International AIDS Vaccine Initiative, The Netherlands, and 2Royal Free and University College
Medical School, London, UK
The 6th International AIDS Impact Conference was held on 7/10 July 2003, in Milan, Italy.
As the epidemic evolves, treatments improve, access is debated and psychosocial ramifications
are underscored, the importance and relevance of such a meeting was immense. The
conference linked the psychological, social and socio-political, together with the biomedical
aspects of HIV and AIDS and emphasized the fact that in order to fight this epidemic, a
comprehensive approach is needed.
The broad themes of the 2003 conference were:
1. Living with HIV/AIDS, with the sub-themes: quality of life; adherence to,
complications of and reasons for discontinuation of HAART; disclosure; sexual
behaviour and dysfunction; prevention issues; care and treatment issues, especially
in disadvantaged populations (migrants, the homeless, drug users).
2. Prevention of HIV, addressing the challenges and advances in different target groups
(gay men, drug users, sex workers, adolescents, women and men), as well as discussing
the need for new preventive technologies, such as vaccines and microbicides.
3. The social, socio-political and socio-economical aspects of the epidemic: law, human
rights and ethics (disclosure; infecting others, while not disclosing known serostatus;
migrant populations). Access to and cost of treatment and other interventions.
4. Tomorrow’s generation, addressing transmission in pregnancy, parenthood, children,
policy, stigma and the integration of approaches.
These themes were discussed during oral and poster presentations, workshops, challenge
sessions and interactive symposia.
In this special edition of AIDS Care, a selection of contributions made to the conference
are collated. They give a brief taster of the variety within the meeting rather than a
comprehensive coverage. The focus of the contributions is very much on the psychological
dynamics and impact of HIV: the impact of attitudes, opinions and beliefs on behaviour
(Kalichman et al ., Simbayi et al ., Sherr et al ., Peretti-Watel et al .); care, treatment and well
being: Quality of Life, adherence, affected families, sexual health, disadvantaged populations
(Orr et al ., Preau et al ., Spire et al ., No¨ stlinger et al ., Florence et al ., Surratt et al .); predictors
of infection and effectiveness of preventive interventions (Harding et al .).
Address for correspondence: Professor Lorraine Sherr, Department of Primary Care and Population Sciences,
Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK. Tel: /44 0207 794
0500; Fax: /44 0207 794 1224; E-mail: [email protected]
AIDS CARE (July 2004), VOL. 16, NO. 5, pp. 547/549
ISSN 0954-0121 print/ISSN 1360-0451 online/04/050547-03 # Taylor & Francis Ltd
DOI: 10.1080/09540120410001716324
As we all know, despite valiant efforts to mobilize and expand prevention efforts, the
global AIDS pandemic continues to escalate:
. Since the start of the epidemic, more than 70 million people have become infected
with HIV. Of these, more than 42 million people worldwide are currently living with
HIV/AIDS and over 28 million have died. It is estimated that the epidemic is likely to
reach 100 million cumulatively within less than a decade.
. Of the 15,000 people throughout the world who become newly-infected with HIV
every day, approximately 95% live in developing countries that are least able to absorb
the social and economic consequences of the epidemic or cope with the financial
burden of treatment.
. By far the worst affected region in the world, sub-Saharan Africa is now home to 29.4
million people living with HIV/AIDS. Approximately 3.5 million new infections
occurred there in 2002, while the epidemic claimed the lives of an estimated 2.4
million Africans in the past year alone.
. Rampant epidemics are underway in southern Africa where, in four countries, national
adult HIV prevalence has risen higher than previously thought possible, exceeding
30%: Botswana (38.8%), Lesotho (31%), Swaziland (33.4%) and Zimbabwe
(33.7%). Elsewhere, in west and central Africa, the relatively low adult HIV prevalence
rates in countries such as Senegal (under 1%) and Mali (1.7%) are shadowed by more
ominous patterns of growth.
. HIV prevalence is estimated to exceed 5% in eight other countries of west and central
Africa, including Cameroon (11.8%), Central African Republic (12.9%), Coˆte
d’Ivoire (9.7%) and Nigeria (5.8%). The sharp rise in HIV prevalence among
pregnant women in Cameroon (more than doubling to over 11% among those aged
20/24 between 1998 and 2000) shows how suddenly the epidemic can surge.
