Reflections from the International AIDS Society Conference

The 2018 International AIDS Society Conference (IAS) provided the ideal platform to check our progress toward ending the HIV/AIDS pandemic. This year, we felt a shared urgency with our global partners to move quicker and smarter toward our mutual goal.

As Dr. Anthony Fauci, my colleague at the National Institute of Allergy and Infectious Diseases (NIAID), reminds us, we now have the tools to stop HIV—if only we could get everyone to use them. The Lancet Commission report released just before the conference found that “the prevailing discourse on ending AIDS has bred a dangerous complacency” and possibly may have contributed to a weakening of global resolve to stop HIV.

More than half of people with HIV in the world are receiving treatment. But what about the remainder? What are we failing to do? And how will we move forward and fund the race to the finish line?

Faced with flat or declining resources, donor governments—the main source of funding for combatting HIV—must allocate existing resources as wisely as possible by constantly evaluating the most promising research areas and identifying research gaps to concentrate efforts accordingly. We must leverage opportunities such as engaging with civil society to better inform the work and scaling up programs while considering the role philanthropists can play locally and nationally.

While we take pride in the many scientific advances that have brought the epidemic to a turning point, more needs to be done to put an end to HIV, including new approaches with antiretroviral drugs such as pre-exposure prophylaxis (PrEP) to reduce the rate of transmission of HIV. This is of particular importance because having fully suppressed HIV is associated with no risk of transmission. This has led to significant drops in new HIV infections in places like San Francisco.

Studies presented at this year’s IAS conference serve as a testament to how far we have come in the fight against the disease. Two encouraging studies worth noting include:

• Treatment as Prevention: a study (PARTNER2) on 77,000 unprotected anal sex interactions among couples of gay men with mixed-HIV-status found zero transmissions of the virus when the HIV positive partner had an undetectable viral load.
• Vaccines: two-year results from a trial of the Imbokodo vaccine gave reason to hope for good results from more advanced research. It proved safe and prompted a broad and durable immune response to HIV. A Phase IIb trial is underway among women in Southern Africa. Conversely, news from two HIV cure studies were not as encouraging. A randomized cure trial which tested a “kick-and-kill” strategy in humans did not decrease the level of viral DNA in trial subjects. Results from another study indicated that an antibody treatment did not cause human participants to control the virus after ending all treatment, as it had in monkeys.

Although we have come far in just over three decades, we do not have another 30 years to get to the finish line. HIV continues to spread and 1.8 million people around the world become infected each year. There are challenges that we must overcome. For example—

• In Sub-Saharan Africa, the region with the greatest number of new HIV cases, the overall population is projected to increase by 50 percent to 1.8 billion by 2035—and to surpass 2.1 billion by 2050.
• Tens of millions of additional teens and young adults will be at risk of HIV exposure in the next decade.
• New infections are increasingly becoming drug-resistant, imposing added challenges and financial hardship on poor countries as the need for costlier second- and third-line treatments grows.
• The need for funding to address the pandemic will increase substantially while funding will remain level, at best.
• Stigma and discrimination remain great challenges for reaching many of those most likely to be infected with HIV—whether in Sub-Saharan Africa or the U.S. South, where recent spikes in new infections associated with injection drug use have been seen in rural communities.

We remain committed to research across all HIV research priority areas—and to catalyzing partnerships that can can help us achieve success. Community stakeholders who often have led the way in confronting the HIV pandemic remain key partners, and we need to continue to work smarter together to stop HIV. For example, an HIV vaccine generated in partnership would provide an effective prevention or therapeutic option that would be easier and more affordable to implement than current lifelong daily treatment for tens of millions of individuals globally.

Behavioral and social sciences research (BSSR) can help us better understand and provide prevention and treatment tools to more people. In addition, successful strategies can help avoid the stigma that keeps some people from using pre-exposure prophylaxis (PrEP) and other prevention or treatment modalities. Longer-lasting control of HIV—whether through medication-free remission or a cure—is feasible and worth exploring.

Overall, we are moving towards ending the HIV pandemic as a serious public health threat that reaches across all ages and geographic regions globally as well as improving the health outcomes of people living with HIV. We recognize the progress that has been made and are inspired to continue our work together to stop new HIV infections and care for those now living with the virus.

Maureen M. Goodenow, Ph.D.
Associate Director for AIDS Research and
Director, Office of AIDS Research
National Institutes of Health