Alejandro Balazs

The session began with community activists demanding greater investment in ending the HIV epidemic followed by a perspective from Dr. Anthony Fauci. The presentation demonstrated the scope and scale of progress made since 1983 focusing on interventions that have emerged over four decades and those now under development.

Laura Waters provided an introduction to the impact that Anthony Fauci has had during his tenure at NIAID over the course of seven US presidential terms. Anthony Fauci delivered his wide-ranging perspective starting from the first Montreal IAS meeting in 1989 which showed grim forecasts while highlighting the promise of drug combinations. Since then, 79 million new cumulative HIV cases have occurred, emphasizing the need for HIV to return to the forefront of the public health response. In the face of grim UNAIDS estimates for HIV prevalence in 2022, the COVID-19 pandemic has negatively impacted the global HIV response through reductions in diagnoses and fewer people starting ART. However, in the United States, a new a national HIV/AIDS strategy has been endorced with the goal of reducing new HIV infections by 75% over the next 5 years and 90% over the next 10. Success in these goals depends on both closing implementation gaps, and development of new and improved interventions. He emphasized the importance of effectively implementing existing ART regimens while simultaneously developing new interventions employing both long-acting ART and broadly neutralizing antibodies. Finally, the need for equitable access to new interventions under development was strongly emphasized.

The session was important in that it provided an important overview of the progress that has been made over the past four decades of HIV research and provided a roadmap for the future. It provided important context for the role of existing antiretroviral therapies in achieving the goals of the US strategy for HIV. It also presented a high-level overview of the numerous prevention studies that have been performed and distilled their lessons to emphasize the need for interventions to produce neutralizing antibodies. Finally, it was acknowledged that accessibility to novel treatments has historically been a major barrier to progress.

Kombatende Sikombe

The impact of Covid on the global HIV response has severely affected diagnosis and treatment in 40/ 50 countries. A decrease in HIV cases e.g., in USA shows the supply chain issues with testing during the pandemic. Global HIV statistics on treatment, new infections, retention, and adherence are unacceptable.

To end the HIV epidemic in 2022 and beyond, we must 1) close implementation gaps, such as testing, retention, suppression, and co-infections, and 2) deliver new treatments. The goal of the global response is to ultimately diagnose early, treat quickly, and prevent new infections with PrEP and syringe services. As a result of the progress made in getting people to use PrEP and PeP, we now have a variety of drugs that we know are effective in reducing HIV transmission and, eventually, eliminating the virus. Several studies have shown effectiveness of long-acting combinations that require an injection every two-months, some even twice yearly for viral suppression- the goal. Global PrEP initiations totaled 2.8 million, with 41% discontinuing PrEP once treatment commenced, whereas the global need is in the tens of millions. USA data shows huge treatment-gaps for people accessing PrEP, with optimal adherence at 39% for those on treatment. The most recent innovations must be accessible regardless of socioeconomic status. We must develop and implement new preventative measures, as well as address barriers to medication use, substance abuse, and pill fatigue. Challenges such as equity need to be addressed as these new drugs may take long to reach Africa.

We must use science to end this pandemic. Scientific progress must be equitable. We should have engaged community sooner in our 1984 HIV-response, and now that we know it works, we should apply it to Monkey-pox and Covid. Stopping TB and HIV testing and treatment won't stop HIV's 40-year pandemic. Cutting resources will set us back, so we should fight Covid, HIV, and Monkey-pox simultaneously. There are attempts to eliminate affordable health preventable services like testing, which could affect U=U. The monoclonal antibodies are going to give us a lot of insights into vaccine hence we should follow this science.

Roman Shrestha

This session was intended to discuss the landscape of HIV research, including HIV prevention and treatment toolkits, vaccines, and implementation gap. The session also focused on lessons learned from the pandemic and the importance of equity and community engagement in building HIV-competent communities and ensuring interventions are relevant.

The session started with Dr. Waters thanking the U=U protestors for their activism and advocacy. Dr. Anthony Fauci gave an incredibly fantastic presentation about the present landscape of HIV research and the next steps forward. He mentioned the two central pillars to ending the global HIV pandemic: 1) close implementation gaps; and 2) deliver and develop new treatment and prevention methods. He also discussed the negative and positive aspects of the SARS-CoV-2 pandemic on HIV response. For example, some negative impacts included: 1) decrease in diagnosing HIV & fewer people on ART; 2) harm reduction services disrupted for PWID; and 3) increase in TB deaths among PLWH. Dr. Fauci also presented the newer tools on the horizon for the HIV medicine cabinet (e.g., LA CAB+RPV, twice yearly Lenacapavir, broadly neutralizing antibodies) and mentioned the potential uses for PrEP. He further discussed increasing global PrEP use; however, he stressed that we must fill the PrEP need and uptake gap. When asked, “What would you do differently if you could travel back to 1984”, Dr. Fauci responded, “engage the community.” He reminded us that equity and community engagement are crucial to scientific advances and paramount to global HIV response.

HIV persists as a serious public health challenge globally. Although significant progress has been made in improving HIV outcomes, considerable challenges remain. Fortunately, there are more tools than ever before available to end the HIV epidemic, which are made possible by tireless advocacy, determined research, and other support. Building on lessons learned in the past 40 years, it is essential to fill the implementation gap to realize the full potential of these tools. It is also important to engage the diverse communities of people with and affected by HIV in planning for and delivering HIV prevention and care services.