. In many parts of the developing world, the majority of new infections occur in young
adults; young women are especially vulnerable. Roughly one-third of those currently
living with HIV/AIDS are aged 15/24 and most of them do not know they carry the
virus. In sub-Saharan Africa, 10 million young people (aged 15/24) and almost three
million children under 15 are living with HIV. Many millions more know little or
nothing about HIV or how to protect against it.
. In Asia and the Pacific, an estimated 7.1 million people are now living with HIV and
AIDS. In 2001, the epidemic claimed the lives of nearly half a million people in the
region. Current projections indicate that within three years more people will become
infected annually in Asia than in the rest of the world combined.
. Eastern Europe and Central Asia*/especially the Russian Federation*/continues to
experience the fastest-growing epidemic in the world; in 2002, there were an estimated
250,000 new infections, bringing to 1.2 million the number of people living with HIV/
AIDS. Uzbekistan, for example, is now seeing explosive growth: in the first six months
of 2002, there were almost as many new HIV infections as had been recorded in the
whole of the previous decade.
. In the USA, Canada, Western Europe and Australia we witness an increase of HIV
infections, notably amongst young gay men and migrant and other disadvantaged
populations.
. AIDS is systematically cutting down life expectancy in those countries where the
disease is most prevalent. Life expectancy has already dropped more than 20 years in
nine African countries. In Zimbabwe, life expectancy has dropped 32 years because of
AIDS.
548 EDITORIAL
. New treatments have opened many doors, but represent a challenge in terms of
delivery, access, adherence, quality of life and the challenges of living with HIV.
. The need to gather an evidence base for prevention and intervention planning has
never been so important. Stigma, discrimination and lack of human rights are often
the bedfellows of HIV. There is an urgent need to understand how these factors alter
the epidemic, impinge on prevention, divert HIV testing and affect quality of life.
. Bereavement, death and palliation are still central core issues, hand in hand with
treatment interventions, vaccine and microbicide development and infrastructure
building.
The International AIDS Conference in Durban marked the beginning of a new era in the
fight against HIV/AIDS: finally the world started mobilizing in order to fight the epidemic in
the developing countries, where the majority of those infected with HIV (/40 million) are
living; and where 95% of the 14,000 new infections per day take place. In order to fight the
epidemic, HIV/AIDS cannot be conceptualized only in technical terms, but has to be phrased
also in terms of international solidarity, international security and human rights. Jonathan
Mann’s words*/‘One world, one hope, once percent’*/come to mind. Since Durban, we
witnessed the declaration of commitment as a result of the UNGASS meeting, the creation of
the Global Fund, the US government initiative and the European Plan for Action on Poverty
related diseases. Treatment programmes in the developing countries are rolled out involving
many organizations: WHO, ITAC, the Clinton Foundation, the Global Fund and
PharmAccess. There is renewed interest for the development of new preventive technologies,
such as microbicides and vaccines.
Africa is taking the leadership role in this new phase in the fight against HIV. It is therefore
with pride that we are able to announce that the 8th International AIDS Impact Conference will
take place in Cape Town, South Africa, 4/7 April 2005 (see AIDSImpact.net). This meeting
will be in partnership with the Human Sciences Research Council and the Nelson Mandela
Foundation. The local South African committee consists of a vibrant interdisciplinary group
under the direction of Dr Olive Shisana of the HSRC. We hope to welcome you there.
Acknowledgements
TheAIDSImpact conferences could not take place without the support and dedication of a large
number of people and organizations. Among those, specific thanks to:
1. Municipality of Milan
2. Franco Moschino Foundation
3. Taylor & Francis, publishers
4. Abbott
5. Gilead
6. AIDS Care
7. AIDS Impact UK (registered charity)
8. National Institute of Mental Health, USA
9. ASA,
10. LILA
11. CEDIUS
12. ANLAIDS
13. ARCHE
14. AIDS-AIUTO
15. Printing People, The Netherlands
EDITORIAL 549
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