Inter Press Service - July 13, 2007
Neena Bhandari

Organisers believe research is critical to informing scale-up efforts in the developing world and ensuring that HIV programmes are effectively targeted and integrated with other health services. One benefit of integrating research into the overall approach will be the expanding cadre of health-care workers trained in research methodologies and practice.

The IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007) will be held in Sydney from Jul 22 - 25. Held every two years, IAS 2007 is being organised in partnership with the Australasian Society for HIV Medicine (ASHM) and is supported by AusAID (Australian Government's overseas aid programme) and the Australian Department of Health and Ageing.

One of the authors of the "Sydney Declaration" and IAS 2007 co-chair David Cooper says: "Our idea is to do more research and evaluation of the large scale roll-out of antiretroviral drugs. If donors are not satisfied with the outcomes of the programme there is no evidence of what the problem is. Only research will tell us."

The organisers are asking national governments and bilateral, multilateral, and private donors to allocate not less than 10 per cent of all resources dedicated to HIV programming for research towards optimising interventions utilisd and health outcomes achieved.

"Common unknowns are the reasons for the high early mortality when patients go onto treatment. Is it that they access treatment too late or do they have unusual toxicities of the drugs? Can we use lower doses of the drugs to produce less side-effects and treat more people? These are some common questions for which there are no answers right now. It would also help train researchers in developing countries," adds Cooper, who is a professor of medicine and director of the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales.

Over the past quarter century, evolution of HIV prevention, treatment, and care has been one of the great successes of medical science. Committed and sustained research efforts have resulted in new prevention technologies and drugs, and new strategies to manage and deliver both.

"Under the guiding premise that, "good research drives good policy and programming," we are inviting all stakeholders involved in the global response -- including people living with HIV, clinicians, policymakers, and of course scientists and other researchers -- to join us in urging national governments and bilateral, multilateral and private donors to allocate "no less than 10 per cent of all resources dedicated to HIV programming for research, " says IAS Executive Director Craig McClure.

"The IAS and ASHM have joined together to develop the "Sydney Declaration", a global sign-on letter calling for the scale up of HIV research as an essential part of a comprehensive response to HIV, which also includes universal access to HIV treatment, care and prevention, " adds McClure.

Although funding remains insufficient to meet the increasing need for services, organisers of IAS 2007 are calling on the global community not to lose sight of the future while responding to the immediate crisis.

The "Sydney Declaration" states that an effective response to HIV/AIDS requires a sustained commitment to ensure that interventions and approaches to service delivery are continuously improved over time. For example, as current first-line antiretroviral (ARV) regimens become increasingly available there is an urgent need to identify optimum, durable, and well-tolerated standardised first-line and second-line regimens, and to monitor and respond to resistance patterns as they emerge.

Operations research is critical, in addition to basic, clinical, prevention, social, and policy research. The "Sydney Declaration" draws attention to learning how to integrate HIV-specific services with primary, tuberculosis, malaria, prenatal and postnatal, and sexual and reproductive health services. Furthermore, greater understanding of the social, political, and cultural barriers that perpetuate stigma and discrimination can contribute to ensuring that governments act in the interests of public health.

The authors of the declaration point out that "Unfortunately, few granting agencies or national health budgets commit designated funds to operations research, and where such funding is available, it is often underused. "

The Global Fund to Fight AIDS, Tuberculosis and Malaria, for example, allows up to 10 percent of each grant to be allocated for operations research, but authors of the delaration say, "this provision is rarely used by countries and the research community is rarely represented on Country Coordinating Mechanisms (CCMs). The lack of participation on CCMs further reduces the likelihood that operations research will be a priority in funding applications."

The authors of the declaration feel all areas of research can further strengthen the efforts of the global AIDS community to confront the absurd theories of AIDS denialists as well as the "magic" cures that continue to confuse policymakers, health-care professionals and communities of people at risk of and living with HIV/AIDS throughout the world.

The four-day conference will continue its strong emphasis on treatment and pathogenesis, while building upon the biomedical prevention agenda introduced in Rio de Janeiro in 2005. According to the 2006 AIDS Epidemic Update report, the estimated number of people living with HIV in 2006 was 39.5 million people.

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+ More IPS Reporting on HIV/AIDS (http://www.ipsnews.net/hivaids.asp)

+ IAS Conference - Sydney (http://www.iasociety.org/)

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