We have the evidence in the basic science & need a greater understanding of social science to END HIV

The first day of the APACC 2018 for an Australian participant highlights the challenges we face in the Asia and Pacific region. As a first-time HIV conference attendee and low-caseload HIV prescriber, I was worried I wouldn't be able to follow the science and intricate complexities of antiretroviral prescribing. I didn't need to be concerned. The message was that we need to progress more at a political and social level to "End HIV" in our region. We have enough evidence in the basic science of HIV and therapeutics. We don't need more statistics to get it done. We need a greater understanding of social science.

 

Opening the conference, Mark Boyd said to beat HIV we need to understand how it can be beaten at the population level as well as the molecular level. Then Nittaya Phapnuphak from Thai Red Cross highlighted some of the population level barriers. We have no approved HIV self-testing policy in any country in our region - a real barrier to the first of the 90/90/90 targets of having 90% of those with HIV diagnosed. Leena Meghaney from MSF pointed to the IP and regulatory barriers to accessing ART and drugs for co-infections.

 

Nick Patton from the National University of Singapore suggested we need to slow down the train that is moving from NNRTI based regimes to INSTI base regimes. He cautioned that the long term data is yet to arrive. He also stated that lower dose EFZ regimes reduce the neuropsychiatric toxicity but still achieve good outcomes and may be the preferred first line

There were reasons to be hopeful. Leena helped us reflect on the enormous impact of Indian generics on HIV and Hep C worldwide. How $1000 pills became $3. Nittaya Phapnuphak did point the way towards 90% on treatment and 90% virally suppressed in our region. She explained the importance of involving affected communities in delivery and control of the health care. The term she used was "Key Populations-Led Health Services" (KPLHS). If we give the affected community control they will drive better outcomes. In Australia we know the importance of our Aboriginal Controlled Community Health Services. I am looking forward to further presentations about KPLHS delivery of HIV care on Saturday. 

 

A very moving speech by Sepi Ardiansyah from the Indonesian Young Key Population Network describing his journey as a young man in Indonesian society who acquired HIV and was rescued by a KPLHS emphasised the point. He also reminded us to see the person. "I am not defined by the virus in my body" We need to broaden our view.