Epidemiology

Upwards of 25,000 policy makers, community activists, healthcare workers and researchers gathered last week in Vienna for the XVIII International AIDS Conference. 

Before flying to Vienna, Wafaa El-Sadr, MD, Director of the International Center for AIDS Care and Treatment Program (ICAP) and one of the conference organizers, sat down for a Q&A with Claudia Wallis, the Mailman School’s Associate Dean for Communications, to discuss growing divides within the AIDS community, the global healthcare community, and HIV challenges in the U.S.

Q: You have an editorial in Science that says there are some important people missing from this year’s conference. Could you explain that?
A: Over the past several years, the conference has become much more inclusive with more and more disciplines. But, many scientists and researchers now refrain from attending this conference, which is very unfortunate because their presence is really necessary and important.

Q: Why would the scientists opt out of this forum?
A: In the early years of the epidemic, AIDS was a mystery disease, and there was a lot of interest – particularly by scientists – to discover what caused AIDS, how to diagnose it, and how to treat it. As HIV became a chronic disease, the focus of these meetings shifted to providing access to care. And with that came a perception that there is no need for discovery or new knowledge, thus no need for scientists to be at this meeting.

But, of course, there are many unanswered questions. We don’t have a vaccine yet. We don’t have a cure for HIV yet. So it is very important for these scientists to come to the conference.

Q: You are going to be presenting at the conference about “Bridging the Divide.” Can you explain more about that?
We are co-sponsoring with the International AIDS Society and the Global Fund a pre-meeting around the theme of bridging the divide which will bring together researchers from different disciplines to debate the issues and identify common questions, pathways and strategies.

Another divide that we aim to bridge is the divide between people who do HIV work and people who work in other areas of public health like maternal-child health or infant mortality.

Q: This is a heated issue. Some people argue that HIV/AIDS gets too large a slice of a limited pie of health resources, foreign aid, and attention. 
It’s a very real dilemma. It’s a challenge, and we need to work together to identify common problems and come up with common solutions using the very limited resources at hand.

Q: Are there examples where funding of HIV/AIDS programs helped deliver actual measureable results in other areas of health like maternal health?
There’s some evidence that HIV work to prevent of mother-to-child transmission has resulted in higher quality prenatal care for all babies; that laboratory infrastructure, which has largely been supported by HIV funding, has helped clinics’ non-HIV patients; and that the systems designed to procure HIV medications have helped to deliver medications for other conditions.

In reality, we need more research to really understand the impact of HIV on non-HIV conditions and health systems as well as to understand the impact of the investment in people who deliver HIV services and their impact on the delivery of other services.

Q: It sounds like a very complicated cost-benefit analysis question, yes?
It’s quite complex. But we’ve observed that when projects have a positive impact on people with HIV you decrease the number of people in the hospitals and clinics, so you increase the quality of services that other people are receiving.

One also has to remember that HIV has had a huge impact on the healthcare workforce. HIV has killed many nurses, doctors, and teachers and by saving the lives of these individuals, it’s really saving a precious workforce and a huge resource for many of the poorest countries in the world.

Q: Let me switch gears and ask you about AIDS right here in the US.
A: Over the past decade, the number of newly infected people with HIV has not changed. So we’ve made no real progress over the past decade.

Today, the HIV epidemic in the U.S. is largely hidden and largely affects vulnerable populations like minority communities, particularly African-Americans and Hispanics, and also affects men-who-have-sex-with-men (MSM), another disenfranchised group in our country. The trends are alarming for MSM – particularly amongst black men. Within this population, the rates rival the rates in many countries of sub-Saharan Africa.

Unfortunately the population at large doesn’t see it and believes that it’s gone. That’s a mistake and it’s quite tragic.

Q: Returning to the global conference,  what outcomes are you hoping for?
A continued sense of urgency – the emergency continues. There are thousands if not millions of people still getting infected around the world. There are millions who are dying, both children and adults.  It’s not over.

July 28, 2010