Midway through the 20th International AIDS Conference (AIDS 2014), stigma and discrimination loom large as culprits, while funding concerns -- whether it's how to get more, or how to do a better job with what we've got -- remain very much in the mix.
With more and more webcasts of conference proceedings appearing, we'll soon have worldwide analysis and commentary from eager eyes and dedicated brains. In the meantime, here's a mix of what's popping up on our screens. You can find much more at TheBodyPRO.com's AIDS 2014 conference coverage page, on the AIDS 2014 YouTube channel, and beyond ...
Across the Planet but Not Off the Agenda: HIV in the U.S.
The HIV epidemic in the U.S. is not a focal topic for AIDS 2014, as opposed to the last conference, which was held in Washington, D.C., in 2012 and drew thousands to a civil disobedience protest at the White House. But whether it's the active presence of U.S. based people living with HIV, advocates and researchers (and one ex-president, Bill Clinton), or new data from the U.S. epidemic, the nation may be across the world from the conference, but it's not off the agenda.
In our second video dispatch from Mark S. King, you can see the indefatigable anti-HIV-criminalization activist Edwin Bernard gave a shoutout to U.S. activists for coming from behind to force some real progress against U.S. criminalization practices.
Here's a few quick hits on some other ways the U.S. has popped up in Melbourne:
CDC: "Unequal Progress and Cause for Concern" About U.S. Youth
In June, the U.S. Centers for Disease Control and Prevention (CDC) issued a Morbidity and Mortality Weekly Report (MMWR) focused on the most recent Youth Risk Behavioral Surveillance survey (YRBS), showing that fewer teens were having sex, and fewer of them were using condoms.
CDC dove back into the 12 years of YRBS data for AIDS 2014, with Laura Kann, Ph.D., head of the School-Based Surveillance Branch in CDC's Division of Adolescent and School Health, presenting on "Unequal Progress and Cause for Concern: Differences in HIV-Related Risk Behavior Trends Among Subgroups of U.S. Adolescents, 1991-2013."
As Kann explained to AIDS.gov, "only about 1 in 5, or 22%, of U.S. high school students that are sexually experienced have ever been tested for HIV."
Here's the rest of the scorecard:
- Overall, and in males and white students, total lifetime sex has gone down or leveled off, depending on period. But for female, black and Hispanic students, the prevalence of sex has increased.
- There's been less multiple partners for female, black and Hispanic students. But overall and among male and white students, this decreased in some periods, leveled off and then, in white students, increased in the last four years.
- Condom use went up from 1991 to 1999, but hasn't changed since then for males, white and Hispanic students, and has decreased among female and black students.
The abstract concluded that "while the gap has narrowed between white, black, and Hispanic students and some progress has been made in reducing HIV-related risk behaviors, decreases in condom use and unequal progress across sex and race/ethnicity subgroups is concerning and may help explain disproportionate rates of HIV infection among adolescents."
Neither this issue of the MMWR nor the AIDS 2014 data mention or analyze sexual identity of youth or their sexual contacts to look for differences between heterosexual, lesbian, gay or bisexual youth. That's because states, territories or local areas can decide whether or not to add optional questions about same-sex sexual contact and sexual identity. And many of them still chose not to, despite encouragement from CDC.
The "Mississippi Baby": Her Virus, and Her Region of the U.S.
Clearly, the implications of the reappearance of virus in the child known as the "Mississippi Baby" extend far beyond U.S. borders and could have global implications in the quest for a cure.
But at the heart of the story is one little girl whose contribution to scientific knowledge could save millions of lives, in an era in which cure research is finding its footing (and you can get an overview of cure-related presentations at AIDS 2014 by Anthony Fauci, M.D., and David Cooper, M.D., right here at TheBodyPRO.com).
Reporting on an update on the case at AIDS 2014, Gus Cairns of aidsmap.com noted that:
Phylogenetic testing showed that the HIV that had reappeared was identical to the HIV that had disappeared some 27 months earlier, and was 98% similar to her mother's HIV. This removed any lingering doubt that the girl might not actually have been infected in the first place but might simply have been passively carrying virus from her mother after being born. Its lack of genetic evolution from the previous sample also showed that it had not been replicating at a very low level in the girl's memory cells, but had probably been carried as a single piece of HIV DNA within a handful of memory cells, or even one cell, until some kind of immune stimulant such as another infection caused the cellular differentiation and the reappearance of an active infection.
The conference presentation confirmed that the child's viral load, under the influence of treatment, was rapidly dropping to undetectable.
But, having heard nothing about the Mississippi mother in the press coverage, several women living with HIV and perinatal care advocates in the U.S. have speculated that she may have lost custody of her child -- the fear of which, it has been shown, can actually keep low-income women and women of color away from prenatal care in the first place.
