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The effects of stigma and barriers to treatment and prevention of HIV will be key to conference discussions in Montreal

Around the world, excitement is building as organizers and delegates plan for the first in-person and virtual International AIDS Conference since the onset of the pandemic. While COVID-19 consumed people’s minds and garnered international media attention, news of HIV took a backseat. The hope is that AIDS 2022, the 24th International AIDS Conference, hosted by IAS – the International AIDS Society – in Montreal will change that.

“We’re all very excited to have this conference in person for the first time in two years,” says Dr. Adeeba Kamarulzaman, IAS president and professor of medicine and infectious diseases at the University of Malaya in Kuala Lumpur. “AIDS 2022 is an opportunity for us to re-engage and get the spotlight back on HIV. The virus, and the stigma that surrounds it, is very much still among us.”

The ongoing effects of stigma on treatment and prevention of HIV, especially in lower- and middle-income countries, will again be a key topic of discussion at AIDS 2022, hosted by the IAS from July 29 to Aug. 2.

“Unlike in the past, someone living with HIV may not necessarily go on to develop AIDS,” Dr. Kamarulzaman says. “HIV, which compromises the immune system, can develop into AIDS and lead to a constellation of other diseases such as tuberculosis, fungal or brain infections, or even cancer. Today we have the tools and very effective medications for treatment and prevention. Sadly, stigma inhibits a lot of people from coming forward to access them.”

At the 65th session of the Commission on Narcotic Drugs in March 2022, Dr. Kamarulzaman described the impact of inequalities on HIV prevention, treatment, care and support among people who use drugs.

“Because of criminalization, stigmatization and underfunding, people who use drugs are disproportionately affected by HIV and viral hepatitis. Access to tailored services is even harder for women, young people, sex workers, refugees, Indigenous people and people of colour,” she says. Anti-homosexual laws in more than 30 sub-Saharan African countries also make it difficult for health workers to identify and locate men who have sex with men (MSM) who may need access to condoms and antiretrovirals.

Dr. Kamarulzaman cites the power of community to create positive change when it comes to battling stigma. “The hard lessons from the HIV crisis in the 1980s tell us about the importance of a rights-based, equality-based response supported by community,” she says. “What we’re seeing now is that communities that adapted a similar approach generally had a better response to COVID-19.”

ViiV Healthcare has a longstanding history of and commitment to fighting stigma and discrimination faced by those living with HIV.

“We take HIV stigma very seriously. For us, it’s not just about treatment. It’s about taking care of the whole person,” says Dr. Harmony Garges, chief medical officer for ViiV Healthcare, one of the conference sponsors. “We know that HIV disproportionately affects vulnerable people. We have an entire arm of our company focused on working with activists, HIV service organizations, and even celebrities to break down stigma and discrimination so that more people feel safe accessing prevention and treatment programs.”

Dr. Garges says the upcoming conference is an important one for ViiV Healthcare, especially this year with the return of its innovative Global Village and Youth Programme. “As sponsor of the Global Village, our goal is to create a vibrant gathering space where communities can share their experiences, what they have learned about the science, and how it translates into advocacy,” she says.

Erika Castellanos, executive director for Global Action for Trans Equality (GATE), is excited to travel from Switzerland to Montreal for AIDS 2022. “If there’s any conference the HIV community looks for, it’s this one. It’s an ideal way to keep up with science and the latest evidence, and to network and learn new ideas and new initiatives from others around the world,” Ms. Castellanos says. “When we go back to our home countries after the conference, we have the correct tools and information to be able to advocate to our governments. It’s really an empowering experience.”

GATE advocates for trans, gender-diverse and intersex equality around the world. Ms. Castellanos, who has been living with HIV since 1995, has worked with the GATE team for 11 years.

“In our experience, one of the biggest challenges for the trans and intersex communities is the criminalization of gender identity,” she says. “In some countries, individuals can face years in jail or even death if discovered. Many don’t have official documents that allow them to go to school, open bank accounts, get adequate employment, or go to the hospital. As a result, many must turn to sex work as a survival strategy, which puts them at risk for HIV.”

Ms. Castellanos says trans people are also the targets of hate crimes, violence, and abuse. “It limits them from everything and anything – from routine health checkups to HIV treatments. It goes even further, preventing them from accessing much-needed vaccines for viruses like COVID-19,” she says.

As part of AIDS 2022′s Global Village, GATE and the International Reference Group on Transgender Women and HIV (IRGT), in partnership with RED Trans Peru and Transgender Europe e.V. with the inclusion of Central Asia (TGEU), will host TRANSport: A TRANS and gender-diverse community re-engagement hub. The hub will offer a safe space to network, share and exchange ideas, experiences, knowledge, and strategies to strengthen communities and local health and HIV responses.

The issue of stigma will also be prominent in the official conference program with a series of satellites, workshops and symposia, and there will be a number of discussions around the needs of the transgender community in accessing HIV and health and broader services.

Knowledge sharing and the exchange of lessons learned from the HIV pandemic have gone a long way toward helping countries around the world respond to new viruses such as COVID-19. Testing people early and then treating them immediately are interventions straight out of the HIV playbook. We have seen over the past two years how key early detection of the novel coronavirus has been, enabling authorities to more effectively track its transmission patterns and to better control its wider spread.

But at the other extreme the COVID-19 pandemic has had a heavy impact on the capacity of authorities and community to respond to diseases such as HIV and tuberculosis, setting back progress in many countries.

While the perception perhaps in many wealthier countries is that HIV is no longer an issue, for regions like sub-Saharan Africa, Eastern Europe and Asia, nothing could be further from the truth. And COVID-19 has only exacerbated the status quo. AIDS 2022 is expected to feature the testimonies of many communities and the challenges of navigating two pandemics.

“Yes, we have made great progress from a time when there was no therapy available, to when therapies involved taking multiple cocktails of pills with countless side effects, to today when most people with HIV take a pill a day or a long-acting injectable. But people can become complacent and preoccupied with COVID or monkeypox,” Dr. Garges says. “A conference like AIDS 2022 offers us an important opportunity to re-engage, follow the science, and remember that it takes a village.”

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