Combination Prevention is the key ask at the AIDS 2008 Conference

by Finola Finnan, Programme Leader, Trócaire's Gender & HIV/AIDS Team.

AIDS 2008 is now well underway. It got off to a start officially on Sunday night and we were amongst the thousands who filed into the Auditorio National in torrential rain. Our spirits were lifted by the amazing Folkloric Ballet of Mexico and the inspirational messages from civil society activists and a host of government and UN leaders over the three hour session. AIDS 2008 is a huge event - twenty three thousand delegates are attending the conference and over 7000 different presentations will be delivered over the coming five days. It can be overwhelming and exhausting – we are lucky that a number of us are covering different events and different issues - Sally and Sandra from Central America, Deirdre, Caroline and I from Head Office, Jihad from EIFDDA in Ethiopia, Theresa and Bernadette from DRC.

The sessions cover diverse topics but the messages are consistent – all speak of the need for continued and accelerated action to turn the tide of the epidemic. There’s a consistent call for a scaled up response to prevention and to ensure that prevention is based on individual contexts and realities. The epidemic took hold firmly in the 1990’s when there was too little investment in AIDS globally and the practice failed to keep pace with the science. The new millennium saw a huge increase in global investment and initiatives and a scale up in treatment. These are finally bearing dividends but there is a real concern that we must maintain a level of leadership to sustain and improve on these advancements. Jeff O’Malley from UNDP spoke of “politics mattering as much as programmes”. The UNAIDS 2008 report published in advance of the conference indicates that the epidemic is stabilising. Some positive signals of change are emerging – treatment is reaching 3 million globally – one million of these in 2007 alone and the numbers of new infections are falling. But it’s not nearly enough – for every 2 people put on treatment, five become infected. 2.7 million people became infected with HIV last year and 33 million are still living with HIV globally. HIV still affects women and young girls disproportionately in sub-Saharan Africa and gender-based violence is pervasive in many cultures and women suffer disproportionately from stigma and discrimination– as one speaker commented – as if women don’t have enough to worry about.

At a session today on prevention – all the speakers spoke of the abysmal results despite 25 years of experience in the area. This conference is calling for Combination Prevention – moving beyond single solutions, recognising that people’s lives and risks are too complex to solve with a magic bullet. Thomas Coates from UCLA told us to bury the ABC and “to elevate the discussion beyond the incessant controversies on individual interventions”. The message is that we need to respond to the complexity of the epidemic and to take account of the behavioural, structural and political issues that affect people’s ability to protect themselves. We need a combination of options that are tailored to people’s needs, to learn by doing, to use what works well and use it more effectively. Programmes for particularly vulnerable groups such as sex workers, prisoners, drug users are a hot topic a the conference with debates on the effects of criminalisation, the stigma and discrimination faced by these most marginalized groups and the lack of services to meet their needs. They get a tiny proportion of the budget in some countries and are invisible in others.

And amongst all of this gender and human rights remain high on the agenda. Sessions on gender and gender-based violence are more visible at this conference than previous ones. The importance of addressing gender based violence and working with men to change cultural norms were stressed. We ended a busy day on a march to demand “All Women, All Rights” ending at the Zocolo, a majestic square in the city centre. The rain stayed away long enough to allow us to hear a young Australian 16 year old with HIV, a Mexican women’s activist, a Zimbabwean lawyer and Annie Lennox. Sadly Annie Lennox didn’t beat out an old Eurythmics song but she did woo the crowd with a rousing speech in Spanish demanding that women are given the rights and dignity they deserve to reach their potential and to protect themselves and their families from HIV and from violence. We left the square just as the skies opened and a four women country band in fluorescent gear took to the stage to head to a meeting of Catholic participants at the Jesuit Centre – I said it was diverse….. but more of that later and on Children and AIDS which is a key topic tomorrow.