Picking up the banner from the watershed International AIDS Conference in Durban in 2000 where international AIDS scientists, researchers, activists, communities and world leaders committed themselves to universal access to antiretroviral treatment and the importance of science, speakers opened the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009) and told world leaders ‘€œwe will not shut up’€.

Speakers at the opening session expressed concern that amidst a lingering global recession there were indications that world leaders were retreating on previous commitments to universal access to HIV prevention and treatment.

‘€œEarlier this month, another G8 summit came and went. HIV/AIDS was indeed the elephant in the room. In 2009 the eight most powerful economies in the world left HIV off their priority agenda,” said IAS President Dr Julio Montaner, who is IAS 2009 Chair.

He told journalists that indications were that governments were using the global recession as an excuse to cut back on funding to AIDS programmes with some worried about their survival.

“If we don’t move forward, we will rapidly lose ground. That is the reality we face at this pivotal moment in HIV scale-up,” Montaner said.

He said that the selection of Cape Town as the host city to more than 5 000 scientists and researchers represented a determined attempt to focus international attention on the epicenter of the HIV pandemic. ‘€œIn fact, in many ways IAS 2009 is a follow-up to the conference held in Durban. That meeting is still regarded as a pivotal moment in the history of the pandemic,’€ Montaner said.

‘€œThe Durban conference opened the door to the roll-out of antiretroviral therapy, something that until then many believed was just not possible,’€ said Montaner, who is also the Director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada.

He warned that amid the economic crisis a retrenchment now would be catastrophic for the nearly four million people who are already on treatment in resource-limited countries, not to mention the six to seven million others who are still waiting for life saving treatment.

‘€œIn four years, the need for bold leadership on AIDS has increased while the voices of our political leaders have diminished. This is a shame,’€ Montaner told delegates.

He said the G8 inaction was life-threatening and called on leaders to ‘€œnot turn your backs on the one thing that works’€.

Montaner was joined by Stephen Lewis, Co-Director of AIDS-Free World and former high-level advisor to the United Nations, who said the G8 actions were ‘€œterrible commentary on what is approaching’€.

‘€œWe’€™re at a crisis point. We are at a moment where we can turn this epidemic around and at this precise moment the G8 is in retreat, it’€™s crazy,’€ he said. ‘€œThis is astonishing delinquency on the part of the G8.’€

Treatment Action Campaign General Secretary Vuyiseka Dubula said there were many report of stock-outs across Africa, which Uganda reporting shortages and shortages of drugs in South Africa ‘€œthe order of the day’€.

‘€œBut this is not only the problem of donors, but also the problem of governments,’€ she said.

Dubula said despite much progress she was going to be ‘€œnasty’€ and state that not enough was being done.

‘€œThey may be hiding behind the global recession, but we know that they started revising their targets as far back as 2005, so we are telling them not to use the economic recession as a scapegoat,’€ she said.

Montaner added ‘€œwe know what needs to be done’€ yet implementation floundered, costing thousands of lives every day.

‘€œThe gap between evidence and implementation is particularly apparent between North and South. In the North we have virtually eliminated vertical transmission of HIV infection with the use of highly active antiretrovirals. We have unrestricted access to drug combinations and new, highly-potent and safer drugs that are easier to adhere to. We also have highly effective second and third line regimens, as well as point of care testing, and routine viral load and resistance testing.

‘€œIn contrast, in the South people living with HIV are often stuck in a therapeutic corner with a paucity of first line treatment options, typically selected based on cost rather than safety and efficacy considerations. While this was acceptable as a means to jump start the roll-out of antiretroviral therapy, this is no longer the case: short-term savings will come back to haunt us in the form of toxicities and tolerability challenges, which will ultimately compromise adherence and in turn effectiveness.’€