In Cape Town, HIV/AIDS takes centre stage… for 4 days… or longer ?

[17 July 2009 - 17h09]
[mis à jour le 25 August 2009 à 15h58]

In Cape Town, HIV/AIDS takes centre stage … for 4 days … or longer ?

Cape Town, built on the aptly named Cape of Good Hope will from tomorrow and for four days play host to 5,000 researchers, doctors and political and association representatives who are leading the battle against HIV/AIDS across the world. The choice of the South African political center is certainly very appropriate because around 22 million of the 33 million people in the world living with HIV live in sub-Saharan Africa. And according to UNAIDS, in 2007, 75% of deaths caused by the disease worldwide occurred in this region. And also because South Africa is paying the highest toll to HIV: 5.2 million South Africans out of a population of 46 million carry the virus…

The International Aids Society (IAS), which is co-organising the conference with the South African NGO Dira Sengwe has more than 13,000 agents in the fight against HIV in 188 countries. It is the principal organisation of AIDS professionals … and carries a great deal of weight in ensuring that the pandemic is treated as a global priority. For its part, Dira Sengwe reflects the emergence in South Africa of a movement of awareness that has allowed the country to break free from the denial in which it had been shut away during the final years of the last century.

Despite the undeniable advances made over the last ten or so years, the situation regarding HIV/AIDS is far from reassuring. True, the introduction of Highly Active Antiretroviral Therapy (HAART) has made it possible to consider HIV infection as a chronic disease rather than a short-term death sentence. Today, more remarkable advances are taking place: the introduction of the first integrase inhibitor has made it possible to control the proliferation of HIV more effectively. Along with reverse transcriptase and protease, integrase is the third enzyme essential for HIV to reproduce within the body. Two pharmaceutical giants – Pfizer and GSK – have come together to form an independent structure with a view to becoming the world leader in HIV/AIDS treatment. And in Canada, a team working with researchers from Florida has broken new ground in reaching the virus in its “reservoirs” – those places where it hides away out of reach of antiretroviral drugs. Targeted chemotherapy – like that used against certain forms of cancer – will make it possible to destroy the cells where the virus takes refuge … and this means that the virus itself will no longer be able to survive without this protection …

A lack of vigilance and intolerable inequalities

However effective current treatments may be, they are still inadequate. The protocols remain very demanding cause iatrogenic problems … and access to care varies greatly from one country to another and from one social class to another in many countries, even those that are highly developed. Moreover, in the more advantaged countries, the very effectiveness of these treatments is resulting in a slacker attitude towards preventative behaviour. The safe sex imperative is being followed less and less by young people and too much faith placed on the advantages of male circumcision…

On the treatment front, there is noticeable progress … but far short of real needs: in South Africa, for example, the number of victims with access to HAART increased 11-fold between 2004 and 2008 but only 550,000 patients benefit from this treatment out of the 5.2 million who are infected. Prevalence of the infection is also uneven. It ranges from 0.1% in the Far East (which is how international statistics refer to Eastern Asia) to 5% in Africa, with 0.3% (in western and central Europe), 0.8% (in eastern Europe) and 1.1% in the Caribbean. Average prevalence is 0.8% according to the most recent UNAIDS report.

The challenges are many. Coordinating care and prevention, combating inequalities and stigmatisation, prevention of mother-to-child transmission, etc. Participants at the Cape Town conference will also have to take into account the fact that although HIV is killing fewer people, tuberculosis is a rising peril for those suffering from HIV. In fact, TB “is the principal cause of disease and mortality among people living with HIV in Africa”, Alastair Reid of UNAIDS pointed out to the 8th International HIV/AIDS and Sexually Transmitted Infections Conference in Dakar, Senegal. This was last December, but the situation is still the same…

Source : Mc Gill University and University of Montréal, 21 June 2009; Human Sciences Research Council (South Africa), June 2009; UNAIDS, July 2009; IAS, 3 July 2009; from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009

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