Bill Gates warns of insufficient HIV prevention efforts

"When it comes to HIV prevention there are even greater gaps, people don't have access to or use condoms consistently; uptake of voluntary male medical circumcision is insufficient; and introduction of oral PrEP is not happening fast enough at the scale need" warned the Microsoft founder Bill Gates.

Speaking at a special session on what is needed to accelerate the AIDS response in high burden countries especially from the sub Saharan region at the International AIDS Conference in Durban, the co-chair of the Bill & Melinda Gates Foundation added that the rate of decline in new HIV infections among adults is stagnating.

"Whereas funding is not increasing, and the fact that we are chronically under-prepared for the looming challenge of the ‘demographic bulge', the need to up our game becomes urgent"  the billionaire philanthropist whose foundation is the largest private funder of all efforts to fight HIV pandemic said.

"The largest generation in history is entering the age when they are at most risk from HIV. Here is what this means to Sub-Saharan Africa. In 1990, there were 94 million people between the ages of 15 - 24. Today that number has more than doubled. And by 2030, there will be more than 280 million young people in this part of the world. That highly vulnerable age group will be around three times as populous in 2030 as it was in 1990". Gates added.

The billionaire added that this would mean that with stagnating incidence rates, if we are only doing as well as we have been doing, there will be lots of more people aged 15 - 24 living with HIV, quickly adding that all the gains made in Sub- Saharan region could be reversed.

So what next?

He therefore said that to start writing the story of the end of AIDS, new interventions and new ways of thinking about treatment and prevention are critical.

He suggested that; delivery of treatment needs to be more effective and more efficient - starting with finding innovative ways to reach and treat the 16 million people worldwide who do not know that they are living with HIV.

That we need more creative and effective ideas to make testing and treatment both more accessible and more acceptable, adding that this includes initiatives like self-testing, simplified community care models and longer-lasting supplies of treatment drugs to cut down the number of visits people make to the clinic.

He also said that every single person living with HIV should be encouraged to seek treatment; be enabled to reach viral suppression; and empowered to sustain it.

"And we know that those benefits don't end with the individual, since treatment also lowers the risk one has of passing the virus to partners and loved ones" Gates said.

Need for a stronger approach

However, he said "We are not going to treat ourselves out of this epidemic; therefore, we need a stronger and more rigorous approach to prevention to help people protect themselves and others from the infection".

Citing examples of success stories from some African countries, he said that South Africa and Zimbabwe have seen increases in condom use, Kenya and South Africa have started systematically rolling out oral PrEP programs beginning with people at high risk.

And that Kenya has shown how a country with a well-organised program that includes sufficient funding, data analysis, and myth-bursting campaigns, can achieve its targets for voluntary male medical circumcision.

"Male circumcision is an amazing advance; the single most powerful one-time intervention there is" he said.

Scientific research has indicated that Voluntary Medical Male Circumcision (VMMC) reduces a man's risk of acquiring HIV from a female partner by up to 60%.

The billionaire, who describes himself as an impatient optimist added that "But the new target calls for 27 million more additional voluntary circumcisions by 2020. And to-date, only about 12 million men and boys have been able to access one".

Therefore "scaling up male circumcision, making it and keeping a routine health intervention must be a priority. But current funding is insufficient and monitoring of uptake inadequate. The payoff from expanding the use and efficiency of existing prevention tool is potentially huge" he added.

All not groom

He however added that there are promising advances in the R&D pipeline, such as anti-retroviral drugs that stay in the bloodstream for long periods of time, or a reasonably effective vaccine.

"Whatever new solutions we come up with, each one must include effective campaigns to counter stigma and discrimination that continue to undermine our efforts to beat this epidemic. We need to gain a deeper understanding of the social and cultural dynamics around this disease. Every place has a unique epidemic; so every place must have a unique response" Gates said.

He continued that "Unless we start to dramatically reduce new infections across all key populations, we face catastrophic consequences. Without huge efficiencies in treatment and prevention; new prevention tools; more funding - both domestic and international including a fully replenished Global Fund; and a greater curiosity about people's lives, then it hangs in the balance whether the next generation actually end up with more HIV than any previous one".

He cautioned that "We can keep doing things the same way, and run a serious risk of a resurgent epidemic, or we can push ourselves to discover, develop, and deliver more effective treatment and prevention methods and strategies".

Bill Gates, whose Foundation's motto is ‘All lives have equal value', concluded that: "If we don't do that, we will have matched our compassion with our capabilities and given millions of our fellow human beings the chance to lead full, productive lives they deserve. And only if we do that, will we turn the promise of an AIDS-free world from a slogan to reality".