International AIDS Society Leaders on the Future of HIV Prevention and Treatment

Over the past 18 months, the COVID-19 pandemic has brought the treatment and prevention of infectious diseases to center stage. For Dr. Adeeba Kamarulzaman, Dean of the Faculty of Medicine at University of Malaya in Kuala Lumpur, Malaysia, and Dr. Sharon Lewin, Professor of Medicine at the University of Melbourne in Melbourne, Australia, the pandemic offers an opportunity for the global health community to review its approach to HIV prevention and treatment and to plot a stronger course going forward.

Adeeba is president of the International AIDS Society, the world's largest association of HIV/AIDS professionals, and Sharon is president-elect and will assume the post next summer. On the heels of  the recent biennial IAS Conference on HIV Science, we spoke with the two experts about the intersection of COVID-19 and HIV and the ways to help bring an end to the epidemic.  

How has the pandemic impacted HIV care, and what have we learned?
Sharon: Without a doubt, gains have been lost with HIV, just as in every area of health sciences. Access to treatments, access to prevention strategies and testing rates - all of that was disrupted. But we will see investments in the diagnosis, treatment and prevention of all infectious diseases following COVID. After COVID, every country will have the capacity to do PCR (polymerase chain reaction) testing and every country will have the equipment for point of care PCR, which will greatly enhance access to HIV viral load tests. Once the pressure of COVID lessens, which it will, all of that infrastructure will be available for more timely diagnosis and monitoring of HIV, as well as other diseases, such as tuberculosis.

Adeeba: All the lessons that we learned during the pandemic can be utilized in our ongoing efforts in HIV. COVID-19 has shown the importance of community organizations and how they can help ensure there’s no disruption in prevention and treatment services. In addition, there are innovations that were brought to the forefront and that we should further study, such as telemedicine support and the ability to conduct self-testing. Both could be avenues for people with HIV who are reluctant to seek care.

What are the biggest global challenges in preventing and treating HIV?
Adeeba: Stigma and discrimination remain the Achilles heel of efforts to end the HIV epidemic. Within many conservative countries around the world, whether it’s people who use drugs, men who have sex with men, sex workers or transgender people, the challenges they face very much have to do with stigma and discrimination. Existing policies and laws that criminalize a lot of these behaviors further hamper treatment and prevention efforts.

Sharon: Helping end HIV depends on eliminating stigma as well as ensuring access to diagnostics and therapeutics. In 1989, at the beginning of the HIV epidemic, I worked in a small hospital in Kenya. We had no treatments to give to people and no one wanted to get tested because of the enormous stigma. Today, with 37 million people living with HIV around the world, stigma remains a significant barrier.

Where would you invest greater global resources in HIV research?
Adeeba: I hope to continue to shine a spotlight on the Asia Pacific region, as it isn’t where it needs to be in terms of the rate of decline in mortality or the rate of declining number of new infections. Strides in the region have not been as impressive as they have been in sub-Saharan Africa or other parts of the world. Part of the reason for that is the heterogeneity of the epidemic in Asia Pacific. So, a lot more work needs to be done.

Sharon: There's still room to commit to make more treatments for HIV, such as further researching implants and long-acting oral agents, and the key will be making these available for everyone. We should also focus on a cure strategy. As hard as that is, it could be transformational.

What do you think needs to be done to meet the United Nations’ 2030 goal of ending the AIDS epidemic?
Adeeba: We are three times behind the promised targets in terms of the number of new infections and we still have millions of people dying, therefore we need to utilize science to create programs that are evidence-based and effective. We could model them off the fantastic examples of community-led programs utilized during COVID. Not only were they effective, but many were also cost effective.

Sharon: I think the UN 2030 goals can be achieved because in countries like Australia and parts of the U.S. we've done it. There have been great gains in the world, but we're not near those targets at the moment. Maintaining those targets indefinitely is going to be the real challenge, which is why we need to pursue innovation as we work towards a vaccine and a cure.