The big five at AIDS 2010

"Rights Here, Right Now" is the theme of the 18th International AIDS Conference, also known as "AIDS 2010", opening on 18 July in Vienna, Austria. Around 25,000 policy-makers, programme implementers, scientists, community workers, activists and people living with HIV will gather to discuss the latest developments in the field of HIV/AIDS.

IRIN/PlusNews has listed some of the issues likely to top the list during the five-day event.

Universal Access – Under different circumstances, the champagne would be on ice as the December 2010 deadline for universal access to HIV prevention, treatment and care approaches; instead, the HIV/AIDS fraternity at AIDS 2010 will be going back to the drawing board, as pitifully few countries have achieved the universal access targets set by the United Nations General Assembly Special Session on HIV/AIDS in 2005.

Participants will look for lessons to be learned. Prevention, in particular, remains a huge challenge: for every two people put on antiretroviral (ARV) treatment there are five new infections. Discussions on new strategies are likely to focus on HIV prevention in high-risk groups like sex workers and mobile populations.

New Science – Researchers will use AIDS 2010 to unveil progress in new prevention technologies. A positive result from CAPRISA 004, a large South African trial of a microbicide gel containing the ARV drug, tenofovir, would give a welcome boost to a field that has promised much but produced few positive results.

Cost-saving in HIV programming – As international donor support for HIV shrinks, policy-makers and implementers are keen to find cheaper and more efficient ways to run HIV treatment programmes.

Possible solutions include task-shifting – using less qualified personnel to carry out some functions usually performed by doctors and nurses – and simplified HIV treatment programmes. Pressure is also mounting on national governments, particularly in developing countries, to increase their budgets for HIV.

The cost-effectiveness of new treatment guidelines by the World Health Organization, which recommend putting people on ARVs at a CD4 count (a measure of immune strength) of 350, up from a previous recommendation of 200, will be examined.

Treatment as prevention - Evidence is mounting that ARV treatment greatly lowers the likelihood of transmitting HIV, as well as mortality from tuberculosis and other opportunistic infections. Mathematical modelling studies show that implementing voluntary universal testing programmes, and immediately starting ARV treatment for people who test positive, could eventually eliminate HIV all together.

Activists will use the possibility of an end to the AIDS epidemic to encourage tired donor nations to increase rather than cut their financial support by emphasising that more people on ARVs will mean fewer new infections and, in the long term, a need for less funding.

The difficulties and possibilities of treatment as prevention, using ARVs to prevent HIV in high-risk groups (pre-exposure prophylaxis), and the short-term use of ARVs to reduce the chance of HIV infection after potential exposure (post-exposure prophylaxis), will all be dissected.

HIV and injection drug use – One of the main modes of transmission in Asia, Eastern Europe and Latin America will be discussed in presentations on preventing high-risk behaviour among injecting drug users (IDUs), their human rights, and their inclusion in HIV prevention and treatment programmes.

On 13 July, former presidents Fernando Henrique Cardoso of Brazil, Ernesto Zedillo of México and César Gaviria of Colombia - countries with major drug-trafficking problems - formally endorsed the Vienna Declaration.

The declaration includes a call to forgo the "drug war" in favour of policies based on scientific evidence of the benefits of needle and syringe programmes and drug substitution therapy.