The 21 st International AIDS Conference Highlights

1. The 21st International AIDS Conference Highlights Emily Newman Editor of BETA www.betablog.org enewman@sfaf.org

2. 1 What is AIDS 2016, and why was it in South Africa? 2 An awesome HIV community—with an agenda Boatloads of HIV research 3 4 The future of HIV prevention? 5 Thank you! SAN FRANCISCO AIDS FOUNDATION

3. AIDS 2016 SAN FRANCISCO AIDS FOUNDATION • Largest public health/development conference • 20,000 people come from all over the world to attend • Held every 2 years, first held in 1985 • Converging research, activism and community events • Truly a global experience

4. AIDS 2016 SAN FRANCISCO AIDS FOUNDATION Why South Africa? • Hard-hit by HIV • One of the most high-profile HIV epidemics in the world • 7 million people living with HIV; 380,000 new infections every year • 20% of adults living with HIV • Also huge successes and inspiring progress • Number of people on treatment doubled since 2010

5. AIDS 2016 2000 • 36.1 million people living with HIV • <1 million on treatment (<5% coverage) • 5.3 million new HIV infections every year UNAIDS 2000 Report UNAIDS 2001, December Report WHO report 2016* • 36.7 million people living with HIV • 17 million on treatment (46% coverage) • 1.9 million new HIV infections every year (*data from 2015) SAN FRANCISCO AIDS FOUNDATION

6. AIDS 2016 “[The AIDS 2000 conference] created a unique belief that we could collectively change the world and created a common purpose to do just that by doing whatever it took to bring AIDS treatment to all those who needed it. Critically, scientists and clinicians walked alongside activists, artists, drug company executives, policy makers, front line health workers, political leaders, clergy, judges and just ordinary people to say altogether that the global inequity in AIDS treatment can no longer be tolerated and that it must change.” - Salim & Quarraisha Abdool Karim SAN FRANCISCO AIDS FOUNDATION

7. Tips for effective presentations Awesome HIV community—with an agenda What lessons can we take away from the success of the AIDS 2000 conference? • The HIV community can made progress with a presence • Speak out & be visible • Support causes that end HIV stigma • Empower people who are marginalized to speak out for what they need to stay healthy and live well with HIV Photos: BETA/San Francisco AIDS Foundation • Sex workers at the AIDS 2016 global village speak out in support of decriminalizing their chosen profession • Protestors lined the halls at demanding generic drug access to ARVs in India • Art and AIDS activism collide in the form of the “SolidariTree,” where people have covered with messages about how to reduce HIV stigma. SAN FRANCISCO AIDS FOUNDATION

8. Tips for effective presentations Awesome HIV community—with an agenda A protest against pharma greed took center stage today at AIDS 2016—interrupting a research presentation about on-demand PrEP. http://betablog.org/hiv-drug-pricing-protest-interrupts-prep-session-aids-2016/ http://betablog.org/losing-passion-aids-activists/ A panel discussion debated, are we losing our passion as AIDS activists? Photos: BETA/San Francisco AIDS Foundation SAN FRANCISCO AIDS FOUNDATION

9. Tips for effective presentations Boatloads of HIV research Long-acting injectable ARVs • Treatment & prevention • LATTE-2 results • Pros & cons • Concern about the “tail” • MWRI-01 study http://betablog.org/learning-new-prep-drugs-delivery-methods-aids-2016/ http://betablog.org/aids-2016-undetectable-injectable-hiv-medications/ (Liz Highleyman) SAN FRANCISCO AIDS FOUNDATION

10. Tips for effective presentations Boatloads of HIV research No transmission with viral suppression PARTNER study • Began in 2010, still ongoing • 888 mixed-status couples • 50,000 instances of condomless sex Rate of HIV transmission in MSM according to sexual behavior reported by the negative partner Results: No HIV-negative gay men having condomless anal sex with an HIV-positive primary partner acquired HIV from their primary partner when that person had an undetectable viral load in the PARTNER study. http://betablog.org/zero-hiv-transmissions-anal-sex-undetectable/ SAN FRANCISCO AIDS FOUNDATION

11. Tips for effective presentations Boatloads of HIV research Serodiscordant couples: PrEP + ART Partners PrEP Demo Project • PrEP as a “bridge” until HIV-positive partner reaches undetectable • Over 1,000 heterosexual couples in Kenya & Uganda • In 2/3 of couples, the woman was HIV-positive “We were able to demonstrate that PrEP as a bridge to ART is not only feasible in this high risk population, but highly effective in preventing HIV transmission.” –Jared Baeten, MD, PhD (Photo: Liz Highleyman) Results: The researchers found a “virtual elimination” of HIV transmission, with an estimated 95% risk reduction in HIV incidence. http://betablog.org/hiv-treatment-plus-prep-virtually-eliminates-hiv-transmission/ (Liz Highleyman) SAN FRANCISCO AIDS FOUNDATION

12. Tips for effective presentations Boatloads of HIV research Simplified therapy PADDLE trial • Very small pilot study (20 treatment-naïve people) • dolutegravir (Tivicay) + lamivudine (3TC or Epivir) Results: All 20 people had viral loads <50 copies after 8 weeks of treatment This simplified treatment regimen could potentially lower cost, reduce toxicity and decrease the number of pills people have to take—but more data needed to show if it’s safe & effective SAN FRANCISCO AIDS FOUNDATION

13. The future of HIV prevention? Does Truvada PrEP work when taken “on demand” instead of daily? Results: HIV incidence of 0.19 per 100 patient-years, for an estimated 97% relative risk reduction compared to placebo IPERGAY open-label study • 362 MSM, reporting an average of 9.5 sex acts in prior 4 weeks, 7 sex partners in prior two months • 18 months median follow-up SAN FRANCISCO AIDS FOUNDATION

14. Tips for effective presentations The future of HIV prevention? Women-controlled strategies • Dapivirine ring “People need [PrEP] options. One approach is probably not going to work for everyone. Some people may prefer pills, some people may prefer injections, some people may prefer rings. I think we have the room for lots of different approaches, and I think that’s how we’ll be successful.” (http://betablog.org/hiv-prevention-ring-women-75-effective/) -- Roy Gulick, from Weill Cornell Medicine (http://betablog.org/learning-new-prep-drugs-delivery-methods-aids-2016/) SAN FRANCISCO AIDS FOUNDATION

15. The future of HIV prevention? Uptake among Black MSM (ATN 113 & HPTN 073) • Interest and HIV incidence high • Cultural competency (all staff), stigma and privacy important • Persistent contact, education & employment key to adherence & retention http://betablog.org/young-gay-teens-prep-atn113/ Bone health in young men (ATN 110) • PrEP impacts bone mass • Reductions level off after one year • Trend toward recovery after stopping Condom use & PrEP (IPERGAY & Strut) • Condomless sex increases over time • No HIV infections in adherent users • Increase in STIs difficult to interpret – points to need for increased screening Slide by David Evans New infections vs. drug resistance (Dr. Robert Grant) • PrEP averted 8 new infections for every 1 instance of drug resistance (22 infections averted when excluding cases when PrEP given during acute HIV infection) • Screening for acute HIV infection is critical SAN FRANCISCO AIDS FOUNDATION

16. The future of HIV prevention? Thank you! Susan Buchbinder David Evans Liz Highleyman Courtney Liebi Shannon Weber San Francisco AIDS Foundation SAN FRANCISCO AIDS FOUNDATION

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