Stepping Up the Pace: IAC 20 heads to Melbourne

When researchers, activists, health care providers, and policymakers convene in Melbourne, Australia, July 20–25, 2014, for the 20th International AIDS Conference (IAC), they will be asking themselves—and each other—what recent progress the world has made in understanding how to control, and potentially, cure, HIV/AIDS, and what it will take to accelerate efforts to reach the world’s most underserved populations with proven prevention and treatment strategies.

The conference theme, “Stepping Up the Pace,” serves as a call to action to hasten progress in scaling up life-saving HIV/AIDS services. It also recognizes the critical juncture at which the international AIDS community now finds itself. Even as promising new scientific breakthroughs advance hope that a cure for AIDS may be on the horizon, the fact remains that a considerable number of the 33 million people worldwide infected with, or at risk of being infected with, the human immunodeficiency virus (HIV) remain marginalized within existing outreach programs. There is growing evidence that the rapidity and scale at which governments implement comprehensive HIV/AIDS services—including prevention of mother to child transmission, pre-exposure prophylaxis, and long-term antiretroviral therapies—make a difference in how well they are able to control their epidemics. And there is concern that countries lagging behind in the introduction of services may miss important opportunities to manage the transmission of HIV. For all these reasons, the Global Committee that oversees the Geneva-based International AIDS Society, which organizes the biennial conferences, chose to emphasize the issue of pace at the 2014 event.

The 2014 theme builds on that of the 19th International AIDS Conference, “Turning the Tide Together,” which emphasized the potential for significant momentum in the quest for an “AIDS-Free Generation” if support for global AIDS programs did not falter in the context of financial crises and austerity measures. That conference, which met in Washington, DC, in July 2012, was notable for its size, high-level participation, and demonstration of bipartisan support for sustained U.S. leadership in the global fight against HIV/AIDS (See the 2012 CSIS report, Lessons Learned from AIDS 2012.) It was also the first time the international meeting had taken place in the United States since 1990, thanks to the 2009 lifting of the U.S. visa restrictions for HIV-infected travelers, which had been in place since 1987.

Expected to assemble over 14,000 people, the 2014 Melbourne conference will be the first time the IAC, the largest gathering of global health professionals in the world, meets in Australia. Its location recognizes the country’s bipartisan leadership in responding to HIV/AIDS domestically and internationally and offers an opportunity to engage stakeholders in Oceania and the Asia-Pacific region, particularly China and India, who may not have been able to travel to recent meetings in Washington, DC (2012), Vienna (2010), Mexico City (2008), and Toronto (2006). The last IAC to meet in the region took place in Bangkok in 2004. The Melbourne IAC will be cochaired by IAS president and Institut Pasteur researcher Françoise Barré-Sinoussi and Professor Sharon Lewin of Alfred Hospital and Monash University, and it will be the first IAC to be chaired entirely by women.

According to Lewin, “Hosting AIDS 2014 in Melbourne is an opportunity to focus international advocacy efforts on many issues which are critical for the Asia Pacific region, such as the scale-up of evidence-based prevention programs, and increasing access to life-saving treatment. AIDS 2014 in Melbourne will also showcase the significant success which characterise Australia's response to HIV, in particular our ‘partnership’ approach which actively involves key affected populations, scientists, policy makers and leadership in the development of our prevention, treatment and care services. Australia also has a strong commitment to using the best evidence to guide HIV policy and investing in science and innovation to accelerate the path to finding a cure and a vaccine.”

Work is still underway to finalize the plenary sessions and major topics within the program tracks focused on community, leadership and accountability, and science. However, a focus of the meeting is sure to be recent research advances toward a “cure” for AIDS. The reported cases of HIV-infected patients in Boston who have no detectable virus in their blood following stem cell transplants to treat lymphoma have sparked discussion of the potential to put patients into “remission.” Similarly, the reported cases of the HIV-infected Mississippi baby who was treated with antiretroviral drugs shortly after birth and is, one year later, still HIV free, as well as those of more than a dozen HIV-infected adults in France who have remained virus free after having been off antiretrovirals for nearly a decade, will be of keen interest.

