'the forgotten epidemic': world's largest hiv/aids conference will draw thousands to montreal
"community engagement makes science better and results of uptake better. we learned this from hiv.”
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say “pandemic” and most people think covid-19. yet hiv, which takes a life every minute, remains the deadliest pandemic of our time. according to the joint united nations programme on hiv/aids (unaids), an estimated 79 million people have become infected with hiv, the virus that causes aids. it still has no vaccine or cure, although 28 million of the 38 million people living with hiv today are on life-saving antiretroviral therapy that keeps them well by reducing the amount of virus in their bodies and preventing transmission. that means 10 million people are not.
hiv infections are rising in many countries and progress against new infections has slowed in others. more than four decades after aids was first reported in 1981, “we live in a world where hiv is the forgotten epidemic,” says the program describing the opening session of the world’s largest international meeting focusing on hiv/aids, the 24th international aids conference. the five-day meeting gets underway in montreal on friday.
that first session of aids 2022, as the conference is known, will explore “the mounting apathy” about hiv and consider “why and how the world must re-engage and follow the science” if the virus is to be overcome.
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aids 2022, the largest montreal conference this year, will have a hybrid format: it will bring 7,200 in-person delegates to the palais des congrès — masks are required — and another 800 people will participate virtually through an interactive platform. covid-19 meant the 2020 edition of the biennial conference was entirely virtual.
as hiv researchers and scientists pivoted to develop vaccines and treatments for covid-19, the speed with which they understood the coronavirus was directly related to their hiv research, said dr. marina klein, a professor in the department of medicine at mcgill university, research director in the chronic viral illness service of the mcgill university health centre and a conference speaker.
and the hiv research community “will bring back lessons from working on covid-19 to the hiv field,” she said. “this may have particular benefits for developing an hiv vaccine which, until now, despite decades of research, has been elusive.”
human clinical trials started this year for an experimental vaccine against hiv developed by moderna and the international aids vaccine initiative. it uses the same mrna technology as moderna’s successful covid-19 vaccine to build an immune response.
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“following the covid-19 vaccine discovery, we are closer than ever before to an effective hiv vaccine and even on a path toward a cure,” said aids 2022 co-chair dr. jean-pierre routy, clinical director of the chronic viral illness service at the muhc, louis lowenstein chair in hematology and oncology and senior scientist in the muhc research institute, and professor of medicine at mcgill. “if it works for one disease, it should work for another.”
but it is important to refocus attention on hiv, said routy, who is also co-director of the immunotherapy and vaccine core at the canadian institutes of health research (cihr) canadian hiv trials network.
as resources have been redirected to address the covid-19 pandemic, hiv testing and treatment rates have fallen, access to treatment and prevention services has been restricted, and health-care personnel and community organizations assisting those living with hiv are becoming exhausted, said klein, national co-director of the cihr canadian hiv trials network. without a concerted effort to scale interventions back up, and quickly, “we are quite concerned that progress that was being made will be significantly impacted,” she said.
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in 1989, when the international aids meeting was in montreal for the first time, protesters from community and activist groups took the stage and disrupted the opening ceremony. this mobilization “initiated a transformation of the relationship between medicine and society,” said montreal pride executive director simon gamache. “the voices of patients could no longer be ignored by scientists.”
that meeting provided ignition for “involving the community, of people living with hiv as a partner in the fight,” routy said, and now the conference is “a true partnership” between science and community.
a daylong pre-conference on thursday will gather scientists and people living with hiv at the institut de recherches cliniques de montréal.
in a prelude to montreal pride, which begins aug. 1 and overlaps with aids 2022, the festival will feature cultural events including rapture, a choreographic work intended as a tribute to people who have died of aids. the work “blends commemoration, pain and resilience and aims to remind us of the remarkable advances of the past decades,” gamache said.
“one of the big lessons from hiv is the importance of community engagement and community participation,” said dr. catherine hankins, professor of public and population health at mcgill, co-chair of canada’s covid-19 immunity task force and a conference participant. “it’s not just an add-on to the science. it makes the science better when there is co-creation of studies and joint oversight of studies.”
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in 2004, two trials of pre-exposure hiv prevention in sex workers in cambodia and cameroon were shut down because of inadequate community engagement “and we realized this would affect all prevention trials,” said hankins, who was chief scientific adviser to unaids in geneva from 2002 to 2012.
she convened a meeting and invited representatives of act up, an international grassroots political group working to end the aids pandemic, and what emerged was a need for community guidelines.
community engagement has spilled over into other conditions, including breast cancer, “with survivors being engaged and involved in conferences. i think people have understood that community engagement makes science better and results of uptake better,” hankins said. “we learned this from hiv.”
speakers at the aids 2022 conference will include dr. theresa tam, canada’s chief public health officer.
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although the covid-19 pandemic has greatly hampered efforts to tackle hiv, it has also led to innovation, she said. there was a shift to telemedicine in dealing with hiv, and concerns about pickup for antiretrovirals were addressed.
in a session hosted by global affairs canada, participants will reflect on efforts by the international community to respond to hiv/aids and on relevant lessons for the fight against covid-19 and future pandemics.
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speakers will include bob rae, canada’s ambassador to the united nations; dr. theresa tam, canada’s chief public health officer; unaids executive director winnie byanyima and matshidiso moeti, regional director for the world health organization in africa. the session will feature video remarks by dr. anthony fauci, director of the national institute of allergy and infectious diseases and chief medical adviser to u.s. president joe biden.
programming for aids 2022 was kept flexible to accommodate last-minute additions reflecting current issues, routy said. one is a session on public health management of monkeypox, to include dr. geneviève bergeron of montreal’s public health department. the monkeypox virus is spread through close skin-to-skin contact, and most confirmed cases have been among men who have sex with men.
public health officials announced in june that montreal was the epicentre of the monkeypox outbreak in north america. by mid-july, nearly 10,000 men in montreal and their health-care providers had received the smallpox vaccine, which is effective against monkeypox, and the vaccination campaign was extended to tourists.
“the good news in montreal is that the cases plateaued,” routy said.
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but on saturday, the who, which has received reports of more than 16,000 cases of monkeypox in 75 countries, declared monkeypox “a public health emergency of international concern.”
also added to the agenda was a session on the needs of refugees and others with hiv during armed conflicts like the war in ukraine. it will address, among other things, the difficulty of maintaining delivery of drugs for hiv treatment to areas under bombardment. dr. andriy klepikov, executive director of the alliance for public health in ukraine, will participate virtually from the besieged country.
in the run-up to aids 2022, a canadian coalition of community-based hiv and human rights organizations says domestic response to hiv has been under-resourced for years and that the federal government must increase funding substantially.
“since 2008, federal funding for hiv has been fixed at around $73 million per year,” said jody jollimore, executive director of the community-based research centre, part of the coalition. “meanwhile, the number of people living with hiv in canada has increased 25 per cent.”
the coalition has launched a campaign at hivfunding.ca, encouraging people to sign letters to federal health minister jean-yves duclos calling for an increase in funding to $100 million annually.
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indigenous and black canadians are disproportionately represented among new hiv infections, jollimore said, and more than half of all people living with hiv in canada are gay, bisexual and queer men.
at a glance
the 24th international aids conference takes place from friday, july 29 through tuesday, aug. 2. for more information, see aids2022.org.
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