From August 3-8, over 24,000 participants from 194 nations converged on Mexico City for the XVII International AIDS Conference. The conference, which was the second largest ever held and the first held in Latin America, centred on the theme Universal Action Now, emphasising the need for a continued degree of urgency in the global response to HIV/AIDS and for all those involved to actively move toward this response. The United Nations Secretary-General Ban Ki-Moon, the Director-General of the World Health Organisation Margaret Chan and President of Mexico Felipe Calderon were some of the high profile attendees at the conference.

Dr Graham Brown, President of the Australian Federation of AIDS Organisations and Co Director of the Western Australian Centre for Health Promotion Research, attended the IAS conference and called it ‘one of the very few opportunities where we can present unfiltered evidence to the key decision makers, government officials and health ministers about the reality of the HIV pandemic… Often the evidence is filtered through a religious or moralistic lens that results in programs being misdirected and ineffective, particularly in parts of Africa, Asia and Eastern Europe – but also Western countries, as shown by previous “abstinence only” programs in the USA.’

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According to Dr Brown, ‘HIV prevention and treatment is becoming more and more complex, and issues like human rights, abstinence, STIs, access to condoms, access to treatments, role of circumciscion, discrimination, viral load, treatment as prevention, were all hotly debated.’

Mexican HIV specialist Jorge Saavedra made a powerful presentation highlighting that only 1.2% of HIV funding in 38 countries goes toward programs aimed at MSM, despite MSM being almost 20 times more at risk for infection.

Saavedra suggested that an estimated $29 million was needed in these 38 countries in order to provide adequate resource for MSM populations. He then outlined a recent UNAIDS Global Report that stated only 40% of MSM in 27 countries actually knew where to receive regular HIV testing and access condoms.

In order to better tackle the issue of HIV in regards to MSM, Saavedra said government policies needed to address social-structural determinants such as a change of cultural and social norms, an address of human rights and instances of stigma, discrimination, and homophobia, including decriminalisation of MSM activities in the 86 countries where consensual sex between MSM is still criminalized.

In addition to Saavedra, David Wilson, a senior lecturer at the Centre for International Health at Curtin University and expert from the World Bank Global HIV/AIDS Program, presented on HIV epidemiology among MSM globally.

Dr Brown said, ‘The Australian Federation of AIDS Organisations (AFAO) has been working intensively with the Global Forum on men who sex with men and HIV to ensure that what we knew from “on-the-ground” reports and confirmed from very recent epidemiological evidence led to appropriate recognition and emphasis on MSM and HIV issues at the Mexico City AIDS Conference.

‘In every major city in Asia we have looked at, there are now epidemics of HIV among men who have sex with men – epidemics that remind me us what we saw in the USA, Australia and Europe in the 1980s. Prevalence in MSM in some parts of the world appeared to be rising sharply. Annual surveys from Beijing, for instance, showed that HIV prevalence in gay men had risen year-on-year from 0.8% in 2001 to 5.8% in 2006, and had jumped from 17% in Bangkok in 2003 to 28% in 2005.

‘Even in sub Saharan Africa – whose epidemic is generalised across the community, gay and bisexual men are more likely to acquire HIV than other men, but prevention programs targeting these men are rare. The evidence has been to some extent avoided or ignored by many in those countries until now. We were able to build enough momentum at this conference that we were able to cut through the barriers to seeing what the evidence has been showing for some time.’

The next IAS conference will be held in Vienna, July 18-23, 2010, which is the same year world leaders pledgedd to provide universal access to HIV prevention, treatment, care and support.