7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)

MOPL01 Monday Plenary Session
  Plenary Session
Venue: Session Room 1
Time: 01.07.2013, 08:50 - 10:30
Co-Chairs: Christopher Lee, Malaysia
Elaine J. Abrams, United States
Marina Mahatir, Malaysia

Grant Presentation: Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Grant Programme
L. Bekker, South Africa
F. Barré-Sinoussi, France

Award Presentation: Women, Girls and HIV Investigator's Award
B. de Zalduondo, UNAIDS
F. Barré-Sinoussi, France

Achieving Universal Access and Moving towards Elimination of New HIV Infections in Cambodia
M. Chhi Vun, Cambodia

Paediatrics: The Transition from Adolescence to Adulthood
L. Bekker, South Africa

HIV, Law and Stigma
A. Ahmed, United States

Powerpoints presentations

Achieving Universal Access and Moving towards Elimination of New HIV Infections in Cambodia - Mean Chhi Vun

Paediatrics: The Transition from Adolescence to Adulthood - Linda-Gail Bekker

HIV, Law and Stigma - Aziza Ahmed

Rapporteur reports

Track B report by Jason Brophy

Dr.Linda-Gail Bekker of the Desmond Tutu HIV Centre in Capetown spoke about the challenges of caring for adolescents living with HIV. Two major populations of HIV-infected adolescents exist – those who were perinatally infected and have survived (with the roll-out of effective therapies) to adolescence, often unaware of their diagnosis and with significant treatment experience and residual effects of HIV disease; and those who acquired their infection later in life through sexual or other exposures, treatment naïve and aware of their diagnosis.  Both these groups, with their different needs, require transition to adult care. While many position statements advocate for coordinated, collaborative approaches to transition, there is little evidence to inform best practices and improve outcomes.  A number of transition clinic approaches and group-based support & skills-building programs have been implemented, and measurement of the impact of these programs is needed.  National programs and UNAIDS have been calledupon to create mechanisms to track perinatally and non-perinatally infectedyouth who transition in order to evaluate their treatment outcomes in adultcare, and ensure that they are not “lost in the crowd”.

Track D report by Elvin Geng

At the opening of the second day of the 2013 IAS conference, Dr. Mean Chhi Vun, who directs the national response to HIV/AIDS in Cambodia, described the remarkable success of the Cambodia’s response to HIV – a story which provides insights into strategies for successful implementation.  During this time, Cambodia has invested in a strong structural response: laws were revised to address human trafficking, a unified and centrally coordinate response was formulated, multisector engagement and community involvement were emphasized.  This strategy has led to impressive statistics in the macroscopic processes of health delivery:  high levels of condom use, high ART coverage for eligible patients (87%) and very high retention in care (89% at one year). Strong structures and processes have led to remarkable improvements in health outcomes. In the last 20 years, Cambodia has seen a 10-fold reduction in incidence (from > 20,000 infections /year to < 2000) and in the last 10 years, a 3 fold reduction of annual AIDS related deaths.   Although each national response is unique, Cambodia’s successes offer proof of concept that a post-conflict, low income country with a generalized epidemic can turn the tide, and offers hope for the future of the global response. 

Community Advisory Group report by Kevin Nicholas Baker


The aim of the ambitious goal in Cambodia is the virtual elimination of new HIV infections by 2020.  Three domains – population prevention, treatment as prevention and boost care services.

Cambodia will look to sharper epidemiological targeting to include more specific community groups.

MARP prevention and links to health services – try to reach the hidden population.  Rapid response mechanism will be introduced for these groups.

Want to simplify the referral systems and introducing the figure prick testing.  Make test and treat easier.

Challenges include reaching key affected populations and fragmented health systems.

The mobilizing of the community under a single command and control strategy is possible in a socialist state, but no less bold and remarkable for it. Focusing on speed, the Cambodian government has a target to eliminate HIV infection by 2020. They recognize that they face tremendous challenges, in particular to reach all segments of key affected populations (MSM, TG, IDU+partner).


Teens to grownups – falling through the cracks

Looking at health care for teens and the specific situation in relation to HIV.  6 critical steps to help transition from child to adult health care.  Plans should be developed with patient and family. Barriers include the health systems not wanting to let go.  The adult provider may not feel they have the relevant expertise.  This means it is not done very often – just 16% of adolescence in one study had a transition plan.

 3.4 million under 19-year olds are living with HIV today. 2 groups – perinatally infected youths and behaviorally infected youths.

The pediatric HIV legacy who have grown up with ARV in resource rich settings have experienced up to 7 types of ARV.

Coverage needs attention.  There are high levels of lost to follow-up and therefore leads to resistance. 

What is the impact of HC transition on HIV care – health systems, etc…

What does the health care facility need to provide – be more friendly and accessible.

Transition needs to continuous…often can happen quite late.  Should consider the maturity of the patient and start early.  Planning required participation by patient, family and health care provider.  It should also consider peer led services being available and services relating to the sexuality and gender identity of these adolescents.  What happens to HIV positive adolescents as they become more aware of their sexualities?

Concept – Lost in the crowd – lost to follow-up and how many children do actually transition.  There is a value to support and solidarity.  Clinicians should make transition attractive to adolescents.  Should be flexible.  Allow adolescences to express at their own opinions.

There are currently 180,000 children (<15 years) in the Asia Pacific region infected by HIV – do we know who they are and what they need?


HIV and the Law

Laws were created in fear of those who have HIV. Looks at the role of the law and how is can best be used and support the HIV response.

Criminal law as a barrier to health care service and delivery is a reality – it stops the delivery of much needed heath services and instead marginalizes and stigmaties PLHIV.  Laws that criminalise transmission target PLHIV – over 60 countries worldwide criminalise transmission.

Criminal laws on sex work also demonstrate and have consequences on the health of sex workers.  Over 116 countries have such laws.  Anti-trafficking laws also create barriers to HIV care and programming.  Criminalising the clients of sex workers are also not helpful and in fact make life more difficult for sex workers.

Laws that crimialise same sex sex and gender identity also impedes HIV work.

Laws that criminalise drug use also negatively affect HIV initiatives.  People who use drugs often suffer from the negative impacts of punitive laws and suffer stigma and discrimination.

Often HIV workers also suffer from the negative impact of the law – staff are under threat of arrest of harrassment.  This does not enable HIV services.

Woman and girls are also affected by the law – e.g. sexual and reproductive health rights suffers from abortion and other such laws.  Age of consent laws also negatively impact on health services for young people.

Laws also govern research and programming on HIV and the political and self-censorship that is linked to funding is ‘chilling’ – e.g. PEPFAR discriminated sex workers and drug users.  Anti-prostitution loyalty oath is another example of policy negatively impact on HIV programming.  This has now been struck down in US Supreme Court.

Stigma and discrimination beyond the law – enforced sterilization is an example of this and happens in many settings around the world.  According to Malaysian community young, unmarried girls are denied access to condoms and SRH services – this needs further action.

Examples of laws being disabled – India anti-sodomy laws


    The organizers reserve the right to amend the programme.