At the biennial International AIDS Conference, HIV/AIDS researchers and professionals gather with policy makers, activists, persons living with HIV and other individuals committed to ending the pandemic, in an effort to raise resources and awareness around treatment and prevention.
Dr. Christopher C. Beyrer ’81 — an internationally renowned expert on AIDS and outgoing president of the world’s largest body of HIV professionals, the International AIDS Society (IAS) — chaired the 2016 conference, held this summer in Durban, South Africa, the site of the 2000 conference. Beyrer is the inaugural Desmond M. Tutu Professor in Public Health and Human Rights at Johns Hopkins University, with joint appointments in epidemiology, international health, health, behavior and society, and nursing. He is the founding director of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health; associate director of the Center for Global Health; and the co-principal investigator for the Johns Hopkins Center for AIDS Research.
Here, Beyrer reflects on the challenges that HIV/AIDS researchers and activists face, the successes of this year’s conference, and the message going forward: “We’re not done yet.”
What’s the significance of the International AIDS Conference returning to Durban 16 years later?
In 2000, we had effective therapy for HIV and clinical AIDS, but it was unavailable in much of the developing world and virtually unavailable in Africa. The conference that year produced a global consensus that this was unsustainable and morally wrong. In 2003, the global treatment era began with the UN Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief — that was a sea change in getting people on daily oral treatment for life.
Now, 16 years later, we’re back in South Africa, a country that had been in denial about HIV being the cause of AIDS, where it took many years to get treatment available. There are now more than three million people on antiviral treatment in the country. Having the conference there is a very powerful symbol that reflects the extraordinary commitment undertaken, not only in South Africa but across the continent.
But there are worrying trends we wanted to highlight this year. There’s the decline in global donor support — about a billion-dollar decrease in funding. We’ve also seen sustained incidents of new infections in adults, and trouble with primary prevention of the disease among gay men and men who have sex with men, sex workers, drug users, trans women. The big overall message of the conference is that we’re not done yet.
What progress did this year’s conference make in addressing the threats you mentioned in your introductory remarks — complacency, declining funding, neglected human rights and social justice?
The Second Durban Declaration lays out five principle challenges and five steps to address them. The critical issues are to (1) maintain and expand donor support; (2) be more strategic and efficient with the funds we have; (3) galvanize primary prevention; (4) get the remaining 20 million people living with HIV and not in treatment, into treatment; and (5) address human rights issues.
We have to put funds where they’re needed, in places with at-risk populations, instead of spending money on mass education campaigns of dubious value. We could strategically and effectively address new infections if we do a better job tailoring interventions, so we have to stop campaigns that are based on moralism instead of scientific evidence. For example, sex workers need prevention and treatment as a public health priority. What you see in country after country, though, is that they are excluded from services and have extraordinary rates of infection. In countries where injection drug use is heavily criminalized, you see ongoing and expanding epidemics. The new declaration uses the evidence of where we are now to argue that it’s much too early to declare victory.
Looking back on your tenure, and looking out into the future, what is your measure of success for the IAS and HIV/AIDS activism more broadly?
For me personally, leading the IAS — the largest professional body in the field — has been one of the great honors of my career. As a scientist, as an epidemiologist, I think our public health decisions and human rights decisions first and foremost ought to be based on evidence.
Second, as the first openly gay person to lead the IAS in its three decades, it was important for my tenure to put human rights, social justice and LGBT issues front and center — the evidence suggests we won’t be able to control this epidemic without doing so. My first long-term partner died in 1991– for seven years I was part of a discordant couple — and as a gay New Yorker, I buried a lot of friends and lovers. It’s important that those stories and perspectives are brought forward.
Third, we want to get HIV back into the global conversation around sustainable development and to some degree we’ve achieved that. I chose as my conference co-chair an outstanding South African scientist and the country’s first post-Apartheid health leader. Together, we emphasized the idea that the struggle for African women and girls, the most affected population on that continent, is the same struggle that gay men and other key populations are facing globally regarding access to care. This united front, this call on constituencies to join hands, is a powerful message.