Salim Abdool Karim

Salim Abdool Karim at AIDS 2014: “Step up the pace!”

24 July 2014
Annie Holmes

Professor Salim Abdool Karim challenged delegates at the 2014 International AIDS Conference in Melbourne to intensify strategic, evidence-based prevention. His presentation on the “State of the Art: Epidemiology and Access” emphasised the importance and implications of local epidemiology, key populations (especially young women in Africa), geographic hotspots and structural factors, alongside biomedical prevention methods.

Despite impressive progress, the spread of HIV has yet to be controlled. In 2013, there were:

  • 1.5 million HIV deaths
  • 35 million living with HIV
  • 2.1 million new infections"

Professor Salim Abdool Karim, director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA)

Among key challenges for the field, Professor Karim identified stigma, discrimination and legislative hurdles as constituting a major obstacle to prevention and care. He also included social and gender norms as structural drivers of HIV infection in key populations. For those such as STRIVE working on structural factors, this kind of acknowledgement is significant in widening the prevention lens beyond the focus on biomedical “silver bullets”.

Taking “the end of AIDS” as an aspirational vision, Professor Karim said that without a cure or vaccine the epidemiological concepts of elimination and eradication are not applicable to HIV. Rather, he reviewed the evidence for the possibility of epidemic control, to the point where each HIV infection results in less than one new transmission in the lifetime of a person living with HIV (versus the current rate of three onward transmissions.)

To achieve the objective of epidemic control is possible, Professor Karim said, but would require:

  • Implementing a combination of new scientifically proven prevention methods (medical male circumcision, early antiretroviral therapy, pre-exposure prophylaxis), tailored for local epidemiology and changes
  • prioritising key populations (young women in sub-Saharan Africa, men who have sex with men, sex workers)
  • prioritising geographic “hotspots” (one third of all people living with HIV are in South Africa, Nigeria and India, while 80% of the world’s positive population live in just 20 countries)
  • tackling the underlying social drivers of the epidemic

To conclude, Professor Karim emphasised the strategic opportunities of the present, resulting from progress in:

  • scientific discovery
  • resource mobilisation
  • political commitment
  • implementation

“The world cannot afford to miss this historic tipping point and risk losing momentum against AIDS.”

See Professor Karim's presentation here.

Photo credit: International AIDS Society/Steve Forrest