AIDS conference 2016: the gains, the gaps, the next global steps

As the 21st International AIDS Conference wraps up in Durban, South Africa, Professor Linda-Gail Bekker, incoming International AIDS Society President, talks to The Conversation Africa health and medicine editor Candice Bailey about what was achieved and what still needs to be done.

What are the three interventions or innovations that stand out at the conference in terms of taking the fight against HIV forward?

There has been exciting work about how we do treatment better to make sure we get to the 34 million who are infected. And that’s absolutely critical. We have to reach those 34 million people but we know that health systems, particularly in the sub-Saharan region, are struggling. So there was some wonderful work on differentiated models of care, how we can do business more effectively and efficiently and ways we can do the steps in the cascade more efficiently.

And I’ve loved some of the testing innovations. Addressing all the steps from testing is critical.

Secondly I’m passionate about primary prevention but I think we’ve got some gaps on how we can do it. I’m a great proponent of daily pre-exposure prophylaxis and I really think we should roll it out because it works. But I’m very excited about the prospect of what’s coming down the road in terms of less frequent dosing for pre-exposure prophylaxis.

Number three is a fresh approach to adolescents. This conference has reinvigorated the notion that we have to get adolescents to the table. We have done well, I think, in getting adolescents to be really well represented. And it works. You feel their voice.

The message I have heard here is that we need to have an integrated approach. We can’t just talk HIV treatment or just HIV prevention. It has to take into consideration structural issues, behavioural issues, rights, access – a lot of issues. And I think it becomes a model of how we really look after our adolescents around the world and HIV is a great catalyst within that.

Based on the discussions at the conference where are the gaps in the global HIV response?

At the moment it’s money. There is a horrible funding gap that we have to address. We had so much money when we didn’t have the tools. Now we have the tools and we don’t have the money. I feel desperate about that.

In 2000 we missed opportunities because we didn’t have our systems and our thinking right. I’m taking collective responsibility but there was a leadership gap and we lost lives because of that. Here we stand now and if we don’t act in the way that we should, we will have lots of lost lives and infections that we don’t have to. And I don’t want that on my record.

When we get help from Sir Elton John, Prince Harry, Princess Mabel from The Netherlands and Charlize Theron to shine a focus on this we are eternally grateful. We need help from everyone to carry the message that the job isn’t done. Otherwise we will miss the moment and we will have regrets. And I don’t want to be in that camp.

I am very pleased that the Replenishment of the Global Fund Conference is being held in Canada because I think the Prime Minister of Canada is really showing that he can get the job done. Justin Trudeau’s a great example of moving forward when he needs to move forward and doing uncomfortable things when they have to be done because it’s right. I have a sense that he does what’s right. So I’m excited about that because I think that’s important.

We have to keep showing people that it’s not only the right thing and the compassionate thing and the humane thing but that it makes good financial sense. We are bleeding where we don’t need to bleed in terms of finance. And if we can shut it down earlier we will do the world a favour.

What is the message that is coming out of this conference?

The job is not done. We have tools that can be deployed; we have a lot of work to do. We have the energy but this is not the time to not have the resources. It’s a collective global effort. And we’re excited.

Durban has re-energised the whole sense of community and engagement. Now we need the rest of the world to get on board. And I think we can do it. The optimism that I have felt here is real. But the reality is that if we don’t move forward from today that trajectory will flatten out.

As incoming International AIDS Society president what would you like your legacy to be?

I think the tagline of the conference is the legacy: access and equity and making sure no-one is left behind. The best bang we can get for our buck is that we don’t make HIV languish because in the long term it will cost more. If we want to see a good response we have to be speedy about it.

Traditionally this conference has not always been the place where new science is shown. But it was brought to our attention beautifully that there is hope in vaccines and there is hope in treatment remission and so the ongoing innovation is still critical. We can talk about minimising disease and reducing statistics but if we really want to talk about eradication, we are going to have to find ourselves a vaccine that works. That is the ultimate investment.

I’m so excited that my country is playing such a significant role in that solution. I’m really proud to be South African. We have 54 million people in a very big world of people but we are playing a significant role. We have made lemonade out of lemons.

We have the biggest burden. In some ways we were the pariah in 2000 – we were failing on so many levels. But we have changed that and we are contributing, we are not only surviving and that is an extraordinary privileged position to be in. And I’m hoping young people in South Africa will get that and will get on board. It’s a mission and we are all looking for a mission. We fought for our freedom and now we are fighting for our futures and that’s significant.