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The Mandela Legacy: Leadership Can Transform HIV/AIDS

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It's been quite a month and I had planned on beginning this blog with an initial reflection on the recent ICAAP conference in Bangkok but that has been superseded by the passing of Nelson Mandela, a champion of the HIV/AIDS cause.

We are indebted to Mr Mandela for his leadership role in making HIV/AIDS in sub Saharan Africa an issue that the world could no longer ignore. Mr Mandela's speech at the International AIDS Conference in Durban in 2000 changed the course of the epidemic in both his country and the continent.

As a direct result of his speech, mother to child transmission in the region almost immediately became a priority and so did access to antiretrovirals. I would like to take this opportunity to reiterate the recent words of my AIDS 2014 conference co-chair Françoise Barré-Sinoussi:

"I have no doubt that Mr Mandela's words that day did indeed save the lives of so many people and continues to do so. For this we thank you Mr Mandela."

Mr Mandela's legacy lives on and I can't help thinking that the kind of political leadership he demonstrated on the epidemic is sorely needed in the Asia Pacific today if we are to even get close to universal access to treatment, prevention and care for those most affected by HIV/AIDS.

The message at the recent ICAAP 11 meeting in Bangkok was loud and clear - the key affected populations of sex workers, transgender people, men who have sex with men (MSM) and people who inject drugs (PWID) are being left behind and in many respects their fate is being driven by stigma and discrimination combined with government inaction and indifference in many parts of the region. It was disturbing to hear that countries like Thailand, China and The Philippines are experiencing such dramatic increases in new infections amongst young MSM and it is equally concerning that the number of PWID accessing treatment remains so abysmally low in the region.

As I noted in my speech at the ICAAP 11 closing ceremony and again on World AIDS Day, it is unacceptable that still only around 30 per cent of pregnant women are offered an HIV test in Asia that across the region only around 16 per cent of HIV-infected pregnant women receive antiretrovirals to prevent mother-to-child transmission of HIV.

We are determined that the tough issues facing the Asia Pacific region will be given a sharp focus at AIDS 2014 - it was uppermost in our minds at the World AIDS Day events taking place in Melbourne last week with the presence of Doa Aung San Suu Kyi. Her own political party took on HIV /AIDS as an issue very early on and it was clear after spending time with her that she is passionate that the epidemic is, and remains, a major priority for Burma.

It was an honour to have both Doa Aung San Suu Kyi and UNAIDS Executive Director Michel Sidibé by my side as AIDS 2014 was launched at Government House. Together they launched the UNAIDS #zerodiscrimination campaign. This initiative will launch the new Zero Discrimination Day on 1 March 2014, adopting the butterfly as the transformative symbol for zero discrimination. Stigma and discrimination still remain the two biggest barriers to delivering appropriate prevention and treatment for HIV so this initiative is of great importance in the HIV response.

And it is an unfortunate reality that in many countries these barriers are being driven by official policy. Look no further than the recent decision by the Indian Supreme Court to restore a 19th-century ban criminalizing homosexuality despite that law being deemed unconstitutional by a lower court in 2009. The decision is a horrifying reflection of deep seated discrimination that still exists at the highest levels. These laws will significantly weaken efforts to implement effective health policies on the ground.

Immediately after attending a series of events over a weekend where Melbourne really did turn it on for World AIDS Day I left for Miami for the 6th International Workshop on HIV Persistence during Therapy - a major HIV Cure meeting on my calendar.

The big news, as many of you will know, was that the two HIV positive Boston patients who received bone marrow transplants and who were subsequently taken off treatment with no evidence that the virus have bounced back after 7 and 11 weeks respectively, have unfortunately seen their HIV return and both are now back on treatment.

This was very disappointing news. However, I strongly believe that setbacks like this ultimately provide clues to the way forward, as do the lead researchers on the Boston Patients case. We know that the path to an HIV Cure is a long one but something we must give our best shot - so in the very same week it was indeed welcome that President Obama announced $US100 million for HIV Cure research.

Even in these tough economic times, it is this kind of vision and leadership being shown by President Obama that I hope will continue to transform the epidemic globally. Just as Nelson Mandela did for Africa. Just as Doa Aung San Suu Kyi is doing in her beloved Burma. If only we had leaders like this in every century.... and in every country.