The 1st day of IAS 2009 in Cape Town was marked by much (though not exclusively) good news– and by how far South Africa and the rest of the world have progressed from the International AIDS conference in 2000 in Durban.
*For a start, conference co-chairman Dr Jerry Coovadia told me how the attendance of high-ranking politicians (deputy president, minister of health and director general) at the opening ceremony showed how the relationship between scientists and the state in South Africa had crossed a threshold and reached an “equable level”.
*At the plenary Dr Louise Kuhn reported how much prevention of mother-to-child-transmission had advanced since 1994 in saving infant lives, improving regimens, integrated care of mother and infants and lactation support.
But she said still only about 30% of the women who need it are covered and often by sub-optimal regimens.
*Dr Wafaa El-Sadr reported on a dramatic decrease in mortality among HIV-positive patients since 1996. The majority of these patients are growing old on antiretroviral treatment, but what’s discouraging is that they are dying of non-AIDS related diseases, such as cardiovascular, renal and hepatic complications. Inflammation associated with HIV (not the drugs) is thought to be contributing to this.
El-Sadr challenged the concept that people with HIV have a long period of “clinical latency”. She suggested instead that there is ongoing morbidity from HIV during this time, and argued that treatment needs to be initiated earlier for patients than the current system (CD4 counts of 250 and below in the public health system).
*Dr Gavin Churchyard, CEO of Aurum Health, reported exciting developments in the TB vaccine field, describing this as a time of “great promise’, with the release of new drugs, new vaccines and new diagnostic tools.
*Jerald Sadoff, president of the Aeras Global TB Vaccine Foundation, agreed that there was resurgence in the TB field – which is hugely significant for South Africa given that it has the greatest number of HIV infected patients with TB.
*Tony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US, said that President Barack Obama was committed to make sure that PEPFAR funding stayed high and that conditions for the funding – like abstinence promotion and restrictions on needle programmes – were being removed. He also said the US would be removing restrictions affecting people with HIV travelling to the States.
*The newly-appointed US Global AIDS co-ordinator Ambassador Eric Goosby said they were committed “not to give up on excellence or quality or urgency”.
*Dr Francois Venter, president of the HIV Clinicians Society of Southern Africa, said the model of universal voluntary testing and immediate antiretroviral treatment was one of the most exciting new ideas on prevention” (Story in The Times tomorrow).
*But underlying all these positive reports were two significant concerns: a crisis in global funding and the failure of world leaders to fulfil their promises; and the persistent failure to fully involve people living with HIV/AIDS in conferences like these – as pointed out by activist Paula Akugizibwe

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