The End of AIDS: Biomedical Technologies and Social Determinants - Ever the Twain Shall Meet?

"Throughout the XIX International AIDS Conference (aka 'AIDS 2012'), which was held in Washington, DC [US] this past July, speaker after speaker enthused that we were poised to create an 'AIDS-free generation' and that we were on the verge of 'ending AIDS.'"

In this commentary accompanying the discussion: "Will There ever Be an AIDS-Free Generation?" (available in video format), the author, Judith Auerbach, discusses the reasons for hope, belief, and doubt that the end of HIV/AIDS as an epidemic is in sight. As stated here, the optimism is "based on a set of recent scientific breakthroughs that, when added to those already in the 'toolbox', could reduce new HIV infections sufficiently to usher in the end of the pandemic." However: "Although it became almost heretical to register any doubt at AIDS 2012 about achieving an end to AIDS in the near future, there were many scientists, practitioners, policy advocates, and community representatives who pointed out some of the challenges. These include the fact that even if new infections decline precipitously in coming years, there will still be millions of people living with HIV for quite some time."

Auerbach continues that funding and "a host of other social factors" are critical in the success of HIV/ADS programming. "These include social/structural issues related to such things as the structure and capacity of health systems, equality or inequality in access to services, education and social marketing about HIV prevention and care, appropriate targeting of interventions to particular population groups, and the influence of local culture, religion, and law on stigma or acceptance of people living with or at risk of HIV. There are also psycho-social issues related to the perceptions individuals have about and the meanings they give to HIV prevention and treatment strategies." Because adherence is the critical factor in all treatment modalities, "their effectiveness at a population level will be affected by complex social and behavioral conditions that exist in 'the real world.'"

Some sessions at AIDS 2012 focused on social determinants of health. "Speakers highlighted the ways in which macro and micro social factors, such as political economy, gender inequality, housing, migration, conflict and violence, human rights laws, organized religion, etc. affect HIV epidemics and responses to them. The causal chains between social forces and individual health outcomes are complex and often non-linear, and they operate through multiple intermediate factors at the institutional and individual levels... [As] many scholars and advocates have argued, it is essential to address social/structural factors as both drivers themselves of HIV epidemics and as potential facilitators of the effectiveness of technological advances in HIV prevention and treatment."
 
"What was both fascinating and troubling to observe at AIDS 2012 was that these two conversations - one focused on biomedical technologies (particularly "treatment as prevention")... and the other focused on the "social determinants of health"... took place on parallel tracks. Almost no one brought the two streams together. But this is precisely what must occur if we are to truly 'end AIDS'. New technological developments will only work if people who need them have unfettered access to them (including payment for them), believe they will help more than harm them, and are able to take them up without fear of discrimination or social marginalization, regardless of their sex, gender, class, age, religion, race/ethnicity, citizenship or immigration status. Getting to this place will require more cross-disciplinary discussions that genuinely value the contributions of social, behavioral, and biomedical sciences equally, and it will require more inter-sectoral discussions seeking ways to translate scientific evidence into social and structural changes that can truly facilitate the end of AIDS."