Bertrand Audoin, antiguo director de IAS y actualmente vinculado a IAPAC-ONUSIDA, ofrecerá esta tarde una de las ponencias inaugurales del X Congreso GeSIDA: ‘The science behind strategy 90 90 90.
Do you think the global fight against HIV can achieve the 90-90-90 targets set by UNAIDS by 2020?
When looking at current figures and trends, most countries in Western Europe, the USA, Canada, and some countries in toher parts of the world will have achieved the 90-90-90 targets – which also means that most couintries in Africa and Asia, and some in South America, Central and Eastern Europe and the Pacific won’t.
In addition, we should take more data and components into account:
In countries that will globally have achieved 90-90-90, some parts of the same countries won’t; at the same time, some cities will have achieved 90-90-90 when the country they belong to won’t – as will probably be the case in Switzerland, the UK, Germany, the Netherlands and many other countries.
In places where 90-90-90 will be reached globally, we need desagregated data to show if these numbers are reached in all communities – if a place has reached that target but its sex workers, MSM, migrants or any other of its communities lies behind, what is the added value of having reached the global targets from an equality perspective?
This leads to another crucial component of our efforts: the fight against stigma and discrimination. If the number of new infection decreases in the MSM community in France, when at the same time the nulmber of homophobic assualts increases, how can we say we have won the battle? We know that stigma and discrimination, on top of being morally ujnacceptable in itself, leads to increased risk.
Lastly, 90-90-90 is not the end of the road, as stad in the Fast-Track Cities’ Paris Declaration: no one must be left behind, and 90-90-90 means we still have work to do to get as close as possible to 100-100-100.
What are the biggest barriers facing the fight against AIDS in order to reach those 2020 goals? In your opinion, what steps should be taken decisively to achieve them?
In Europe, the main barriers don’t lie in access to care and treatment, but in three other aspects of the fight:
Again, stigma and discrimination – if individuals or communities face stigma or are being discriminated, their access to testing, prevention, care and tretament is jeopardized. Why would you get tested if you fear being greeted by moralistic stances on your private life? How can you equally access treatment if decision-makers and care providers think that you somehow don’t deserve them? Health inequalities but we fought evrey day.
Political leadership – the Fast-Track Cities Initiative is enrolling political leaders in the fight agaisnt HIV again, one reason being that in many places, they haver been on the forefront fopr a lon,g time but rtarelmy acknowledged for their efforts. But what about national or provincial governments and congress members? IAPAC is partnering with UNITE to enrol more on our side, as we all know that no bold target will be acheived if political leaders don’t support the efforts.
The HIV environme,nt is also changing quickly. Today, we speak of global access to PrEP, self-tests, de-medicalization of HIV-related acts. These must not only bne discussed, they must be implemented as many scientific studies now show that they do make a real difference towards reaching the targets.
In order to achieve the UNAIDS 90-90-90 target, what role does science play (and has to play)? And the communication / awareness policies?
We must be clear: science provides the tools we need to achive the targets. The ground reason why we are disussing 90-90-90 today is because scientists discovered highly active and efficient treatements, and because scientific research puts its “seal of approval” on recent tools lkike PrEP and self-tests. All this would have been unacghievable without science. This reminds me of my friend Pf Barré-Sinoussi, Nobel prize laureate for the discovery of the HIV virus, who is involved today in cure research, but also in supporting HIV clinicians and communities in the implementation of these new tools. HIV scientists have always worked hand in hand with other stakeholders, and that’s what makes our movement as strong as it is.
This is also why awareness poilciies are needed more than ever. We need to move away from the 1990’s paradigm that HIV kills everyone quickly, treatements change all your life and the only prevention means is a condom. That was ture 20 years ago – campaigns need to show what the new paradigm is.
What is your opinion of the work that is being done in the fight against HIV in Spain?
I feel uncomfortable giving an outsider’s perspective on Spain. What I can say for sure is that IAPAC is lucky to work with very dedicated, well-informed and -connected, professional and responsive individuals and organizations at all levels. The role played by some clinicians, but also communities and NGOs in advancing the fight against HIV, and the fact that some HIV pioneers ara still deeply involved today, both make a real difference, and are a true sign that HIV is not a forgotten topic in Spain. IAPAC is hopeful that these efforts will translate into significant advancements.
Do you predict the emergence of a HIV functional cure in coming years? Do you think that this possible cure will be accessible in an equal way throughout the world?
I am not good at predictions – but looking qt the recent history of HIV treatments, the announcements that we are all waiting for in terms on monthy-lasqting injections, and all the efforts abnd budgets being put into cure research globally, it is clear that a functional cure could be discovered one day. Whether it will be in five or twenty years I think is impossible to say – that’s why we have to focus our ,edical and community efforts into a maximized use of existing tools aznd in overcoming moral barriers.
If we do that as we have always done, I am confident that, the day a cure is discovered, our movement will be strong enough to fight for an equal access to it for all – but again, take my word, that will be a fight!