective antiretroviral treatment for HIV, but he was not able to control HCV, even though he received treatment with Interferon and ribavirin a couple of years ago. Now his liver is not working properly. But he could be cured from HCV if only he could receive the new drugs.
Waiting for the revolution
But when they become available these new oral treatments will revolutionize the HCV context, opening the door to pan-genotypic, (meaning all different strains of the virus) well-tolerated regimens with high cure rates and radically shorter treatment duration.
It should now be possible in low and middle income countries to simplify and scale up treatment of hepatitis C. However, for government programmes to really address the true burden of the epidemic, new oral treatments must be affordable.
Research has shown these drugs could potentially cost less than $500 for a package of diagnosis and treatment, as stated in a passionate meeting by Dr Isabelle Meyer-Andrieux, HIV and hepatitis C medical advisor for MSF.
Market competition
Allowing market competition with generic drugs based on these revolutionary treatments is absolutely necessary to ensure reduction of prices and access for hepatitis C patients. Patent monopolies should not restrict treatment to only those who can afford to pay.
According to MSF, the World Health Organisation should be urged to include hepatitis C drugs in its pre-qualification programme. Furthermore, stakeholders such as PEPFAR or the Global Fund should include hepatitis B and C treatment as part of their funding priorities. We have to do better simply because Mario, as thousands of other people living with hepatitis C, just cannot wait that long.
Let us not miss this key opportunity to turn the tide of viral hepatitis. We need more advocacy, that’s true. More than 80 per cent of people living with hepatitis C do not know their status – and most of them belong to hard to reach key populations – so how can we expect advocacy and activism?
To start, we need to bring those most affected out from under the umbrella of stigma or we will never see the sun shine on our day of revolution – which we need if universal access to treatment is to be achieved.
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