The world needs to “scale up” its treatment of HIV – particularly in women and children – to achieve the cherished goal of a generation free of Aids, the former US president Bill Clinton has said.
Speaking at the Aids 2014 conference in Melbourne on Wednesday, he said the world was on a “steady march” to stamp out Aids but, with an estimated 20,000 children a month still being infected and stigma on the increase, much still needed to be done.
More than 2,000 people crammed into the Melbourne Convention and Exhibition Centre to hear Clinton speak, as thousands more watched him from a video feed in other parts of the building.
The start of his speech was then delayed by protesters calling for a global financial transaction, or “Robin Hood” tax, to fund HIV treatment,
But after first paying tribute to the victims of MH17, six of whom were bound for the Aids conference, Clinton acknowledged the protesters and said different voices “needed to be heard”.
"This is called a conference but I think it's really a movement. That's why it's OK if someone stands up and has their say," he said.
Ensuring people were on good treatment was vital to preventing HIV spread because antiretroviral drugs greatly reduced the risk of passing on the virus during unprotected sex, Clinton said. In many parts of the world, particularly parts of Africa, eastern Europe, HIV-positive mothers had no access to treatment and passed the virus to their children, who also did not receive care.
“Paediatric treatment continues to lag behind in many countries,” Clinton said. “We are trying to help countries eliminate mother-to-child transmission and this is one of the most exciting goals in public health and entirely achievable, and essential to achieving an Aids-free generation.”
“We need to scale up treatment and get it to those who need it if an Aids-free generation is to be within our reach.”
Part of that effort would include combating stigma and prejudice that prevented those living with HIV from getting tested, accessing treatment and staying on that treatment, he said.
"We need to redouble our efforts to combat stigma and prejudice,” he said. “Unbelievably, stigma is on the rise in some places.”
A report released at the conference by Open Society Foundations revealed that in countries including Russia, Burma and Vietnam, police harass and arrest drug users who try to obtain health information and sterile syringes from pharmacies. In China, police have detained outreach workers at needle exchanges and arrested people attempting to get clean syringes. There were still 76 countries that criminalise same-sex relationships.
The former US president said there must be a renewed effort to combat such prejudice, an effort driven by the lives lost of those on board MH17, several of whom were HIV activists and researchers.
"We have to remind people that the people we lost on that airplane gave their entire lives to the proposition that our common humanity matters a hell of a lot more than our interesting differences," he said.
New World Health Organisation HIV guidelines recognised pregnant and breastfeeding women, as well as children under five, should receive lifelong antiretroviral treatment, Clinton said.
Up to half of all new paediatric HIV infections occurred during breastfeeding, he said. “We need to drastically remove transmission during the breastfeeding period,” he said.
“And we must identify and treat children infected over the past decade. They have fallen through the cracks. We all have a responsibility to ensure they receive the care they need to live the full, rich life they deserve.”
Clinton highlighted Botswana as a success story in the HIV fight, saying mass coverage of antiretroviral therapies meant new infections were flatlining. While Botswana still has one of the highest rates of HIV in the world, transmission of the virus from mother to child has reduced from 30% at the peak of its epidemic to as low as 2.1% by 2013, UN data shows.
“We know treatment is the most effective tool we have to fight Aids,” he said. “New data suggests 70% of HIV-related deaths could have been prevented if all countries had coverage rates as high as Botswana’s.
“But we could all do better in terms of quantity and quality of treatment.”
While high-income countries had a key role to play in providing funding for treatment and education in developing countries, he emphasised it was important HIV awareness was raised in those countries, too. Early testing and detection was an important goal everywhere, Clinton said.
“HIV remains a high-income country problem, too,” he said.
