#MentalHealthNow for #PositiveYouth at #AIDS2016
The 2016 International AIDS Conference (AIDS 2016), with its 18,000 participants who descended on the Durban International Conference Centre three weeks ago, was a smorgasbord of new ideas, information, inspiration, and reminders of what we know about the HIV/AIDS epidemic and what still needs to be done. With its jam-packed programme including basic science and developments towards a cure and a vaccine, clinical trial results, and a focus on human rights issues, it is not surprising that many attendees and non-attendees alike are still grappling with all the information, publications, and new contacts. Surely as this information is processed, more insights and reflections will emerge.
There can be no doubt of the progress made in the global AIDS response since the International AIDS Conference was last held in Durban in 2000. The South African context in particular has seen a dramatic shift from an era of government denialism and a complete lack of access to anti-retroviral treatment (ART) to the largest government-supported ART programme in the world. However, focusing only on this progress poses the danger of moving into an era of complacency, where HIV is no longer considered a public health concern.
UNAIDS (2016), in its recently released Prevention Gap Report, has raised alarm that new HIV infection rates have not declined in the last 5 years, warning that a resurgence in infection rates would make the epidemic uncontrollable. There is also a worrying decline in political will and international funding commitments. Incoming president of the International AIDS Society, Professor Linda-Gail Bekker, remarked at the conference that although at present we have many tools to prevent new infections and unnecessary deaths, the funds for their implementation are lacking. A key message of the conference was that it is too early to declare victory in the AIDS epidemic.
A recurrent issue highlighted at AIDS 2016 was that although access to treatment and biomedical prevention modalities are essential, they are insufficient; behavioural, structural, and social issues also need to be taken into account. While this acknowledgement is important, the non-biomedical aspects of treatment and prevention still seem to be somewhat sidelined or treated superficially, despite their obvious impact. Various clinical studies presented at the conference indicated adherence as a key challenge to the success of biomedical methods of both HIV treatment and prevention – sometimes resulting in a loss of potentially efficacious tools. Many of the responses to the challenge of adherence still include expensive methods like digital pill boxes and simplistic methods like pill counting, which fail to address the complex psychological and social issues related to adherence, including a lack of social support, struggles with mental health problems, and concerns about stigma.
The focus on young people and adolescents as a key population, and the remarkable efforts made by the organisers of AIDS 2016 to involve them in the conversation, is significant and exciting. Work with adolescents highlights many of the psychological, social, behavioural and structural factors standing in the way of ending the AIDS epidemic.
Projects like Msantsi Wakho presented findings that showed a direct impact of psychological issues on HIV treatment and prevention among adolescents. Organisations, including the SHM Foundation’s Project Khuluma, alongside Sentebale, Paediatric AIDS Treatment for Africa (PATA), and Zvandiri, shared insights from their work and a common commitment to the centrality of psychosocial support to the health outcomes of adolescents living with HIV. But inspiring work and common purpose aside, the reality is (as was mentioned repeatedly over the course of the conference) that many of the organisations providing these services survive off limited funds, for which they must compete with each other. The question remains: did AIDS 2016 allow those who make the funding decisions to really hear and understand the value of these projects? What will it take to convince them that they are far more than a ‘nice-to-have’?