20th International AIDS Conference - Melbourne, Australia

TUPL01 What's Holding Us Back and How Do We Move Faster?
  Plenary Session
Venue: Plenary 2
Time: 22.07.2014, 08:20 - 10:30
Co-Chairs: Catherine King, Australia
Jan Beagle, UNAIDS
Kieran Daly, United States

Webcast provided by International AIDS Society
Award Presentation: Women, Girls and HIV Investigator's Prize

Award Presentation: Prize for Excellence in Research Related to Children Affected by HIV

Strengthening Health Systems and Community
O. Shisana, South Africa

Gender Inequality and HIV
J. Gatsi Mallet, Namibia

Better and Smarter Investments in the HIV Response
M. Dybul, Switzerland

Powerpoints presentations

Gender Inequality and HIV - Jennifer Gatsi Mallet

Rapporteur reports

Track D report by Angela Kelly-Hanku

 The presentations of this plenary session explored the nexus at which we now find ourselves at. In very different ways, each of the three presenters provided not only the challenges of the present but critical ways of looking, thinking and, most importantly, acting into the future.


Beginning with a presentation on health systems by Prof Olive Shisana the audience could see how and why health system strengthening is imperative to ensuring the health and well-being of people with HIV as they face long term survival on ART alongside TB-co-infection and emerging non-communicable diseases such as cancers and heart disease. These conditions (HIV, TB and NCDs) not only occur in the same locations, asserted Shisana, but they manifest in the same people. In the face of unprecedented challenges to the health system, evidence-informed approaches to health care and a review of programs to ensure their appropriateness and usefulness is necessary.  To ensure integrated health services  new and effective means based on evidence must be in place. Offering examples from Brazil, Morocco and elsewhere two issues were stressed: the need for “smarter” spending of domestic and global monies and an understanding that “quick fixes” will not ensure sustained and effective health care for PLHIV as they live longer and with more co-morbidities.  It was a refreshingly, interesting and accessible presentation.


Addressing the issue of gender equity, Jennifer Gatsi-Mallet of Namibia described key issues in responding to HIV through a lens of gender equity. As an openly HIV positive women, most of her discussion focused on women yet she made strategic and important references throughout her presentation to ensure greater gender inclusivity.  Jennifer highlighted what we already know and offered  key points about how to assist communities to address gender inequality.   The “blame approach” (often used by ‘outsiders’) undermines local practices and beliefs and results in resistance to exploring transformative relations, at times increasing gender biases and binaries. Because gender is so normative and deeply entrenched, programs must work from within, and female support leaders are crucial to achieve that. Other examples includes working with girls and boys in schools. Addressing normative masculine identities which dis-empower both women and non-conforming men, as well as recognizing that,  indeed, gender inequality differentially affects all women and all men, and all children, and being able to monitor and evaluate work on gender are challenges to be faced. The audience was impressed with Jennifer’s extensive work on advocating for the rights of women and for the stopping of forced sterilization of women, an important aspect on gender inequality and HIV to discuss at this international forum.


Speaking from the point of view of the Global Fund, Mark Dybul emphasized the unique moment in the history of the epidemic; ‘innovation in science, epidemiology and services delivery offer a new historic opportunity unique to this moment’. The by-product of this should be the ability to make better and smarter investments based on location and specific populations. Having provided an overview of the standard biomedical interventions of condoms, voluntary male circumcision, harm reduction and the diverse use and application of ART (PMTCT, treatment and treatment as prevention)  the presenter acknowledged that ‘life is complicated’ , daily life is much more complex,  people do not live in ‘clinical trials’, and there is a need to humanize biomedical approaches. In order to ensure programs are effective they must be responsive and take into account that people’s risk profiles change over and throughout the lifespan. If we do not use what we now know of the epidemic and if we do not change what we are doing now, Dybul concluded, the epidemic will surge. Using data from a multitude of countries and from key populations the presenter stressed the importance of responding to where the epidemic is (not where we might think it is). The greatest challenge to smart investments will be both leadership and a commitment to fully funding the response. Time will judge the Global Fund's fulfillment of its promise.

Community report by Catherine Shepherd

Tuesday’s Plenary Session began with the presentation of two awards:

The Women, Girls and HIV Investigator's Prize went to Xu-Dong Zhang, of the International Centre for Reproductive Health at Ghent University, Belgium, for her abstract entitled, “Sexual and reproductive health in adolescent female sex workers: Kunming, China”.   

The Prize for Excellence in Research Related to Children Affected by HIV was jointly awarded to Irma Eloff of the Department of Educational Psychology, University of Pretoria, for her abstract entitled, “Promoting resilience in young children of HIV-infected mothers in South Africa”; and to Louise Kuhn of Columbia University, New York, USA, for her abstract entitled, “HIV antibody detection in children who started antiretroviral treatment in infancy”. 

Three speakers then addressed the question “What's Holding Us Back and How Do We Move Faster?

For Dr. Olive Shisana, we need to create sustainable health systems by:  

1) strengthening health systems;
2) integrating health services;
3) increasing domestic funding; and
4) ensuring universal health coverage.  

She drew from the findings of recent research and illustrated her arguments with case studies, such as Morocco’s example of integrating HIV into public health services; Zimbabwe’s example of an innovative funding mechanism for sustaining health systems through an AIDS levy; and Brazil’s example of the single-payer model of funding health care. In short, the global response to epidemics such as HIV/AIDS and TB must be undergirded by health systems that are both resilient and adaptive.  These can be achieved by a deliberate focus on building sustainable and effective health systems through evidence-based approaches.

Jennifer Gatsi Mallet of Namibia reminded us that understanding the gender dimensions of HIV will help to foster a more sustainable response to AIDS. She highlighted four exemplary community responses to gender inequality and HIV

  • Albania’s Useful to Albanian Women Association, sees gender justice as integral to a democratic society and promotes women’s participation in public campaigns, decision-making and community actions;
  • working in India and the USA, Breakthrough uses media, arts, pop culture, and technology to make discrimination and violence against women and girls unacceptable;
  • Thailand’s Positive Women’s Group improves the quality of life of HIV-positive women through economic empowerment and peer support;
  • Zambia’s Copperbelt Health Education Project uses games and sports to challenge gender-based stereotypes and stigma among in-and-out-of-school youth and vulnerable children.  
  • Gatsi Mallet recommended, inter-alia, the inclusion of gender equity and action to address HIV in the post-2015 development agenda; increased funding for community-based gender and HIV work; and promotion of sexual and reproductive health and rights of women living with HIV.  

In the words of Angeles Serrano, a grandmother and community activist from Manila’s Leveriza slum, “Act, act, act.  You can’t just watch.” 

According to Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, innovation in science, epidemiology and delivery, combined with better, smarter investments offer a new, historic tipping point: to end HIV/AIDS as a public health threat. To make the paradigm shift from epidemic to low-level endemicity requires nothing less than combination prevention. The availability of highly detailed data can help make HIV services more efficient, as the case of India demonstrates. Combination prevention focused on geography, key populations and interventions will result in fewer infections.  The question is no longer “Can we do it?” but “Will we do it?” Full funding will be needed for the fight.


    The organizers reserve the right to amend the programme.