You could almost - almost - be forgiven for feeling like the biomedical developments in HIV have come to their hump-day.  Vaccines research hasn't been as successful as we had hoped, microbicides are good but not great. New drugs are refinements (and handy combinations) rather than truly novel compounds. Cure still seems so painfully far away - although there certainly has been progress announced this week - see https://theconversation.com/cancer-drug-promises-to-break-down-barrier-to-hiv-cure-47558 for some discussion.

We have excellent treatments, which we now know without doubt are good for patients, good for partners and good for the population. In Wednesday's morning plenary session, Mike Cohen emphasised his belief that there is now no justification for delaying therapy.  Long live test and treat.  Prevention studies continue to add weight to arguments for Treatment as Prevention and Pre-Exposure Prophylaxis. 

The Wednesday afternoon plenary session and Friday's session on migration were reminders to step back, and consider how lucky we are in Australasia, but that this is not universal.  HIV is a global disease; our 27,000 Australians living with HIV are but a tiny fraction of the 40 million people infected worldwide.  People in low and middle income countries are not only living with HIV, they are still dying from it.

 

Clearly this isn't because there aren't treatments as our local experience shows.

People are dying because of lack of access.

 

In the developed world, we have has some success in fighting legal discrimination against people with HIV;  this is not the case everywhere.  Laws criminalising homosexuality or injecting drug use can only act as a barrier to Test and Treat.  Thursday's session on Criminalisation highlighted the dangers posed by laws such as these. The HIV sector can stand tall for their efforts in fighting these laws - to improve health and to remove stigma.

An area of advocacy that, as a group, we often don't consider, however, is intellectual property and global trade.  Charles Chauvel from the United Nations Development Project gave an excellent talk on the risks of IP laws for global access to medication.

Antivirals are expensive; and rather than becoming cheaper, there is a very good chance that these IP laws, coming into effect as part of free trade agreements, will limit the development and availability of generic antivirals, which are so crucial the low and middle income countries.

 

Australia is a world-leader in HIV research. While we look to a cure, tantalising us on the horizon, we should all remember to pause and look back, so we can make sure that no one is left behind.