According to IAS president-elect Chris Beyrer, professor at the Johns Hopkins University Bloomberg School of Public Health, the conference program will feature a heavy focus on recent scientific breakthroughs: “The cure landscape is rapidly evolving and changing. We will see compelling data on the cure research agenda at the meeting.”

Beyrer also noted that the Melbourne conference will have a focus on how to reach ethnic, tribal, and indigenous populations, which are routinely marginalized within health programs, with critical HIV/AIDS prevention and treatment services.

There will certainly be intensive debate, considering the extent to which debate has characterized nearly every IAC since researchers first met in Atlanta in 1985 to share information about a virus that was unknown just four years earlier. Organizers may decide to feature controversy over such issues as uptake of pre-exposure prophylaxis (PREP) within diverse populations or tiered drug pricing during formal, lunchtime sessions to allow for broad discussion of the issues, as well as audience participation. An emphasis on the importance of high-level political leadership is also likely; previous conferences have featured remarks by current and former heads of state and prominent parliamentarians, as well as philanthropists and celebrity advocates.

There may be a focus on Australia’s foreign policies, as well. Australia’s development assistance policies related to HIV/AIDS have not generated controversy in the way U.S. government restrictions on using federal funding for programs dealing with injection drug users or prostitution did in the past, but Australia’s strict immigration policies requiring HIV testing may provoke commentary and discussion. Australia had in recent years signaled its intent to increase its overseas development assistance through the country’s bilateral aid agency, AusAID, but in the context of Australia’s recent economic downturn newly elected Prime Minister Tony Abbott has vowed to cut foreign aid, merging AusAID with the Department of Foreign Affairs and Trade at the end of October and ending planned increases in the overseas aid budget. The recent news that the number of HIV infections in Australia rose 10 percent in 2012, the greatest annual increase in at least two decades, may also provoke commentary and debate.

U.S. government policies regarding HIV/AIDS and overseas assistance are always a topic of interest at the meetings. With the 2013 Institute of Medicine evaluation of PEPFAR, as well as a recent New England Journal of Medicine commentary raising questions about the timing and pace of the planned transitions of PEPFAR programs from broad program support to an emphasis on country ownership, reduced budgets, and technical assistance, conference attendees are likely to see discussion about how to ensure that the downsizing of U.S. programs does not leave patients in clinics formerly supported by PEPFAR without access to care or lifesaving medicines.

Building on the efforts of previous hosts, the organizers of the Melbourne conference plan to enhance opportunities for virtual participation to ensure those unable to travel to Australia can learn about recent progress in the HIV/AIDS field and make their voices heard. Donor support for the conference appears to be slightly down from previous years, in part due to concerns over the cost and scale of the meetings, which some critics feel have become unwieldy and unfocused. (See the 2012 CSIS report, The International AIDS Conference Returns to the United States.) Reduced support means there will be fewer funds available to support travel to the IAC, which may limit participation from developing countries.

To facilitate broad participation at AIDS 2014, the IAS has initiated a series of webinars to encourage those who wish to submit papers or posters to familiarize themselves with the application process. The abstract submission process opens on December 1, 2013, and closes on February 6, 2014. As the conference date approaches, participants can expect to see more detail about the high-level speakers, content of plenary sessions, and featured topics of debate on the conference website and in communications from the IAS.

The 21st IAC is scheduled to take place in Durban, South Africa, in 2016. Durban was the site of the 2000 International AIDS Conference, the first to be held in a developing country with a significant population of people living with HIV. It was the first of the International AIDS Conferences to feature considerable civil society engagement and a decisive moment in the development of global consensus for ensuring treatment for HIV-infected people living in developing countries.

Katherine Bliss is a senior associate with the Global Health Policy Center at the Center for Strategic and International Studies in Washington, DC.

Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).

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