XVI International Conference Toronto Canada August 2006 Report Overview - Leadership - Treatment - Prevention - Socio-Economic issues - Policy - Address by Stephen Lewis - Key Challenges

Leadership - The need for and Adult/Youth partnership in the fight against HIV - The need for and Adult/Youth partnership in the fight against HIV - The importance of business leadership, especially through Business Coalitions - The importance of business leadership, especially through Business Coalitions - The importance community leadership - The importance community leadership - The need for the development of prerequisites for leadership - The need for the development of prerequisites for leadership - The need to mover from rhetoric to delivery - The need to mover from rhetoric to delivery - The need to set targets - The need to set targets - The need to id, and grow new leadership, especially amongst the youth. - The need to id, and grow new leadership, especially amongst the youth.

Treatment Treatment delayed = treatment denied Nutritional supplements may augment treatment success Where treatment is freely provided, programs are better There has been an improvement in women accessing treatment Non-adherance should not be used as a reason for slowing down treatment

Treatment cont To increase adherence, reduce the number of pills Might be a case for compliant triple drug patients, going onto single/mono therapy TB is the leading cause of death in Africa With 10% of patients developing drug resistance in some cohorts, DR is becoming a significant problem

Treatment cont The growth of Hepatitis C as a form of co- infection PMTCT Research – Conspicuous by its absence We cannot treat our way out of the epidemic, rather innovative ways of preventing new infections need to be found

Epidemiology and Prevention Uganda is seen as the example of how to respond at all levels. But data shows that there is no room for complacency There is a need to remove punitive sex legislation Drivers of the epidemic occur at a individual, community, country and global level The importance of VCT as a prevention gateway

Prevention cont The importance of MTCP – especially triple drug therapy 10% of the Global HIV population is amongst IDU’s – therefore need to focus upon needle exchange programs Need to focus more on infections amongst young men and women The importance of Pre exposure prophylaxis, including better condom use, and the development of microbicides. The need to further research the issue of circumcision.

Socio Economic Sciences The hidden epidemics - marginalized people, people in prison, mobile populations, displaced populations - marginalized people, people in prison, mobile populations, displaced populations Gender inequalities make ABC almost impossible ARV’s can be introduced in resource poor settings Knowledge gaps have tended to homogenize the epidemics – leading to one size fits all approach Sex cultures remain unexplored areas for research – especially risk taking

Socio Economic Sciences cont We need to look more closely at the historical context of HIV We need to look at new prevention technologies – eg microbicides, preventive and therapeutic vaccines, and other areas of research such as circumcision and anal microbicides.

Socio Economic Sciences cont Possible future research areas include: - the causes of homophobia, and issues raised by the provision of second line therapy The research agenda must be crafted with civil society, including PLWA’s, drawing on lived experiences.

Policy The need to put Human Rights at the center of the fight against HIV, and the universal access will not be achieved without the focus on HR’s Ensure that there is no conflict between HR, and Public health The key to solving the problem lies with groups who are presently seen to be driving the epidemic – msm’s, sex workers, migrants There is a lack of focus on the children – eg rights, access to information and condoms

Policy The need to decriminalize sex work The issue of the disempowerment of people living in prison The caution against overriding human rights in favor of routine testing. The condom gap – a human right? Needle Xchange for IDU’s Trade agreements

Stephen Lewis Address Abstinence does not work Governments being told what to do is a form of neo-colonialism Research into circumcision as a method of prevention should be promoted Growing excitement about micobicides MTCP should be at the top of the agenda Nutrition should run in parallel with ARV’s Insufficient focus on sexual violence

Key Challenges Accelerating research - Ethics of research amongst children - Ethics of research amongst children New treatments A time to measure Treatment as a form of prevention The need for universal access in the workplace Removal of stigma and criminalization