The 21st International AIDS Conference: AIDS 2016 returned to Durban South Africa after an absence of 16 years. The 13th International AIDS Conference was held here in 2000 at a momentous time in the history of the AIDS epidemic.

By 1996, triple drug combinations (later referred to as “highly active antiretroviral therapy or HAART) had fundamentally changed the prognosis for people with HIV – at least in highly developed countries – and had transformed the temporary improvement noted with single or dual antiretroviral regimens into long-term suppression and reversal of the severe immunologic impairment associated with HIV disease. 

In less developed countries and particularly in sub-Saharan Africa, the outlook for people living with HIV remained grim with little availability of antiretroviral therapy compounded by denial by political leaders,  challenges with adherence, and woefully inadequate national programs to develop and maintain the complex healthcare infrastructure needed to diagnose and treat the vast majority of these patients. 


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Saving the next generation of African children by the institution of perinatal prophylaxis to prevent mother-to-child transmission remained the only bright hope in a cloud of doom that surrounded the AIDS epidemic in Africa. No other country in the world was more impacted than South Africa, with women then as now disproportionately impacted by the HIV epidemic.

The situation has vastly changed by 2016 when the 21st International AIDS Conference convened on the evening of July 18 in the International Convention Centre in Durban. 

Symbolically, the Conference opened on Nelson Mandela Day the annual memorial honoring South Africa’s iconic ad greatly beloved first President. Reminders, photographs, and anecdotes about “Tata Madiba” (as he is universally and affectionately referred to in South Africa) were everywhere in the Opening Ceremony. Already quite feeble, he had electrified the conference by his appearance on the stage at the 13th International Conference in 2000. 

The conference was officially opened by Cyril Ramaphosa, Deputy President of South Africa. Chris Breyer from Johns Hopkins University in the United States, President of the International AIDS Society (sponsor of the biennial International AIDS Conferences), and Desmond Tutu, retired Anglican Archbishop Emeritus of Cape Town  who appeared via videotape were among the many political, cultural, and activists who addressed the Opening Session.

Each speaker noted the enormous progress with the rollout of antiretroviral therapy in South Africa since 2000, with nearly 3.5 million people in South Africa alone on treatment and an enormous decrease in mother-to-child transmission.  

Yet each speaker also noted the enormous work yet to be done and the challenges faced in South Africa and other developing countries because of political apathy, inadequate domestic and international funding for HIV prevention and treatment programs. 

Disparities continue to exist in South Africa with unacceptable rates of new infections (especially in young women) and marginalization of specific risk groups such as men who have sex with men, commercial sex workers, and incarcerated persons. 1 Taken all in all, it was a moving Opening Ceremony filled with gratitude for all the accomplishments since 1960 and challenged by the work still undone.

 

Reference

1. Dolan K, Wirtz AL, Moazen B, et al. Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. Lancet. 2016;  doi.org/10.1016/S0140-6736(16)30466-4