XIX International AIDS Conference

WEPDD02 Global Policy
  Oral Poster Discussion Session : Track D
Venue: Mini Room 9
Time: 25.07.2012, 13:00 - 14:00
Co-Chairs: Nathan A. Paxton, United States
Morten Skovdal, Norway

Analysis of political governance as a determinant of level of ART coverage using country-level data
W.Y.N. Man1, H. Worth1, D. Wilson2, A. Kelly1,3, P. Siba3, Y. Wong4
1University of New South Wales, International HIV Research Group, Sydney, Australia, 2University of New South Wales, Kirby Institute, Sydney, Australia, 3Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea, 4University of New South Wales, School of Public Health and Community Medicine, Sydney, Australia
H. Worth, Australia

UNAIDS' gender policy: strengths and weaknesses
S. Olinyk1, A. Gibbs2, C. Campbell3,4
1University of Michigan, Ann Arbor, United States, 2University of KwaZulu-Natal, Health Economics and HIV/AIDS Research Division (HEARD), Durban, South Africa, 3London School of Economics, London, United Kingdom, 4University of KwaZulu-Natal, Durban, South Africa
A. Gibbs, South Africa

Investing in HIV prevention in a global recession: HIV prevention research and development funding trends 2000-2011
K. Fisher1, E. Donaldson1, B. Gobet2, L.M. Green3, T. Harmon4, P. Harrison1, R. Lande3, M. Warren1
1AVAC, New York, United States, 2UNAIDS, the Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland, 3International Partnership for Microbicides, Silver Spring, United States, 4International AIDS Vaccine Initiative, New York, United States
E. Donaldson, United States

Complementary production of global public goods for health: measuring contributions of HIV/AIDS initiatives
J.A. Nixon Thompson1,2
1University of Maryland, College Park, Sociology, College Park, United States, 2International Institute for Applied Systems Analysis, Health & Global Change, Laxenburg, Austria
J. Nixon Thompson, United States

Three I's for HIV/TB and early ART to prevent HIV and TB: policy review of HIV and TB guidelines for high HIV/TB-burden African countries
S.S. Gupta1, R. Granich1, A.B. Suthar1, C. Smyth1, R. Baggaley1, D. Sculier1, A. Date2, M.A. Desai2, F. Lule3, E. Raizes2, L. Blanc1, C. McClure1, G. Hirnschall1
1World Health Organization, Geneva, Switzerland, 2Centers for Disease Control and Prevention (CDC), Atlanta, United States, 3World Health Organization (WR Country Office), Brazzaville, Congo, Republic of the
S. Gupta, Switzerland

International blood donation guidelines for men who have sex with men (MSM)
N. Schaefer, R. Valadéz
Gay Men's Health Crisis, Public Policy, New York, United States
N. Schaefer, United States

Moderated discussion

Powerpoints presentations
Analysis of political governance as a determinant of level of ART coverage using country-level data - Heather Worth

UNAIDS' gender policy: strengths and weaknesses - Andrew Gibbs

Investing in HIV prevention in a global recession: HIV prevention research and development funding trends 2000-2011 - Emily Donaldson

Complementary production of global public goods for health: measuring contributions of HIV/AIDS initiatives - J. Alice Nixon Thompson

Rapporteur reports

Track D report by Dr. Richard Wolitski–

This session addressed key policy issues affecting research, prevention and care programs and human rights.

An analysis of political governance as a determinant of ART coverage found that countries with better control of corruption, higher levels of political accountability and voice, lower regulatory quality, and more political stability have higher levels of ART coverage. The control of corruption strongly associated with ART coverage (Adj. OR = 1.8, 95% CI = 1.23, 2.62). Indicators of economic development dropped out when control of corruption was included in multivariate regression model.

While total funding for all biomedical HIV prevention R&D decreased by US$30 million from 2010 to 2011, HIV prevention science had one of its most successful years in 2011.  Continued investment is needed to develop an effective vaccine, demonstrate the effectiveness of PrEP and improved microbicides for vaginal and rectal use, and develop efficient and effective systems to deliver and increase coverage of treatment as prevention and male circumcision.

