GBD fuels discussion and debate at the International AIDS Conference

Published August 11, 2016

In June of 1981, the CDC reported five cases of Pneumocystis carinii pneumonia among previously healthy young men in Los Angeles. Thirty-five years later, and millions of words, thousands of scientific papers, and countless celebrities’ speeches later, AIDS has evolved from an obscure disease to a movement crossing medical, social, political, and economic boundaries.

Last month, Durban, South Africa was at the center of that movement. And the Institute for Health Metrics and Evaluation (IHME) was recognized among many of the nearly 20,000 delegates as an important and invaluable source of data and analysis influencing the movement. On July 19, IHME Associate Professor Dr. Haidong Wang presented at a press conference on the paper, “HIV 1980–2015: The Global Burden of Disease Study 2015,” which was published simultaneously in The Lancet HIV. Dr. Wang was the first author of the paper, which is the first Global Burden of Disease Study 2015 publication to be released.

The paper finds that while AIDS deaths are falling in most countries worldwide, the rate of new infections increased in several nations over the past decade, thereby threatening to undermine efforts to end the AIDS epidemic by 2030. Moreover, 74 countries saw increases in the age-standardized rate of new infections between 2005 and 2015, including Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico, and Russia.

In addition, new infections of HIV fell by an average of only 0.7 percent per year between 2005 and 2015, compared to the 2.7 percent drop per year between 1997 and 2005.

Professor Peter Piot, who is the director of the London School of Hygiene and Tropical Medicine and was the founding executive director of UNAIDS, also spoke at the press conference, sponsored by Lancet HIV.

“This study shows that the AIDS epidemic is not over by any means and that HIV/AIDS remains one of the biggest public health threats of our time,” Professor Piot said. “The continuing high rate of over 2 million new HIV infections represents a collective failure which must be addressed through intensified prevention efforts and continued investment in HIV vaccine research.”

Another panelist at the press conference, Nduku Kilonzo, director of the National AIDS Control Council of Kenya, spoke the following day at a special session, “Accelerating the Decline of the Burden and Incidence of HIV in Sub-Saharan Africa.” Bill Gates, co-chair of the Bill & Melinda Gates Foundation, gave the keynote address at that session. He remarked that if the goal to treat twice as many people with HIV is to be achieved, efficiency also must be doubled, since funding likely will not be doubled.

Efficiency in health facilities is the subject of a separate paper released July 20 and co-authored by IHME and collaborators from Action Africa Help-International in Kenya, the Infectious Diseases Research Collaboration in Uganda, and the University of Zambia in Zambia. That paper, published in BMC Medicine, concludes that health facilities in Kenya, Uganda, and Zambia could extend antiretroviral therapy (ART) to hundreds of thousands of people living with HIV if facilities improved the efficiency of service delivery.

“Improving efficiency can support major gains in expanding ART to people who need treatment, especially when funding is limited,” says IHME Assistant Professor Abraham Flaxman, senior author of the study. “Now we, as a global health community, need to figure out how.”

Indeed, figuring out how to meet the needs of those infected with and affected by HIV was the subject of discussions, debates, and protests at the conference in Durban.

“There are a lot of distractions – the economic turmoil, the Syrian crisis – to keep us from achieving our goal of an AIDS-free world,” Mr. Gates said according to the South African news service Health e-News. “Research funding has remained at the same level for the past eight or nine years … but funding will determine when we get [to an AIDS-free world].”

Sixteen years ago, Durban hosted the International AIDS Conference, seven years before IHME was established. And while some at the conference last month were hopeful the world truly will see the end of AIDS by 2030, it was apparent the world faces significant challenges in reaching that goal, especially as funding for research, medications, and services grows increasing competitive. What was also apparent is that IHME will play an increasingly prominent role in educating, enlightening, and inspiring policy-makers and other leaders pursuing that goal.