With direct relevance to the social and structural conditions in the U.S. South that may have led to the situation of a mother who cannot access or stay in care, Megan McLemore of Human Rights Watch took to the conference stage, saying that persistent and broad human rights violations in the U.S. South create an environment of risk.
As noted by TheBodyPRO.com editor Warren Tong, Human Rights Watch has been able to bring about changes on issues such as segregation of HIV-positive prisoners in Alabama and South Carolina, the use of condoms as evidence against sex workers in New Orleans, and access to clean syringes for drug users in North Carolina, but much remains to be done.
Meanwhile, though most of the HIV community's focus is in Australia this week, there are some other important stories happening here in the U.S. The courts have delivered conflicting rulings about whether tax funds can be used to subsidize Affordable Care Act (ACA) plans purchased on the Federal Exchange, and New York City appointed a devoted gay doctor who has brought HIV testing prevention to sex clubs and bathhouses as the new head of the city's massive Bureau of HIV/AIDS Prevention and Control.
The Lancet Launches Sex Work-Focused Issue -- And Sex Workers Lance AIDS 2014 Conference for Marginalization
The much-anticipated special issue of The Lancet on HIV and Sex Workers was released at the conference, along with a detailed infographic and a compelling bottom line:
Decriminalization of sex work could have the largest effect on the course of the HIV epidemic, averting 33%-46% of incident infections over the next decade through combined effects on violence, police harassment, safer work environments, and HIV transmission pathways.
The release and related panel at AIDS 2014 garnered much attention in the press -- but few stories spoke directly to sex workers at the conference, many of whom gathered for a pre-meeting on July 18 and 19, when they voiced frustrations and developed strategies:
As relayed by the Global Network of Sex Work Projects (NSWP), this "key population" weighed in on feeling marginalized by the conference process:
Although there is currently a loud, proud and unrepentant community of sex workers at IAC, sex workers, in addition to members of other highly marginalized communities, have reported that they feel systemically excluded from the conference. Delegates from many countries have stated that the conference organizers have been tokenistic, at best, in their commitment to the GIPA principles and the meaningful inclusion and representation of community activists. Sex workers from across the globe report having their abstracts rejected, being allotted only poster presentations rather than oral presentations and being allocated partial, if any, scholarship support to attend.
Clarissa, a Melbourne based sex worker said, "They give us little booths and a public area we are expected to be grateful for, but it feels like a space where anyone can come and ogle at us -- sex workers, drug users and other stigmatised groups, then talk about us in their big-wig plenary sessions as though they are experts on who we are and what our needs are. Sometimes, it feels like we put in so much time and effort for so little outcome. Some of the activists here have been saying the same things for years. We all know what the solutions to ending the HIV/AIDS epidemic is, so why aren't laws being changed, why don't people have access to safer sex and harm reduction prophylactics, and why aren't the community directing the response?"
Participants in the pre-conference released a consensus statement addressing biomedical issues, stigma and discrimination, human rights (including criminalization of HIV and sex work), migration, mobility and funding.
You May Think It's That ... but It's This!
Why even have an International AIDS Conference if all the answers are known, and everyone agrees? Here's just a few of the many examples of how the research, dialogue, dissent and debate at the conference shows that all may not be as it seems, or at least not for everyone.
We at the conference, and following it online, may see HIV/AIDS as central in our lives. But time and again, really listening to people living with HIV, or those at risk of HIV infection, reveals that it's just one of many concerns in their lives -- and it may be far down the list, or better understood as a consequence of the major concerns and challenges they face:
Is it a disease in a person, or a person with a disease? What should be our first concern? One tweeter, with enthusiasm that would be echoed by many at the conference and the worldwide effort, has a distinct preference, in her affirmation of the stance taken by Diane Havlir, M.D.:
The AIDS 2014 "Progress in the Fight" infographic from the Pharmaceutical Manufacturers Association of America (PhRMA) juxtaposes Arthur Ashe and Magic Johnson, and cites U.S.-only stats about decreases in perinatal transmission and AIDS deaths. Some activist leaders would have preferred that the perennial target would use a worldwide analysis, revealing that perinatal transmission is a persistent problem and death rates have not declined as drastically, which they say is in part due to global patents and the cost of drugs:
Or, on a related note:
Former U.S. President Bill Clinton: Unequivocal HIV/AIDS hero, or someone who could do more to change or challenge global systems that affect the epidemic? The start of his speech was delayed by protesters calling for a global financial transaction, or "Robin Hood" tax, to fund HIV treatment:
And finally, is it a condom, or is it fashion fodder to be fabricated into a frock? BuzzFeed captures the process and work of the perennial International AIDS Conference fashionista, Brazilian artist/designer/activist Adriana Bertini. Will a Truvada tank top be on display in 2016?
Julie "JD" Davids is the managing editor for TheBody.com and TheBodyPRO.com.