A review of HIV and TB treatment guidelines in 70 countries found that recommendations varied considerably. The majority recommend ART for asymptomatic people at CD4 ≤350 cells/mm3 or earlier, and some countries recommend ART for serodiscordant couples. ART irrespective of CD4 count for people with HIV-associated TB is recommended by 24 countries. Old guidelines should be updated based on new clinical and prevention evidence to ensure equal access.

An analysis of 305 Global fund HIV/AIDS grants found that activities to strengthen health systems were associated with grant portfolio performance, but that too many HIV/AIDS prevention and control initiatives do not address overall strengthening of health systems.

The UNAIDS gender policy is strong in content and design, but has significant weaknesses in implementation. Strengths include creating political space for prioritizing women and girls and forming new alliances. Weaknesses include lack of grassroots participation, insufficient resources and tools, and lack of political will within UNAIDS.

The USA has a life-long ban on the donation of blood by gay, bisexual and other men who have sex with men (MSM). This policy is inconsistent with donor deferral policies for high-risk heterosexuals in the USA, those for MSM in other countries, and advances in HIV detection technology.


CPC report by Laurel Sprague

This oral poster session provided findings from studies of a variety of global policies related to the HIV response.

H. Worth shared results from an analysis of political governance as a determinant of ART coverage. Using country level data, the team of researchers determined that countries with good political governance (defined as greater accountability, participation, political stability and lower regulatory quality and corruption), have provided greater levels of ART coverage. Lower levels of corruption were strongly associated with higher ART coverage.

A. Gibbs presented an analysis of UNAIDS’ gender policy, identifying its strengths as the creation of political space for prioritizing women and girls and the opportunities for new alliances. Challenges were identified as lack of grassroots participation, insufficient implementation resources and tools, and a lack of political will within UNAIDS.

E. Donaldson shared results from a study investigating funding trends for HIV prevention research and development. She described increases in funding for HIV prevention science (such as treatment for prevention) combined with large funding decreases for HIV prevention research and development overall. Challenges for combination prevention approaches and human rights raised by this data were not discussed.

J.A. Nixon-Thompson presented findings from an investigation of the effects of Global Fund requirements for health system strengthening (HSS) components in grant applications. Her data indicates that countries are responding by including HSS components in grants, with longer duration grants more likely to have an HSS component. Multiple regression analysis indicated that longer duration grants performed better, as did grants implemented in countries with higher ranked WHO system performance. Components of HSS related to community development and coordination showed a statistically significant positive association with Global Fund HIV grant performance.

S.S. Gupta presented a review of global HIV and HIV/TB policy guidelines. The research team reviewed 108 guidelines from 70 countries and two regions. Ten countries recommended ART initiation when an asymptomatic person living with HIV has a CD4 count of 350 or lower. Five additional countries recommend initiation at 350 but consider offering it at up to 500 CD4s. Of these, twelve countries recommend ART initiation for PLHIV in serodiscordant couples at any CD4 count. Three countries recommend initation when CD4s are at 500 or below; two of these recommend ART for PLHIV in serodiscordant couples irrespective of CD4 count. Only one country, the United States, recommends ART initation for asymptomatic PLHIV irrespective of CD4 count. Regarding TB policies, 41 countries recommend isonizaid preventive therapy (IPT); 18 countries follow symptom-based screening algorithm; 16 countries recommend TST; and IPT is recommended for at least 6 months by all 41 countries

N. Schaeffer analyzed global blood donation policies for men who have sex with men (MSM). His findings showed bans from six months to life in many countries, including the U.S.  Heterosexual high risk activities are treated very differently, with many countries having no bans or one year bans for these activities. He called for a “Behavior Based Deferral” standard for all countries, in which every person who donates blood is screened for high risk activities. This standard has been implemented in Italy and Spain with resulting decreases by 400% of HIV transmission through transfusions.


    The organizers reserve the right to amend the programme.

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