Reflections on the International AIDS Conference and Taking a Look at Our Programs

With this issue of OUTReach, I would like to report on two items; the recent International AIDS Conference and the San Francisco AIDS Foundation's current review of its programs and services.

The richest source of information this year on HIV/AIDS was presented at the 16th International AIDS Conference in Toronto in August. The title of this AIDS Conference was "Time to Deliver" -- a theme reflecting acute awareness that, despite extensive talk and media focus on the impact of HIV globally, resources have yet to be made available to assure adequate HIV prevention and treatment in the hardest-hit places around the globe.

To be sure, there were no major advances announced in the basic science or treatment of HIV infection at this conference. Over the years, the International AIDS Conference has become known for its role in discussing broad issues in the epidemic, while the Conference on Retroviruses and Opportunistic Infections (CROI) has become the meeting at which significant scientific breakthroughs are announced. (The next CROI meeting will be held in February 2007.)

The International AIDS Conference focused on lessons learned and continuing challenges to the delivery of HIV prevention, care, and treatment in resource-limited nations. A great deal of discussion focused on the fact that the industrialized nations have made dramatic pledges of financial support for HIV-related programs, but have been slow to actually write checks to make good on their promises. This includes the United States, which has also made its contributions to the Global Fund contingent upon requirements that funds not be used to respond to sex workers and that prevention efforts promote abstinence from sex.

Nevertheless, contributions to the Global Fund and direct expenditures by certain nations and foundations have begun to positively impact the epidemic in sub-Saharan Africa. Data show that the numbers of people with HIV/AIDS receiving medications in Kenya, Tanzania, and Uganda are increasing at significant levels.

As its contribution to addressing the global HIV pandemic, the San Francisco AIDS Foundation operates the Pangaea Global AIDS Foundation, which brings lessons we have learned from our domestic work to bear on challenges in under-resourced nations. Pangaea delivers HIV treatment to remote areas of China and Ukraine, and soon to Ethiopia. One pilot project, in coordination with the Clinton Foundation, has already placed over 700 patients on HIV treatment in Yunnan province; 97 percent of these patients have achieved undetectable levels of HIV.

Despite their shared concern for the global epidemic, many Americans attending the International AIDS Conference were frustrated that very little attention was paid to the ongoing challenges posed by HIV/AIDS in industrialized nations, including the United States. In particular, there was a notable shortage of speakers or sessions discussing gay and other men who have sex with men (MSM). Given the continuing growth of new infections in this group, particularly among African American and Latino MSMs in the Americas, the omission felt negligent or intentional, or both. The anger and disappointment over this issue led organizers of the 17th International AIDS Conference, to be held in Mexico City in 2008, to commit to a significant focus on new strategies to deepen our success in preventing and treating HIV among gay and other MSM.

Our commitment at the San Francisco AIDS Foundation is to end the pandemic and human suffering caused by HIV at the local, national, and global levels. We are currently evaluating the way we conduct all of our programs to ensure that our prevention, client services, and public policy work are still built upon effective, evidence-based strategies.

We are also engaging in deep thought about how to have greater impact on leading indicators in the local epidemic that have not changed for some time. Rates of new infections remain relatively stable after many years, and the number of HIV-positive people who do not know that they are infected remains stable at 20 percent, as does the percentage of people who know they have HIV but are not in care or treatment. We are also considering the clear intersection between substance use and HIV infection and its impact on clinical outcomes for people who are HIV positive.

You will see our current evaluation process reflected in the upcoming media campaigns we conduct and in strengthened prevention programs and client services -- all built with the goal of eliminating new HIV infections in San Francisco and providing greater care to those already infected.

You are our partners in this work! I appreciate interacting with the readers of OUTReach and members of the community at large both about our current work at the AIDS Foundation and our evolving work. Please feel free to email me at mcloutier@sfaf.org if you have questions or concerns, or want to get involved.