Don’t know what to look forward to in 2013? Try these:
A few international conferences will highlight the hottest areas of HIV research and activism in 2013:
1. IAS 2013 – The less-popular sibling of the International AIDS Conference that was held in Washington DC in 2012, the International AIDS Society’s Conference on HIV Pathogenesis, Treatment and Prevention will be held in Kuala Lumpur, Malaysia. Look for this conference to release the latest scientific findings on HIV, with this year’s special focus on HIV and substance abuse.
2. International Harm Reduction Conference - After an unintended break in 2012, IHRC is back and being hosted in Vilnius, Lithuania from June 9th to 13th. While harm reduction is by no means limited to HIV, this conference promises to focus on the “urgent need to provide sufficient political and financial support to address the HIV epidemic driven by injecting drug use in many parts of the world”. In contrast to IAS 2013, this event is sure to focus more on policy and advocacy.
3. TasP Workshop – While there has been – and promises to be – considerable buzz about “treatment as prevention” (TasP) at all international HIV gatherings, this dedicated meeting in Vancouver will provide the latest data coming through on TasP – particularly much-awaited information on cost-effectiveness.
The two single largest donors for global HIV programs have some big changes to face this year. Watch these closely, as their decisions in 2013 will affect the future of the HIV epidemic for years to come:
4. The New GFATM – We’ve all watched for over a year now as the Global Fund has flailed and attempted to right itself through changed leadership and revised policies. With a new director in place, and the Fund’s inspector general dismissed (note: no relation to this author), the GFATM undoubtedly looks to 2013 to be a fresh start. The biggest thing to watch will be how the new funding model is implemented, especially as more information on the future of funds becomes available in September 2013.
5. PEPFAR 3.0 – The current round of PEPFAR funding is authorized for 2008-2013, which means some big decisions will be made this year about the future of the funding mechanism. If it continues to exist as a stand-alone mechanism (most signs point to ‘yes’ on that), watch for whether the last vestiges of antiquated, conservative policies on abstinence, sex work, and promotion of needle/syringe exchange will be wiped away (sadly, most signs probably point to ‘no’ on that…).
The evidence base…
More important than any donor politics or international gathering will be the scientific progress made in 2013. Aside from the TasP data and harm reduction progress that are noted above, watch for initial data on these topics:
6. Expansion of PrEP – While it’s unlikely that we’ll see mass expansion of pre-exposure prophylaxis (PrEP) in low-resource settings anytime soon, watching its continued expansion in higher-resource settings and pilots in low-resource settings will provide an evidence base that can advise whether this is a cost-effective option for select individuals (e.g. sero-discordant couples) in countries receiving donor assistance.
7. Over-the-counter HIV Tests – Much like PrEP, it’s unlikely that home testing will be a trend that catches on across the globe anytime soon. But, with the FDA’s approval of over-the-counter home HIV tests in 2012, we should all be watching whether the availability of tests – however expensive – helps to reach populations that won’t be tested otherwise, and how newly diagnosed individuals link to care. Without new measures to expand access to and demand for HIV testing, we’re unlikely to be able to change the high percentage of people (UNAIDS reported 60% in 2011) who are unaware of their HIV positive status.
8. Stigma Reduction Measures That Actually Work – The Global Fund, UNAIDS, and PEPFAR – and just about anyone who’s ever worked a day on HIV/AIDS issues – all recognize stigma and discrimination reduction as a major priority for the future. But how to do this remains elusive; groups like the Stigma Project and the Stigma Index are hard at work both quantifying stigma and launching campaigns to combat it. Look for an increased emphasis on this from international donors and implementers alike, and hopefully, for some data we can put into our evidence base.
9. The Vaccine - The Holy Grail of HIV, an effective vaccine has been sought after since the earliest days of the HIV epidemic. With much frustration and many failures has come limited success in recent years; in 2009, the RV144 clinical trial in Thailand showed a candidate vaccine to reduce transmission by about 30%. Some speculate that 2013 might be the year of the big breakthrough: a Canadian vaccine has had positive early results in 2012, and with safety and tolerability given the OK in human trials, study participants have also shown an encouraging increase in HIV-1 antibodies. Could 2013 be the year that we can finally say that we have an effective HIV vaccine?
A happy and healthy 2013 to all – see you in the new year!